Adherence intervention to promote optimal use of insulin pumps in adolescents wit

依从性干预促进青少年胰岛素泵的最佳使用

• 批准号: 8523840
• 负责人: Kimberly Driscoll
• 金额: $ 16.73万
• 依托单位: FLORIDA STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-01 至 2016-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8523840
• 关键词: Address; Adherence; Adolescent; Adult; American; Award; Behavior; Behavioral; Behavioral Research; Blood Glucose; Bolus Infusion; Caring; Child; Childhood; Clinic; Clinical; Clinical Research; Clinical Trials; Commit; Communities; Comorbidity; Consult; Data; Data Analyses; Decision Making; Development; Diabetes Mellitus; Endocrinologist; Environment; Evaluation; Evidence based intervention; Evidence based treatment; Experimental Designs; Extramural Activities; Faculty; Family; Feedback; Florida; Foundations; Frequencies; Fright; Functional disorder; Funding; Future; Goals; Gold; Health; Housing; Hypoglycemia; Information Technology; Insulin; Insulin Infusion Systems; Insulin-Dependent Diabetes Mellitus; Intervention; Knowledge; Lead; Libraries; Licensing; Life; Literature; Measurement; Measures; Medical; Medicine; Mental Depression; Mentored Patient-Oriented Research Career Development Award; Mentors; Mentorship; Metabolic Control; Methodology; National Institute of Diabetes and Digestive and Kidney Diseases; National Research Service Awards; Patient Self-Report; Patients; Performance; Physicians; Population; Positioning Attribute; Problem Solving; Protocols documentation; Psychologist; Psychosocial Factor; Public Health; Publications; Publishing; Pump; Quality of life; Reading; Recording of previous events; Reporting; Research; Research Personnel; Research Training; Resources; Secure; Statistical Models; Strategic Planning; Summary Reports; Techniques; Technology; Time; Training; Translating; Translational Research; Treatment Protocols; United States National Institutes of Health; Universities; Wit; Writing; base; career; career development; college; cost effective; depressive symptoms; design; diabetes management; effective intervention; effective therapy; flexibility; glucose monitor; glycemic control; improved; innovation; meetings; new technology; novel; patient oriented; point of care; programs; psychosocial; routine care; skills; statistics; user-friendly

DESCRIPTION (provided by applicant): The aims of this study specifically address two of the research objectives outlined in NIDDK's Strategic Plan for the Scientific Community: 1) combine new technology for diabetes management with behavioral and translational research; and 2) mitigate psychosocial complications and comorbidities of diabetes to improve quality of life. NIDDK recognizes that research is needed to "develop behavioral approaches to improve family function, and ultimately metabolic control in the patient" and to "determine the most effective ways to translate strategies [to improve adherence] into routine pediatric care. This K23 study is significant because it addresses the critical need for improving insulin pump adherence where non-adherence has severe and potentially life threatening consequences. Continued misuse of insulin pumps compromises the health of patients with T1D and the ability of physicians to provide effective treatment. If the aims of this project are achieved, this study will change insuln pump practices by providing a comprehensive assessment approach relevant to insulin pump use. In addition, this study's use of a highly efficient experimental design to determine effective intervention components should lead to a cost-effective, clinic-based intervention to improve insulin pump adherence. This project is innovative because it: 1) objectively measures insulin pump adherence data, which is rare in the extant diabetes literature; 2) develops an insulin pump assessment protocol that targets insulin pump knowledge/skills and BGM-BOLUS adherence behaviors that can be used in the clinical setting; and 3) uses a methodological approach for optimizing intervention components to be delivered at point of care. This study also explores modifiable barriers that could potentially interfere with effective insulin pump use including fear of hypoglycemia, adolescent responsibility, and depression, and could be incorporated into future interventions. The specific aims of this study are: 1) develop an insulin pump assessment protocol focused on knowledge/skills relevant to BGM-BOLUS adherence behaviors; 2) use a highly efficient experimental design to determine whether the two components of the Pump It Up! Intervention, Personalized Insulin Pump Feedback and Insulin Pump Problem-Solving, are effective at improving BGM-BOLUS adherence behaviors; and 3) identify moderators associated with BGM- BOLUS adherence behaviors. My overall goal is to become an independent, patient-oriented clinical researcher in T1D by establishing an independent line of research focused on understanding the modifiable barriers associated with suboptimal BGM and insulin adherence, which can be improved through the implementation of innovative interventions during the routine care of patients with T1D. I plan to focus on pediatric patients who use insulin pumps as this population has been understudied in the extant literature. This K23 proposal will provide the necessary foundation for my transition to an independent researcher in T1D. I have several qualifications that make me an ideal Candidate for a K23 Mentored Patient-Oriented Research Career Development Award. I am a licensed clinical psychologist with a strong scientific background in evidence-based treatments. I was a recipient of an NIDDK supported T32 postdoctoral NRSA and the NIH Pediatric Loan Repayment Program. I am fully committed to establishing my academic research career in T1D and am well-prepared to capitalize on a K23 award. I have spent the first years of my faculty position designing and conducting preliminary studies in T1D, establishing important collaborative relationships with endocrinologists, and publishing articles in T1D. I have carefully chosen a mentorship/consulting team that will facilitate my transition to an independent academic research career in T1D. My primary mentor on this award is Dr. Suzanne Bennett Johnson, a well- established pediatric psychologist with expertise in T1D, adherence, and clinical trials with more than 30 years of NIH funding. Dr. Larry Deeb, co-Mentor, is a pediatric endocrinologist and past President of the American Diabetes Association. Consultants include Dr. Roger Mazze, an expert in technological advancements associated with T1D care; Dr. Linda Collins, an expert in innovative methodologies and intervention techniques; and Dr. Daniel McGee, an expert in sophisticated measurement and statistical models and longitudinal data analysis. The environment at the Florida State University College of Medicine is rich in resources that support my early career development including space to conduct research and house research staff, state-of-the-art library and information technology facilities, and additiona funds to complete the project if necessary. The faculty in my department is prolific with regard to publications and securing extramural funding. The goals contained in my training plan include: 1) develop expertise in the pathophysiology, medical management, and psychosocial factors of T1D; 2) develop expertise in the objective measurement of T1D treatment regimen adherence; 3) extend knowledge of innovative statistical approaches involving BGM and insulin pump technology data; 4) develop expertise in innovative methodological approaches; and 5) augment scientific writing skills. The combination of my training and research plan and mentoring/collaborative team who have a long history of NIH funding assures that the training and scientific goals of this application will be met and that I will become and independent academic T1D researcher.

描述（由申请人提供）：本研究的目的特别针对NIDDK科学界战略计划中概述的两个研究目标：1）将糖尿病管理新技术与行为和转化研究联合收割机相结合; 2）减轻糖尿病的心理社会并发症和合并症，以改善生活质量。NIDDK认识到，需要进行研究，以"开发行为方法来改善家庭功能，并最终控制患者的代谢"，并"确定将策略转化为常规儿科护理的最有效方法[以提高依从性]。这项K23研究具有重要意义，因为它解决了改善胰岛素泵依从性的关键需求，其中不依从性具有严重和潜在的危及生命的后果。胰岛素泵的持续滥用损害了T1D患者的健康和医生提供有效治疗的能力。如果本项目的目标得以实现，本研究将通过提供与胰岛素泵使用相关的综合评估方法来改变胰岛素泵的使用。此外，本研究采用了高效的实验设计，以确定有效的 干预成分应导致成本效益高、基于临床的干预，以改善胰岛素泵依从性。该项目具有创新性，因为它：1）客观地测量胰岛素泵依从性数据，这在现有糖尿病文献中很少见; 2）开发了一种胰岛素泵评估方案，其目标是可用于临床环境的胰岛素泵知识/技能和BGM-BOLUS依从性行为; 3）使用方法学方法来优化在护理点提供的干预成分。这项研究还探讨了可能干扰有效胰岛素泵使用的可改变障碍，包括对低血糖的恐惧，青少年责任和抑郁症，并可纳入未来的干预措施。本研究的具体目的是：1）制定一项胰岛素泵评估方案，重点关注与BGM-BOLUS依从行为相关的知识/技能; 2）使用高效的实验设计来确定Pump It Up!干预、个性化胰岛素泵反馈和胰岛素泵问题解决可有效改善BGM-BOLUS依从性行为;以及3）识别与BGM-BOLUS依从性行为相关的调节因子。我的总体目标是成为一名独立的，以患者为导向的T1D临床研究人员，建立一个独立的研究线，重点是了解与次优BGM和胰岛素依从性相关的可修改障碍，这可以通过在T1D患者的常规护理期间实施创新干预来改善。我打算专注于儿科 使用胰岛素泵的患者，因为这一人群在现有文献中研究不足。这个K23提案将为我过渡到T1D的独立研究人员提供必要的基础。我有几个资格，使我成为一个K23指导以病人为导向的研究职业发展奖的理想候选人。我是一名有执照的临床心理学家，在循证治疗方面有很强的科学背景。我是NIDDK支持的T32博士后NRSA和NIH儿科贷款偿还计划的接受者。我完全致力于在T1D建立我的学术研究生涯，并准备好利用K23奖。我花了我的教师职位的第一年设计和进行T1D的初步研究，与内分泌学家建立重要的合作关系，并在T1D发表文章。我仔细 选择了一个导师/咨询团队，这将有助于我过渡到T1D的独立学术研究生涯。我在这个奖项上的主要导师是苏珊娜班尼特约翰逊博士，她是一位声誉卓著的儿科心理学家，在T1 D，依从性和临床试验方面拥有30多年的NIH资助。Larry Deeb博士是一位儿科内分泌学家，也是美国糖尿病协会的前任主席。顾问包括T1D护理相关技术进步专家Roger Mazze博士;创新方法和干预技术专家琳达柯林斯博士;以及复杂测量和统计模型以及纵向数据分析专家丹尼尔麦基博士。佛罗里达州立大学医学院的环境资源丰富，支持我的早期职业发展，包括进行研究和容纳研究人员的空间，最先进的图书馆和信息技术设施，以及必要时完成项目的额外资金。我系的教员在以下方面很有成就： 出版物和获得校外资金。我的培训计划中包含的目标包括：1）发展T1D病理生理学、医疗管理和心理社会因素方面的专业知识; 2）发展T1D治疗方案依从性客观测量方面的专业知识; 3）扩展涉及BGM和胰岛素泵技术数据的创新统计方法的知识; 4）发展创新方法学方法方面的专业知识;（5）提高科技写作能力。我的培训和研究计划以及具有NIH长期资助历史的指导/合作团队的结合确保了本申请的培训和科学目标将得到满足，并且我将成为独立的T1D学术研究人员。