ONBOARD: OvercomiNg Barriers & Obstacles to Adopting Diabetes Devices

船上：克服障碍

• 批准号: 10541137
• 负责人: Molly Leah Tanenbaum
• 金额: $ 16.96万
• 依托单位: STANFORD UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-01-01 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10541137
• 关键词: Address; Adopted; Adoption; Adult; Algorithms; Attention; Award; Behavior Therapy; Behavioral; Behavioral Research; Caring; Chronic Disease; Continuous Glucose Monitor; Data; Devices; Diabetes Mellitus; Distress; Doctor of Philosophy; Dose; Eating; Education; Ensure; Feedback; Fingers; Focus Groups; Future; Glucose; Goals; Health; Individual; Insulin; Insulin Infusion Systems; Insulin-Dependent Diabetes Mellitus; Intervention; Interview; K-Series Research Career Programs; Mentors; Minority; Mollies; Outcome; Outcome Measure; Persons; Phase; Physical activity; Population; Problem Solving; Psyche structure; Quality of life; Randomized; Randomized, Controlled Trials; Readiness; Recommendation; Regimen; Research; Research Personnel; Resources; Risk; Sampling; Self Management; Series; Signal Transduction; Standardization; Surveys; System; Technology; Time; Training; Trust; Work; blood glucose regulation; career; career development; data management; design; diabetes distress; diabetes management; diabetes self-management; empowerment; evidence base; experience; glucose monitor; glycemic control; improved; intervention refinement; post intervention; prevent; psychosocial; research study; skills; social; standard of care; tool; uptake

Project Summary Type 1 diabetes (T1D) is a burdensome chronic disease that requires a demanding self-management regimen to optimize glycemic control and prevent short- and long-term complications. Advances in insulin pumps and continuous glucose monitoring (CGM) technologies have enabled improved glycemic control and reduced risk of complications and have laid the groundwork for the arrival of closed loop systems – the first of which became commercially available in 2017. Closed loop systems, which integrate an insulin pump and CGM to partially automate insulin delivery, represent a major paradigm shift in diabetes care such that people with T1D will offload some of the diabetes management burden to an automated system, resulting in tighter glucose control and better quality of life. However, a minority of adults (18-50) with T1D currently use CGM – a core component of closed loop - and a concerning proportion quit CGM within the first year, which does not bode well for the adoption of closed loop. Low uptake and high discontinuation of CGM among adults with T1D signal the need for well-designed, tailored interventions that provide education, support and problem-solving skills to empower device users to work through physical, social, and other barriers to maximize benefit from advanced diabetes technologies. In this application, Molly Tanenbaum, PhD, proposes a series of studies with an overarching goal of developing advanced behavioral research skills while refining a comprehensive behavioral intervention package to equip adults with T1D with the resources and skills to maximize benefit and minimize daily interference from CGM, with application for closed loop system adoption. The specific aims in this career development award proposal are: 1) to deliver, iteratively refine a behavioral intervention package, ONBOARD (OvercomiNg Barriers & Obstacles to Adopting Diabetes Devices), in a small sample of adults with T1D using CGM, and then conduct a randomized controlled trial of ONBOARD comparing device use, health and psychosocial outcomes after adults with T1D receive the intervention versus CGM-only; and 2) to use qualitative interview data to adapt ONBOARD for adults initiating closed loop systems. Results from these studies will provide preliminary data to inform a larger trial of ONBOARD for CGM and closed loop adoption and sustained use in a future R01 application. Dr. Tanenbaum’s long-term career objective is to be an independent investigator with a programmatic line of research focused on optimizing use of emergent diabetes technology to improve health and quality of life outcomes for adults with T1D. The mentoring, coursework, and career development activities proposed in this 5-year training award will provide Dr. Tanenbaum with the advanced statistical training and experience conducting a randomized controlled trial – skills necessary for a successful career as an independent behavioral diabetes researcher.

项目摘要 1型糖尿病（T1 D）是一种负担沉重的慢性疾病，需要严格的自我管理方案 优化血糖控制并预防短期和长期并发症。胰岛素泵的进展和 连续葡萄糖监测（CGM）技术已经能够改善血糖控制并降低风险 复杂性，并为闭环系统的到来奠定了基础-其中第一个 于2017年投入商用。闭环系统，集成胰岛素泵和CGM， 部分自动化的胰岛素输送，代表了糖尿病护理的主要范式转变， 将把一些糖尿病管理负担转移到自动化系统上， 控制和更好的生活质量。然而，少数T1 D成人（18-50岁）目前使用CGM -核心 闭环的组成部分-和有关比例退出CGM的第一年内，这并不预示着 采用闭环控制。T1 D成人患者中CGM的低摄取率和高中断率 表明需要精心设计、量身定制的干预措施，以提供教育、支持和解决问题 使设备用户能够克服物理、社会和其他障碍的技能， 先进的糖尿病技术。在这项申请中，Molly Tanenbaum博士提出了一系列研究， 发展先进的行为研究技能，同时完善一个全面的 行为干预包，为T1 D成年人提供资源和技能，以最大限度地发挥效益， 最大限度地减少CGM的日常干扰，并应用于闭环系统采用。具体目标是 这个职业发展奖的建议是：1）交付，迭代地完善行为干预包， ONBOARD（克服采用糖尿病设备的障碍和障碍），在一小部分成年人中， 使用CGM进行T1 D，然后进行ONBOARD随机对照试验，比较器械使用、健康 T1 D成人接受干预与仅接受CGM干预后的心理社会结局; 2）使用 定性访谈数据，以使ONBOARD适用于启动闭环系统的成人。从这些 研究将提供初步数据，为更大规模的ONBOARD CGM和闭环采用试验提供信息 并在未来的R 01应用中持续使用。Tanenbaum博士的长期职业目标是成为一名 一个独立的研究者，专注于优化紧急糖尿病的使用 改善T1 D成人健康和生活质量的技术。辅导，课程，和 在这个为期5年的培训奖励中提出的职业发展活动将为Tanenbaum博士提供 先进的统计培训和经验进行随机对照试验-必要的技能， 成功的职业生涯作为一个独立的行为糖尿病研究者。