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An interactive mHealth app for better glycemic control in families of young kids with T1D

一款交互式 mHealth 应用程序，可帮助患有 T1D 的幼儿家庭更好地控制血糖

基本信息

批准号：
9036786
负责人：
Eve-Lynn Nelson
金额：
$ 101.93万
依托单位：
UNIVERSITY OF KANSAS MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2015
资助国家：
美国
起止时间：
2015-09-20 至 2021-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9036786
关键词：
3 year old 5 year old 6 year old Academy Address Adherence Adopted Adoption Age Behavior Behavior Therapy Behavioral Caring Characteristics Child Child Rearing Childhood Clinic Clinical Trials Cognitive deficits Data Development Diabetes Mellitus Diagnosis Diet Dietary Intervention Disease Eating Education Educational process of instructing Electronic Mail Face Family Fright Glucose Glycosylated hemoglobin A Goals Health Health Services Accessibility Hypoglycemia Incidence Insulin Insulin-Dependent Diabetes Mellitus Internet Intervention Lead Learning Methods Morbidity - disease rate Outcome Parents Patients Physical activity Problem behavior Progress Reports Public Health Publishing Randomized Readiness Regimen Reporting Research Research Design Risk Scheme Self Care Series Staging Stress Symptoms Technology Testing Time Treatment Protocols Ursidae Family Waiting Lists Work age group base design diabetes management externalizing behavior flexibility glycemic control high risk improved innovation insulin sensitivity iterative design mHealth macrovascular disease mortality personalized medicine programs public health relevance randomized trial response skills success targeted treatment therapy development treatment adherence

项目摘要

DESCRIPTION (provided by applicant): To achieve good glycemic control families of young children with type 1 diabetes mellitus (T1D) must adhere to a well-designed and rigorous treatment regimen. Unfortunately, our research program has published data showing that many young children have glucose levels that exceed pediatric targets and show a high rate of glucose variability. By virtue of their age, size, and developmental status, young children with T1D face many unique challenges to adherence (i.e., increased insulin sensitivity, unpredictable physical activity and food intake, oppositional behavior). We've also identified other barriers to good glycemic control, including mealtime behavior problems, child defiance, and parental stress and fear of hypoglycemia. In order to address these barriers and improve children's glycemic control, we created and tested a parent-based behavioral-nutrition intervention, BEST MEALS. Initial results suggest a mean decrease of 26 mg/dl in young children's daily glycemic levels without increasing hypoglycemia. Building on this success and in response to parents' requests for more assistance delivered in a flexible format that matches their busy lives, in this new study we propose to substantially advance our BEST MEALS intervention through three new design features: 1) new treatment content addressing additional domains of T1D self-care (i.e., insulin use, parental hypoglycemia fear), 2) new child-focused and developmentally targeted treatment content allowing for a family-focused approach and learning activities appropriately matched to each young child's stage of development and readiness to engage in learning about T1D (i.e., helping out with T1D self-care), and 3) a mHealth delivery format using video-based microlectures accessible via the internet to increase scalability and personalized weekly progress reports emailed to families to reinforce the positive changes they make to their child's T1D self-care and glycemia. Thus, our current aims include: 1) to develop DIPPer Academy (Diabetes Information for Parents of Preschoolers), a family-focused mHealth behavioral intervention to promote glycemic control and adherence in young children, 2) to assess relevance, engagement, feasibility, and acceptability of DIPPer Academy through a family-centered iterative design scheme, and 3) to explore the initial efficacy of DIPPer Academy using a randomized, wait-list control design. The project is significant because it directly addresses the limited availability of developmentally-targeted behavioral interventions for families of young children with T1D and proposes to use mHealth to deliver DIPPer Academy thereby making it easier for families to access the treatment and easier to disseminate to other diabetes centers. It is innovative in its plan to include child- focused and developmentally-targeted treatment content in addition to parent treatment content, two treatment tracks based on child age (Li'l DIPPer for children <3 years old and Big DIPPer for 3-5 year olds), and in its plan to use a mHealth delivery format. We expect DIPPer Academy, developed and pilot-tested in this study, will have public health significance by improving health outcomes for young children with T1D.

描述（由申请人提供）：为了实现良好的血糖控制，1型糖尿病（T1 D）幼儿家庭必须坚持精心设计和严格的治疗方案。不幸的是，我们的研究项目已经公布的数据显示，许多幼儿的血糖水平超过了儿科目标，并显示出高血糖变异率。由于他们的年龄，大小和发育状况，患有T1 D的幼儿面临许多独特的坚持挑战（即，增加的胰岛素敏感性、不可预测的身体活动和食物摄入、对立行为）。我们还发现了其他影响血糖控制的障碍，包括进餐时的行为问题、儿童违抗、父母的压力和对低血糖的恐惧。为了解决这些障碍并改善儿童的血糖控制，我们创建并测试了一种基于父母的行为营养干预措施，BEST MEALS。初步结果表明，幼儿每日血糖水平平均降低26 mg/dl，而不增加低血糖。在这一成功的基础上，并响应父母要求以与他们忙碌的生活相匹配的灵活形式提供更多帮助的请求，在这项新研究中，我们建议通过三个新的设计特征大幅推进我们的BEST MEALS干预：1）新的治疗内容，解决T1 D自我护理的其他领域（即，胰岛素使用、父母低血糖恐惧），2）新的以儿童为中心和以发育为目标的治疗内容，允许以家庭为中心的方法和学习活动，这些活动与每个幼儿的发育阶段和参与T1 D学习的准备程度相匹配 (i.e.,帮助T1 D自我护理），以及3）移动健康交付格式，使用基于视频的微型讲座，可通过互联网访问，以增加可扩展性，并通过电子邮件向家庭发送个性化的每周进度报告，以加强他们对孩子的T1 D自我护理和自我护理所做的积极改变。因此，我们目前的目标包括：1）发展DIPPer学院（学龄前儿童父母的糖尿病信息），一种以家庭为中心的移动健康行为干预，以促进幼儿的血糖控制和依从性，2）通过以家庭为中心的迭代设计方案评估DIPPer Academy的相关性，参与性，可行性和可接受性，3）使用随机，等待列表控制设计。该项目意义重大，因为它直接解决了T1 D幼儿家庭发育目标行为干预措施的有限性，并建议使用mHealth提供DIPPer Academy，从而使家庭更容易获得治疗，更容易传播到其他糖尿病中心。它的创新计划包括以儿童为中心和以发展为目标的治疗内容，除了父母的治疗内容，两个基于儿童年龄的治疗轨道（3岁以下儿童的Li 'l DIPPer和3-5奥尔兹的Big DIPPer），以及计划使用移动健康交付格式。我们预计，在本研究中开发和试点测试的DIPPer Academy将通过改善T1 D幼儿的健康结果而具有公共卫生意义。