Tech-Ex: A Peer Mentorship Program to Increase Equitable use of Continuous Glucose Monitoring Systems

Tech-Ex：一项旨在提高连续血糖监测系统公平使用的同行指导计划

• 批准号: 10797425
• 负责人: MELISSA A. ALDERFER
• 金额: $ 15.68万
• 依托单位: ALFRED I. DU PONT HOSP FOR CHILDREN
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-03-01 至 2027-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10797425
• 关键词: Acute; Black race; Caregivers; Case Manager; Child Health; Clinic Visits; Complex; Continuous Glucose Monitor; Diabetes Mellitus; Disparity; Educational Materials; Enhancement Technology; Equity; Family; Glycosylated hemoglobin A; Health; Health Personnel; Hispanic; Insulin-Dependent Diabetes Mellitus; Intervention; Journals; Measurement; Mentors; Mentorship; Outcome; Patients; Randomized; Randomized, Controlled Trials; Reduce health disparities; Research; Schedule; Site; System; Technology; Testing; Time; Training; Treatment Efficacy; Treatment Protocols; Waiting Lists; Work; Youth; acceptability and feasibility; digital; disparity reduction; efficacy testing; experience; glycemic control; improved; patient-clinician communication; peer; pilot test; primary outcome; programs; recruit; screening

Youth with type 1 diabetes (T1D) must follow a complex treatment regimen to approximate normal glycemic levels and avoid acute and long-term health complications. Continuous glucose monitoring (CGM) systems can improve glycemic control. However, Black and Hispanic youth with T1D have worse glycemic control than White youth and are less likely to use CGM. Disparities in the use of CGM may be one cause of disparities in diabetes health outcomes. Thus, reducing disparities in the use of CGM may be promising approach to reducing health disparities in youth with T1D. The objective of the current proposal is to refine and pilot-test Technology Experts for Equity (Tech-Ex), a technology-enhanced intervention to increase use of CGM among Black and Hispanic youth with T1D. In Tech-Ex, families will work with other families who have experience using CGM (Technology Experts) and also have access to technology supports through the Nemours App. In the Technology Expert components, youth and their caregivers will work with a mentor family to overcome common barriers to CGM use. The Technology Supports will include access to culturally-tailored educational materials, a digital journal to facilitate patient-provider communication around issues with CGM, and SDOH screening and intervention. During the first year of this proposal, we will work with patient, caregiver, and healthcare provider stakeholders to refine the technology coaching program and technology supports, develop plans to deliver the interventions, refine the measurement strategy, and recruit and train mentor families and a care manager. After incorporating stakeholder input, we will test Tech-Ex in a pilot randomized controlled trial. Families will be recruited during or after regularly scheduled clinic visits and randomized (1:1) to Tech-Ex or a 6-month waitlist control. Primary outcomes will be intervention acceptability and feasibility, perceived barriers and facilitators to using CGM, use of CGM, and glycemic control (i.e., HbA1c, time in range). Findings from the current study will inform future research aimed at testing the efficacy of the intervention in a larger, multisite randomized controlled trial.

1型糖尿病（T1D）的青年必须遵循一种复杂的治疗方案，达到正常血糖水平，避免急性和长期健康并发症。连续的葡萄糖监测（CGM）系统可以改善血糖控制。但是，具有T1D的黑人和西班牙裔青年的血糖控制效果要比白人青年差，并且使用CGM的可能性较小。使用CGM的差异可能是糖尿病健康结果差异的原因之一。因此，减少CGM使用差异可能是减少T1D青年健康差异的有前途的方法。当前建议的目的是完善和试点测试技术专家（Tech-EX），这是一种技术增强的干预措施，以增加CGM在T1D的黑人和西班牙裔青年中使用CGM。在Tech-EX中，家庭将与其他使用CGM（技术专家）经验的家庭合作，并且还可以通过Nemours应用程序获得技术支持。在技​​术专家组件中，青年及其护理人员将与导师家庭合作，克服CGM使用的常见障碍。该技术支持将包括获取文化定制的教育材料，一本数字杂志，以促进有关CGM问题的患者提供沟通以及SDOH筛查和干预。在此提案的第一年中，我们将与患者，护理人员和医疗保健提供者利益相关者合作，以完善技术教练计划和技术支持，制定计划以提供干预措施，完善测量策略，招募和培训导师家庭以及护理经理。在纳入利益相关者的投入后，我们将在一项随机对照试验中测试Tech-EX。在定期安排的诊所就诊期间或之后，将招募家庭，并随机分组（1：1）到Tech-EX或6个月的候补列表控制。主要结果将是干预可接受性和可行性，使用CGM，使用CGM和血糖控制的障碍和促进者（即HBA1C，范围内的时间）。当前研究的发现将为未来的研究提供旨在测试干预措施在较大的多站点随机对照试验中的功效的未来研究。