Minimizing Hypoglycemia in Adults with Type 1 Diabetes through an Integrated Mobile Health and Continuous Glucose Monitoring System

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Project Summary / Abstract Level 2 hypoglycemia (blood glucose <54 mg/dL) is a medical emergency that can lead to confusion, cardiac arrhythmias, and even death. This dangerous condition occurs frequently in patients with type 1 diabetes (T1D), including those using continuous glucose monitoring systems (CGMs). In prior studies of patients not using CGMs, researchers identified patient beliefs that interfere with hypoglycemia treatment. However, treatment interfering beliefs in CGM users remain to be evaluated, and an intervention to impactfully address these beliefs among CGM users is needed. The goal of this project is to comprehensively evaluate beliefs that interfere with hypoglycemia treatment in adult T1D CGM users, and to develop a novel behavioral intervention program to address these beliefs and minimize hypoglycemia. Mixed methods techniques can guide identification of hypoglycemia treatment interfering beliefs, and determine those predictive of level 2 hypoglycemia for targeted intervention development. Mobile health (mHealth) technology can be linked to CGM data to develop widely accessible, patient-centered, real-time interventions to address treatment interfering beliefs. Central hypothesis: An mHealth-CGM behavioral intervention program can mitigate beliefs that interfere with hypoglycemia treatment and reduce hypoglycemia in T1D CGM users. Aims: (1) Acquire an in-depth understanding of CGM users’ beliefs that interfere with hypoglycemia treatment; (2) Develop an mHealth text messaging program that generates automated, real-time behavioral interventions to mitigate beliefs that interfere with hypoglycemia treatment; (3) Assess the feasibility, acceptability and preliminary efficacy of the mHealth-CGM behavioral intervention program in reducing hypoglycemia in a pilot behavioral clinical trial. Candidate: Yu Kuei Lin, MD is an endocrinologist and early career investigator with the career goal of becoming an independent investigator, identifying and developing interventions to mitigate barriers to hypoglycemia management and prevention in diabetes patients. He has a successful history of designing and conducting hypoglycemia survey studies and biomedical clinical trials, but needs more training in advanced behavioral science research. This K-23 award will provide him with unique skills necessary to identify barriers to managing or preventing hypoglycemia, and to develop and evaluate patient-centered, targeted intervention programs delivered through mHealth aimed at optimizing hypoglycemia management and prevention. Training Objectives: (1) Acquire skills in conducting qualitative and mixed methods research; (2) Gain skills in developing mHealth behavioral interventions; (3) Develop expertise in conducting behavioral clinical trials. Dr. Lin’s training will be supported by highly experienced, complementary mentors and advisors, advanced didactic coursework, and participation in research and career development seminars and meetings within a resourceful, enriching training environment. An NIDDK K-23 award will provide Dr. Lin the protected time and training needed to help all patients with diabetes minimize hypoglycemia and improve health outcomes.