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.

患有1型糖尿病（T1 D）的青少年必须遵循复杂的治疗方案，以接近正常的血糖水平，避免急性和长期的健康并发症。动态血糖监测（CGM）系统可以改善血糖控制。然而，黑人和西班牙裔T1 D青年的血糖控制比白色青年差，使用CGM的可能性更小。CGM使用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使用的差异可能是减少T1 D青年健康差异的有希望的方法。目前提案的目的是完善和试点测试公平技术专家（Tech-Ex），这是一项技术增强的干预措施，旨在增加T1 D黑人和西班牙裔青年对CGM的使用。在Tech-Ex中，家庭将与其他有使用CGM（技术专家）经验的家庭合作，并通过Nemours应用程序获得技术支持。在技术专家组件中，青年及其照顾者将与导师家庭合作，克服CGM使用的常见障碍。技术支持将包括访问文化定制的教育材料，数字杂志，以促进患者与提供者围绕CGM问题进行沟通，以及SDOH筛查和干预。在本提案的第一年，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，完善技术辅导计划和技术支持，制定实施干预措施的计划，完善测量策略，并招募和培训辅导家庭和护理经理。在纳入利益相关者的意见后，我们将在一项试点随机对照试验中测试Tech-Ex。将在定期安排的诊所访视期间或之后招募家庭，并随机（1：1）分配至Tech-Ex或6个月的等待名单对照组。主要结局将是干预的可接受性和可行性、使用CGM的感知障碍和促进因素、CGM的使用和血糖控制（即，HbA 1c，范围内时间）。目前研究的结果将为未来的研究提供信息，旨在通过更大规模的多中心随机对照试验测试干预措施的有效性。