Home Telemedicine to Optimize Health Outcomes in High-Risk Youth with Type 1 Diabetes

家庭远程医疗可优化 1 型糖尿病高危青少年的健康结果

• 批准号: 9302223
• 负责人: Kimberly Driscoll
• 金额: $ 79.48万
• 依托单位: UNIVERSITY OF COLORADO DENVER
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-04-01 至 2019-06-01
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9302223
• 关键词: 17 year old; 18 year old; Acute; Address; Adherence; Admission activity; Adolescent; Age; Amputation; Appointment; Appointments and Schedules; Behavior; Biological Markers; Blindness; Blood Glucose; Caring; Characteristics; Child; Childhood; Clinic; Clinic Visits; Clinical; Comorbidity; Complication; Complications of Diabetes Mellitus; Diabetic Ketoacidosis; Dose; Effectiveness of Interventions; Employment; Endocrinologist; Frequencies; Goals; Health; Healthcare; Heart Diseases; Home environment; Hospitals; Hyperglycemia; Individual; Injection of therapeutic agent; Insulin; Insulin Infusion Systems; Insulin-Dependent Diabetes Mellitus; Intervention; Kidney Failure; Lead; Life; Longitudinal Studies; Maintenance; Medical; Mental Health; Mental Health Services; Methodology; Modality; Myocardial Infarction; National Institute of Diabetes and Digestive and Kidney Diseases; Outcome; Parents; Pathway interactions; Persons; Physical assessment; Pilot Projects; Provider; Public Health; Research; Schools; Severities; Specialist; Stroke; Telemedicine; Time; Travel; United States; Visit; Work; Youth; age group; behavioral health; behavioral health intervention; cost; cost effective; design; diabetes management; effective intervention; effective therapy; flexibility; follow-up; glucose monitor; glycemic control; high risk; high-risk adolescents; improved; improved outcome; innovation; intervention program; novel; pediatric patients; personalized care; personalized intervention; physical conditioning; point of care; psychologic; psychosocial; stressor; telehealth; young adult

Project Summary/Abstract The severity of T1D complications warrants an urgent need to improve glycemic control since 22% and 17% of children and adolescents with T1D, respectively, have suboptimal A1C >9.5%. Moreover, the T1D Exchange recently showed that an average A1C of 9% in 13-17 year olds is not much lower than the A1C average of 9.5% seen in the same age group at the beginning of the DCCT over 30 years ago. In fact, youth ages 2-17 years have an average A1C of 8.6%. In addition, there is an alarmingly high rate of pediatric DKA in the United States, with 7% of youth <18 years of age hospitalized for DKA. NIDDK recognizes that diabetic ketoacidosis (DKA), a serious acute complication, in youth must be addressed and strategies to reduce it developed, including significantly reducing time spent in hyperglycemia. Suboptimal adherence to critical T1D management behaviors (e.g., blood glucose monitoring, insulin dosing), either alone or in combination with psychosocial stressors, may lead to suboptimal glycemic control. Indeed, individuals with T1D and mental health comorbidities are 2x as likely to be in suboptimal glycemic control, yet 30% of T1D care teams do not have access to onsite mental health services. Moreover, mental health comorbidities are associated with worsening long-term complications. One possible pathway to improving glycemic control is to increase access via home telehealth This study is novel as it will use home telehealth intervention to address suboptimal T1D management and glycemic control by integrating medical and behavioral health (i.e., psychological) interventions to reduce negative and costly physical health outcomes in high-risk youth with T1D. The primary objective of this study is to address the critical need of providing intervention to high-risk (A1C=9-12%) youth with T1D. If achieved, T1D care practices will change by providing high-risk youth with T1D and their parents medical and behavioral health support via home telehealth intervention, which has the potential to significantly change access to T1D care, decrease time spent in hyperglycemia, reduce the frequency of hospital admissions, and improve glycemic control. In addition, use of Multiphase Optimization Strategy (MOST), a highly efficient experimental strategy to determine effective intervention components, should be generalizable to all individuals with T1D, leading to cost-effective, home telehealth intervention programs. Innovative aspects include: 1) assessment of physical and behavioral health characteristics associated with high-risk status; 2) delivery of home telehealth that incorporates: 2a) medical and behavioral health care delivered with the endocrinologist and behavioral health specialist working together with high-risk youth; 2b) personalized intervention to improve T1D adherence and T1D clinical health outcomes; 2c) personalized intervention to improve mental health comorbidities and T1D clinical health outcomes; and 3) an underused methodological approach for optimizing intervention components to be delivered at point of care.

项目总结/摘要 T1 D并发症的严重程度证明迫切需要改善血糖控制，因为22%的T1 D并发症和 17%的T1 D儿童和青少年A1 C> 9.5%。此外，T1 D 最近的交流表明，13-17奥尔兹的平均A1 C为9%，并不比A1 C低多少 在30多年前DCCT开始时，同一年龄组的平均9.5%。事实上，青春 2-17岁的平均A1 C为8.6%。此外，儿童DKA的发生率高得惊人， 在美国，7%的<18岁的青少年因DKA住院。NIDDK认识到糖尿病患者 酮症酸中毒（DKA）是一种严重的急性并发症，必须在青年中得到解决，并制定减少它的策略 开发，包括显着减少在高血糖症花费的时间。 对关键T1 D管理行为的依从性欠佳（例如，血糖监测，胰岛素 给药）单独或与心理社会应激源组合，可能导致血糖控制不佳。 事实上，患有T1 D和精神健康共病的个体处于次优血糖水平的可能性是患有T1 D和精神健康共病的个体的2倍。 尽管如此，30%的T1 D护理团队无法获得现场心理健康服务。此外，心理 健康共病与长期并发症恶化有关。一种可能的途径是 改善血糖控制是通过家庭远程医疗增加访问这项研究是新颖的，因为它将使用家庭 远程医疗干预，通过整合医疗保健，解决T1 D管理和血糖控制不佳的问题 和行为健康（即，心理）干预，以减少负面和昂贵的身体健康 T1 D高危青少年的结果。 本研究的主要目的是解决对高风险患者进行干预的迫切需要。 (A1C=9-12%）T1 D青年。如果实现，T1 D护理实践将通过为高危青少年提供以下服务而改变： T1 D及其父母通过家庭远程健康干预提供医疗和行为健康支持， 可能显著改变T1 D护理的获得，减少高血糖症花费的时间， 减少住院次数，改善血糖控制。此外，使用多阶段优化 战略（MOST），一个高效的实验策略，以确定有效的干预措施的组成部分， 应该推广到所有T1 D患者，从而实现具有成本效益的家庭远程医疗干预 程序.创新方面包括：1）评估身体和行为健康特征 与高风险状态相关; 2）提供家庭远程保健，包括：2a）医疗和行为 与内分泌学家和行为健康专家一起提供的医疗保健， 2b）个性化干预，以改善T1 D依从性和T1 D临床健康结果; 2c） 个性化干预，以改善精神健康共病和T1 D临床健康结局;和3） 未充分使用的方法学方法，用于优化护理点提供的干预成分。