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

项目概要/摘要 使用连续葡萄糖监测仪（CGM）已被证明可显著改善血糖控制， 降低1型糖尿病（T1 D）儿科患者并发症的风险。尽管快速 过去二十年来技术能力的进步，CGM的获得和有意义的使用 并没有在人口中公平分配。在复杂性和潜力方面的持续进步 随着CGM使用的人口水平增加， 在护理中，必须提高对T1 D个人医疗设备优化使用的理解。 我是一名接受过公共卫生培训的儿科内分泌学家;通过这项拟议的K23奖，我的目标是描述 T1 D儿童CGM使用中基于种族/民族和社会经济地位（SES）的差异 统计分析在不同的护理设置和全国范围内的索赔数据。这些分析的来源， 差异将告知我的试点诊所为基础的干预，以缩小CGM使用的差距。该项目建立在 我的研究描述了T1 D儿童的西班牙裔照顾者的经历，我对 波士顿儿童医院（BCH）T1 D项目中代谢控制的人口统计学预测因素， 卫生服务研究和公共卫生方面的培训。这笔补助金将使我能够及时获得新的技能- 事件分析，基于索赔的数据使用，以及干预设计，实施和评估。添加 深入到我的健康服务研究方法和建立一个基础的临床试验，这项赠款，沿着 在BCH的独特环境和多样化的指导下，人口医学系（Department of Population Medicine，简称BCH）， 波士顿医学中心（BMC）将使我能够开始一个独立的研究项目。 在目标1中，我将利用国家健康保险计划索赔数据库来分析个人医疗器械的使用情况 T1 D儿童的急性护理利用率，重点关注种族/民族和SES对 CGM处方和依从性。在我的第二个目标中，我将采用混合方法来量化CGM 在四级转诊中心（BCH）和安全网医院（BMC）接受治疗的T1 D儿童中使用 并对黑人、西班牙裔和低社会经济地位人群持续使用CGM的障碍进行定性评估 两个研究中心的患者，以告知基于临床的干预措施的开发，以改善CGM摄取， 在多样化、边缘化和低资源患者人群中的依从性。在目标3中，我将开发和试验 在BCH和BMC进行的为期6个月的随机对照试验中，根据目标2进行干预，以评估文化上有效的 CGM使用的教育和患者导航，以了解其吸收和相关临床结局的差异。 我的目标是建立一个职业生涯作为一个独立的医生，科学家的背景，在驱动器的儿科 T1 D护理和结果，长期目标是提供公平获得快速改善的 技术创新，以改善T1 D儿童的生活。导师制、正规培训和研究 这K23将提供的经验将使我很好地开始开始一个有影响力的独立研究生涯。

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.