Optimizing Use of Continuous Glucose Monitoring (CGM) to Advance Health Equity Among Youth with Type 1 Diabetes (T1D)

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PROJECT SUMMARY/ABSTRACT Use of continuous glucose monitors (CGM) has been shown to significantly improve glycemic control and decrease the risk of complications for pediatric patients with type 1 diabetes (T1D). However, despite the rapid advancements in technological capabilities over the past twenty years, access to and meaningful use of CGM are not distributed equitably across the population. The continued advancement in sophistication and potential for improved outcomes coupled with population-level increases in CGM use contributes to widening disparities in care and makes essential an improved understanding of optimizing use of personal medical devices for T1D. I am a public health trained pediatric endocrinologist; through this proposed K23 Award I aim to characterize disparities based on race/ethnicity and socioeconomic status (SES) in CGM use for children with T1D utilizing statistical analysis in disparate care settings and nationwide claims data. These analyses of the sources of disparities will inform my pilot clinic-based intervention to narrow gaps in CGM use. This project builds upon my research describing the experience of Hispanic caregivers of children with T1D, my analysis of demographic predictors of metabolic control in the T1D program at Boston Children’s Hospital (BCH), and my training in health services research and public health. This grant will enable my acquisition of new skills in time- to-event analysis, claims-based data use, and intervention design, implementation, and evaluation. Adding depth to my health services research methods and establishing a foundation in clinical trials, this grant, along with the unique environment and diverse mentorship at BCH, Department of Population Medicine (DPM), and Boston Medical Center (BMC) will position me well to begin an independent research program. In Aim 1, I will utilize a national health insurance plan claims database to analyze personal medical device use and acute care utilization among children with T1D with a focus on the impact of race/ethnicity and SES on CGM prescription and adherence. In my second aim I will employ a mixed methods approach to quantify CGM use among children with T1D cared for at a quaternary referral center (BCH) and a safety net hospital (BMC) and conduct a qualitative assessment of barriers to consistent CGM use in Black, Hispanic, and low SES patients at both sites to inform the development of a clinic-based intervention to improve CGM uptake and adherence in diverse, marginalized, and low resource patient populations. In Aim 3, I will develop and pilot the intervention informed by Aim 2 in a 6-month RCT at BCH and BMC to assess the impact of culturally effective education and patient navigation for CGM use on disparities in its uptake and associated clinical outcomes. I aim to establish a career as an independent physician-scientist with a background in the drivers of pediatric T1D care and outcomes, with the long-term goal of providing equitable access to rapidly improving technological innovations to better the lives of children with T1D. The mentorship, formal training, and research experience that this K23 will provide will position me well to begin an impactful independent research career.