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: 9941930
• 负责人: Kimberly Driscoll
• 金额: $ 83.32万
• 依托单位: UNIVERSITY OF FLORIDA
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-01-07 至 2021-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9941930
• 关键词: Home; Telemedicine; Optimize; Health; Outcomes

Contact PD/PI: Driscoll, Kimberly A 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. Project Summary/Abstract Page 6

联系人 PD/PI：Driscoll、Kimberly A 项目概要/摘要 T1D 并发症的严重性迫切需要改善血糖控制，因为 22% 和 17% 的 T1D 儿童和青少年 A1C 未达最佳值 >9.5%。此外，T1D Exchange最近显示，13-17岁人群的平均A1C为9%，并不比A1C低多少 30 多年前 DCCT 开始时，同一年龄组的平均发病率为 9.5%。其实，青春 2-17 岁的平均 A1C 为 8.6%。此外，儿童 DKA 发生率高得惊人。 在美国，7% 的 18 岁以下青少年因 DKA 住院。 NIDDK 认识到糖尿病 酮症酸中毒（DKA）是一种严重的青少年并发症，必须得到解决并制定减少其发生的策略 开发，包括显着减少高血糖的时间。 对关键 T1D 管理行为（例如血糖监测、胰岛素 剂量），无论是单独使用还是与社会心理压力源结合使用，都可能导致血糖控制不佳。 事实上，患有 T1D 和心理健康合并症的人血糖水平不理想的可能性是普通人的 2 倍 控制，但 30% 的 T1D 护理团队无法获得现场心理健康服务。此外，心理 健康合并症与长期并发症的恶化有关。一种可能的途径 改善血糖控制是增加通过家庭远程医疗的机会 这项研究很新颖，因为它将使用家庭远程医疗 远程医疗干预通过整合医疗来解决 T1D 管理和血糖控制欠佳的问题 和行为健康（即心理）干预措施，以减少负面且代价高昂的身体健康 患有 T1D 的高危青少年的结果。 本研究的主要目的是满足为高风险人群提供干预的迫切需要 (A1C=9-12%) 患有 T1D 的青少年。如果实现的话，T1D 护理实践将通过向高危青少年提供 T1D 及其父母通过家庭远程医疗干预提供医疗和行为健康支持，该干预具有 可能显着改变 T1D 护理的可及性、减少高血糖的时间、减少 住院频率，并改善血糖控制。此外，使用多相优化 策略（MOST），一种高效的实验策略，用于确定有效的干预成分， 应该推广到所有 T1D 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）身体和行为健康特征的评估 与高风险状态相关； 2) 提供家庭远程医疗，其中包括： 2a) 医疗和行为 由内分泌学家和行为健康专家与高危人群合作提供的医疗保健 青年; 2b) 个性化干预，以提高 T1D 依从性和 T1D 临床健康结果； 2c) 个性化干预，以改善心理健康合并症和 T1D 临床健康结果； 3) 一个 用于优化护理点提供的干预措施的方法学方法未被充分利用。 项目总结/摘要第 6 页