Developing a diabetes self-management mHealth simulation platform for youth

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PROJECT SUMMARY For the 1.5 million individuals in the United States living with type 1 diabetes (T1D) the importance of maintaining near normal glycemic control, typically measured by glycosylated hemoglobin (A1c), to prevent microvascular and macrovascular complications is well established. Despite recent advancements and increased use of technologies to manage diabetes (i.e., insulin pump, continuous glucose monitoring (CGM), Hybrid Closed Loop (HCL) systems), 70% of individuals with type 1 diabetes (T1D) do not meet their A1c targets. Adolescents fare worse than children and adults with only 17% currently achieving targets. Insulin pump therapy is a more physiologic form of insulin delivery than multiple daily injections, yet these complex machines rely heavily on individual utilization and self-management behaviors. In this Mentored Patient-Oriented Research Career Development Award (K23) we propose three distinct but complementary studies. First, we will examine novel aspects of pre-teen and adolescent diabetes device self-management by conducting a secondary analysis of a large dataset that combines diabetes device self-management, utilization and glucose data from the youth’s diabetes device (e.g. insulin pump, CGM, HCL). Second, we will extend the functionality and test the validity of an existing mHealth diabetes education simulation platform (A1Control) among youth (10-18 years of age) with T1D using participatory design techniques including co-design workshops, and laboratory usability testing. Third, we will conduct a pilot study to assess the feasibility, sustained engagement and impact of the mHealth intervention among youth (10-18 years of age) with T1D. This proposed training award is congruent with NINR’s mission to support research that models or improves understanding of self-management behaviors as well as cross-cutting alignment in advancing data analytics for technology to improve health. Career development objectives are: (1) developing advanced device and sensor data analytics skills; (2) enhancing knowledge and skills of participatory design methods; and, (3) acquiring skills in clinical trials intervention development and testing. Career objectives will be accomplished through a combination of formal didactic and informal trainings; participation in national conferences and workshops; and hands-on research training under the mentorship of an accomplished team of scientists in the field of patient centered technology development (Mion and Happ), data analytics and secondary analysis (Shoben and Mion), and clinical trials research (Mion, Dungan, Happ and Shoben). The candidate’s mentors and collaborators comprise a transdisciplinary team from nursing, endocrinology, engineering, and public health. The skills, experience, and training gained from this career development award will position the candidate for a successful career as an independent investigator focused on the science of chronic disease self-management and technology utilization with development and organization of future large scale trials aimed at fostering improved outcomes for individuals with diabetes.