Support to Adopt and Retain Technology (StART) CGM: A pilot study to support continuous glucose monitoring in primary care

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PROJECT SUMMARY/ABSTRACT Candidate: Kara R. Mizokami-Stout, MD, MSc is an adult endocrinologist and early career investigator focused on personalized diabetes management to improve health outcomes. Dr. Mizokami-Stout’s long-term career objective is to become an independent physician-investigator who promotes evidence-based, system-level changes to prevent diabetic complications and improve diabetes-specific quality-of-life. Research Context: Continuous glucose monitoring (CGM) improves glycemic control, reduces hypoglycemia and facilitates personalized care in insulin-requiring type 2 diabetes (T2D). Despite these benefits, only 3% of eligible T2D patients seen in primary care are utilizing CGM devices and nearly one-third of CGM-users stop using these devices after six months. A comprehensive evaluation and a coordinated strategy to target key determinants of CGM adoption and retention is lacking for T2D, particularly in primary care settings where over 90% of patients with T2D receive their diabetes care. Interventions that address determinants at multiple levels of influence (e.g., patient, provider, health system) are required to achieve such coordinated delivery and improve effectiveness of CGM in insulin-requiring T2D. Research Aims: Dr. Mizokami-Stout will utilize Implementation Science (via the Tailored Implementation in Chronic Diseases checklist) to: (1) develop an in-depth understanding of patient-, provider-, and system-level barriers and facilitators to CGM use; (2) design an evidence- and theory-based multilevel intervention entitled Support to Adopt and Retain Technology (StART) CGM that addresses key determinants of CGM adoption and retention; and (3) evaluate the feasibility, acceptability, and preliminary efficacy of StART CGM to improve CGM adoption and retention in insulin-requiring T2D in primary care. Career Development Plan: Dr. Mizokami-Stout will develop expertise in: (1) Implementation Science for intervention development and evaluation; (2) designing multilevel, tailored interventions utilizing the electronic health record; and 3) mixed methods evaluation of pragmatic trials. Dr. Mizokami-Stout’s training will be supported by highly experienced, interdisciplinary mentors; advanced didactic coursework; and participation in research and career development meetings and seminars within an ideal training environment. An NIDDK K-23 award will allow Dr. Mizokami-Stout to become an independent physician-investigator and national leader in developing, testing and implementing multilevel interventions to incorporate evidence-based diabetes technology into routine diabetes care.