Optimizing Technology Uptake and Use in Hard to Reach Adolescents with Type 1 Diabetes

优化难以接触到的 1 型糖尿病青少年的技术吸收和使用

• 批准号: 10340417
• 负责人: RANDI STREISAND
• 金额: $ 35.7万
• 依托单位: CHILDREN'S RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-12-01 至 2024-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10340417
• 关键词: Acute; Address; Adherence; Adolescence; Adolescent; African American; Age; Attention; Behavior Therapy; Behavioral; Black race; Caring; Chronic; Clinical; Communication; Complex; Conflict (Psychology); Data; Deterioration; Development; Devices; Diabetes Mellitus; Diagnosis; Disease; Distress; Education; Ensure; Ethnic Origin; Family; Family health status; Glucose; Goals; Health; Health Personnel; Hispanic; Household; Hyperglycemia; Hypoglycemia; Income; Insulin; Insulin-Dependent Diabetes Mellitus; Insurance; Intervention; Interview; Joints; Knowledge; Low income; Measures; Medical; Motivation; Not Hispanic or Latino; Outcome; Outcome Assessment; Parents; Participant; Personal Satisfaction; Pilot Projects; Population Heterogeneity; Positioning Attribute; Problem Solving; Process; Race; Randomized; Randomized Clinical Trials; Reduce health disparities; Regimen; Reporting; Research; Resources; Risk; Site; Social support; Source; Specialist; Structure; Technology; Telemedicine; Time; Work; Youth; acceptability and feasibility; adolescent health; age group; cost; dashboard; design; diabetes distress; diabetes education; diabetes self-management; efficacy evaluation; eligible participant; ethnic minority; expectation; experience; family support; follow-up; glucose monitor; glycemic control; group intervention; health disparity; high risk; improved; innovation; novel; parent-adolescent communication; participant retention; peer; peer support; pilot trial; primary outcome; psychosocial; public health insurance; racial and ethnic; racial minority; randomized trial; recruit; response; routine care; satisfaction; secondary outcome; skills; standard care; uptake; wearable device

PROJECT SUMMARY/ABSTRACT Young adolescents (ages 10-15) with type 1 diabetes (T1D) are at high risk for deterioration of glycemic control and relatedly poor overall T1D self-management. Continuous glucose monitors (CGM) provide real-time indicators of glucose levels and alert users to hypoglycemia and hyperglycemia. Consistent, informed use of CGM has the potential to improve glycemic control and related T1D health outcomes. However, adolescents with T1D are the least likely age group to utilize CGM and significant health disparities exist in access to and use of CGM among youth from racial and ethnic minority backgrounds and youth with public insurance. Adolescent CGM users also continue to evidence A1c levels above recommended targets, potentially due challenges related to perceived CGM burden and related family functioning. Novel, developmentally targeted interventions delivered early in adolescence could promote optimal uptake and use of CGM and reduce psychosocial barriers to sustained use but must be evaluated in rigorous pilot trials that attend to health disparities. The current study proposes to evaluate an innovative behavioral intervention that utilizes certified diabetes care and education specialists (CDCES) to teach problem-solving and communication skills around CGM data and use, targeting adolescent-parent T1D interactions related to glucose data, individualized CGM challenges, and weekly adolescent-parent joint review of CGM reports. The intervention also addresses HCP knowledge of health disparities in diabetes technology through interactive education, and boosts family support through connection with peer parent consultants. This study aims to evaluate the preliminary efficacy of the behavioral intervention to enhance CGM use and resulting T1D health outcomes. Sixty adolescents and their parents will be recruited for this pilot randomized trial, randomly assigned to either an immediate intervention group or a delayed intervention group serving as a standard care comparison. Intervention content will be delivered via 3 telemedicine sessions with adolescents and a parent and supported by connection with a peer parent consultant. Medical and psychosocial data (including A1c, CGM indicators, CGM burdens and benefits, diabetes distress, and diabetes-related family conflict) will be collected from adolescents and a parent at baseline and three follow-up time points across the first year after CGM initiation. We will employ quantitative and qualitative analyses to evaluate intervention feasibility, acceptability, and impact. Enhancing CGM access and use at this key developmental juncture provides an excellent opportunity for tailored support and problem- solving, resulting in potentially lasting improvement in diabetes self-management. Results of this pilot trial will directly inform a multi-site randomized clinical trial to evaluate efficacy, with the long term goal of identifying effective behavioral strategies that can be integrated into routine diabetes education and care.

项目摘要/摘要 具有1型糖尿病（T1D）的年轻青少年（10-15岁）有高血糖控制恶化的高风险 以及总体上差的T1D自我管理。连续葡萄糖监测器（CGM）提供实时 葡萄糖水平的指标，并提醒用户低血糖和高血糖。一致，明智的使用 CGM有可能改善血糖控制和相关的T1D健康结果。但是，青少年 使用T1D是使用CGM的年龄段最小可能的人群，并且存在重大健康差异。 在种族和少数民族背景的年轻人中使用CGM以及具有公共保险的青年。 青少年CGM用户还继续证明A1C水平高于推荐的目标，可能到期 与感知到的CGM负担和相关家庭功能有关的挑战。新颖的，发展方向 青春期早期提供的干预措施可以促进最佳摄取和使用CGM并减少 持续使用的社会心理障碍，但必须在严格的试验中进行评估，以进行健康 差异。当前的研究建议评估使用经过认证的创新行为干预 糖尿病护理和教育专家（CDCE）教授解决问题和沟通技巧 CGM数据和使用，针对与葡萄糖数据相关的青少年 - 父母T1D相互作用，个性化的CGM 挑战，以及每周的青少年参与CGM报告的联合审查。干预措施还解决了HCP 通过互动教育了解糖尿病技术中健康差异的知识，并促进家庭支持 通过与同伴父母顾问的联系。这项研究旨在评估 行为干预以增强CGM使用并产生的T1D健康结果。六十名青少年及其 父母将被招募参加此试点随机试验，随机分配给立即干预 作为标准护理比较的组或延迟干预组。干预内容将是 通过3个远程医疗会议与青少年和父母交付，并通过与同伴的联系来支持 家长顾问。医疗和社会心理数据（包括A1C，CGM指标，CGM负担和福利， 糖尿病困扰和与糖尿病有关的家庭冲突）将从青少年和父母那里收集 CGM启动后第一年的基线和三个随访时间点。我们将使用定量 以及定性分析以评估干预性，可接受性和影响。增强CGM访问 并在此关键发展时使用为量身定制的支持和问题提供了绝佳的机会 - 解决，导致糖尿病自我管理的持久改善。该试点试验的结果将 直接通知多站点随机临床试验以评估功效，其长期目标是确定 有效的行为策略可以融入常规的糖尿病教育和护理中。