ONBOARD: OvercomiNg Barriers & Obstacles to Adopting Diabetes Devices

项目摘要 1型糖尿病(T1D)是一种负担沉重的慢性疾病，需要严格的自我管理 优化血糖控制，预防短期和长期并发症。胰岛素泵和胰岛素泵的研究进展 连续血糖监测(CGM)技术能够改善血糖控制并降低风险 并为闭环系统的到来奠定了基础--其中第一个 于2017年投入商业使用。闭环系统，集成了胰岛素泵和CGM以 部分自动化胰岛素输送，代表了糖尿病护理的重大范式转变，使患有T1D的人 将把糖尿病管理的部分负担转移到自动化系统，导致血糖更高 控制和更好的生活质量。然而，少数患有T1D的成年人(18-50岁)目前使用CGM-a核心 闭环系统的组成部分--以及一个令人担忧的比例，在第一年内退出CGM，这不是一个好兆头 很好地采用了闭环系统。成人T1D患者对CGM的低摄取和高停用 表明需要精心设计、量身定做的干预措施，以提供教育、支持和解决问题 帮助设备用户克服物理、社交和其他障碍的技能，从而最大限度地受益于 先进的糖尿病技术。在本申请中，Molly Tanenbaum博士提出了一系列研究 首要目标是发展高级行为研究技能，同时完善全面的 行为干预套餐，为患有T1D的成年人提供资源和技能，以最大限度地提高收益和 将CGM的日常干扰降至最低，申请采用闭环系统。其中的具体目标 这项职业发展奖建议是：1)提供、反复完善行为干预一揽子计划， On Board(克服采用糖尿病设备的障碍和障碍)，在一小部分患有糖尿病的成年人中进行 T1D使用CGM，然后进行随机对照试验，比较机载设备的使用情况、健康状况 与仅接受CGM干预相比，成人T1D患者接受干预后的心理社会结果；2)使用 定性访谈数据，以适应船上启动闭环系统的成年人。来自这些的结果 研究将提供初步数据，为更大规模的车载CGM和闭环系统采用试验提供参考 并在未来的R01应用中持续使用。Tanenbaum博士的长期职业目标是成为 独立研究人员，有计划的研究路线，专注于优化紧急糖尿病的使用 改善成人T1D患者健康和生活质量的技术。指导，课程作业，以及 在这个为期5年的培训奖项中提出的职业发展活动将为Tanenbaum博士提供 进行随机对照试验的高级统计培训和经验-- 作为一名独立的行为糖尿病研究人员，取得了成功的职业生涯。

Project Summary Type 1 diabetes (T1D) is a burdensome chronic disease that requires a demanding self-management regimen to optimize glycemic control and prevent short- and long-term complications. Advances in insulin pumps and continuous glucose monitoring (CGM) technologies have enabled improved glycemic control and reduced risk of complications and have laid the groundwork for the arrival of closed loop systems – the first of which became commercially available in 2017. Closed loop systems, which integrate an insulin pump and CGM to partially automate insulin delivery, represent a major paradigm shift in diabetes care such that people with T1D will offload some of the diabetes management burden to an automated system, resulting in tighter glucose control and better quality of life. However, a minority of adults (18-50) with T1D currently use CGM – a core component of closed loop - and a concerning proportion quit CGM within the first year, which does not bode well for the adoption of closed loop. Low uptake and high discontinuation of CGM among adults with T1D signal the need for well-designed, tailored interventions that provide education, support and problem-solving skills to empower device users to work through physical, social, and other barriers to maximize benefit from advanced diabetes technologies. In this application, Molly Tanenbaum, PhD, proposes a series of studies with an overarching goal of developing advanced behavioral research skills while refining a comprehensive behavioral intervention package to equip adults with T1D with the resources and skills to maximize benefit and minimize daily interference from CGM, with application for closed loop system adoption. The specific aims in this career development award proposal are: 1) to deliver, iteratively refine a behavioral intervention package, ONBOARD (OvercomiNg Barriers & Obstacles to Adopting Diabetes Devices), in a small sample of adults with T1D using CGM, and then conduct a randomized controlled trial of ONBOARD comparing device use, health and psychosocial outcomes after adults with T1D receive the intervention versus CGM-only; and 2) to use qualitative interview data to adapt ONBOARD for adults initiating closed loop systems. Results from these studies will provide preliminary data to inform a larger trial of ONBOARD for CGM and closed loop adoption and sustained use in a future R01 application. Dr. Tanenbaum’s long-term career objective is to be an independent investigator with a programmatic line of research focused on optimizing use of emergent diabetes technology to improve health and quality of life outcomes for adults with T1D. The mentoring, coursework, and career development activities proposed in this 5-year training award will provide Dr. Tanenbaum with the advanced statistical training and experience conducting a randomized controlled trial – skills necessary for a successful career as an independent behavioral diabetes researcher.