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

项目摘要/摘要 使用连续血糖监测仪(CGM)已被证明显著改善血糖控制和 降低1型糖尿病(T1D)儿科患者的并发症风险。然而，尽管快速 过去二十年来技术能力的进步、获得和有意义地利用气候变化框架公约 并不是在人口中平均分配。在复杂性和潜力方面的持续进步 为了改善结果，加上人口水平的增加，CGM的使用导致了差距的扩大 在护理方面，并使对T1D优化使用个人医疗设备的理解变得至关重要。 我是一名受过公共卫生培训的儿科内分泌学家；通过这个提议的K23奖，我的目标是 T1D使用CGM儿童的种族/民族和社会经济地位(SES)差异 对不同的护理环境和全国范围内的索赔数据进行统计分析。这些对来源的分析 差异将为我的试点诊所干预提供信息，以缩小CGM使用的差异。这个项目是建立在 我的研究描述了患有T1D儿童的西班牙裔照顾者的经历，我对 波士顿儿童医院(BCH)T1D项目代谢控制的人口统计学预测因素，以及我的 卫生服务研究和公共卫生方面的培训。这笔赠款将使我能够及时获得新的技能- 对事件的分析、基于索赔的数据使用以及干预设计、实施和评估。添加 深入我的健康服务研究方法，并在临床试验中建立基础，这笔赠款，以及 在独特的环境和不同的导师在BCH，人口医学系(DPM)，和 波士顿医学中心(BMC)将为我开始一项独立的研究计划做好准备。 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设备的使用情况 T1D儿童的急性护理利用情况，重点关注种族/民族和社会经济状况对儿童的影响 CGM处方和依从性。在我的第二个目标中，我将使用混合方法来量化CGM 在第四转诊中心(BCH)和安全网医院(BMC)护理的T1D儿童中使用 并对黑人、西班牙裔和低SES中持续使用CGM的障碍进行定性评估 向两个地点的患者通报以临床为基础的干预措施的发展，以改善CGM摄取和 多元化、边缘化和低资源患者群体的依从性。在目标3中，我将开发和试验 在BCH和BMC为期6个月的RCT中，由Aim 2提供干预信息，以评估文化有效性的影响 CGM使用的教育和患者导航，以了解其摄取和相关临床结果的差异。 我的目标是成为一名独立的内科科学家，具有儿科司机的背景 T1D护理和结果，长期目标是提供公平的机会，迅速改善 技术创新，改善T1D儿童的生活。指导、正式培训和研究 K23将提供的经验将使我很好地开始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.