Glucose Optimization Through Technology Assisted Management (GO TEAM!):Use of a diabetes dashboard and community health worker to decrease disparities in technology use in pediatric T1D

通过技术辅助管理优化血糖（GO TEAM！）：使用糖尿病仪表板和社区卫生工作者来减少儿科 T1D 技术使用的差异

• 批准号: 10708941
• 负责人: Sarah A MacLeish
• 金额: $ 47.94万
• 依托单位: CASE WESTERN RESERVE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-22 至 2026-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10708941
• 关键词: Acute; Address; Adoption; Attitude; Black race; Caring; Characteristics; Child; Childhood; Childhood diabetes; Collaborations; Communities; Community Health Aides; Continuous Glucose Monitor; Control Groups; Data; Devices; Diabetes Mellitus; Diagnosis; Disparity; Educational Technology; Effectiveness of Interventions; Electronic Mail; Family; Feedback; Frequencies; Glucose; Glycosylated hemoglobin A; Goals; Healthcare; Insulin; Insulin Infusion Systems; Insulin-Dependent Diabetes Mellitus; Insurance; Intervention; Interview; Letters; Manufacturer; Measures; Microvascular Dysfunction; Minority; Monitor; Not Hispanic or Latino; Outcome Measure; Participant; Patients; Perception; Protocols documentation; Provider; Pump; Race; Recommendation; Resources; Risk; Role; Self Efficacy; System; Technology; Telephone; Time; Triage; Trust; Youth; black patient; dashboard; data sharing; diabetes distress; diabetes management; disparity reduction; effectiveness evaluation; experience; glycemic control; group intervention; health care disparity; high risk; implementation evaluation; implementation intervention; improved; insulin dependent diabetes mellitus onset; minority patient; mortality; novel; prevent; primary outcome; randomized, controlled study; recruit; remote monitoring; response; secondary outcome; smartphone application; socioeconomics; standard of care; treatment arm; treatment as usual; young adult

Project Summary/Abstract Disparities in glycemic control and diabetes technology use are now widely recognized at all socioeconomic levels in Non-Hispanic Black (NHB) patients with type 1 diabetes (T1D). Recent data shows that NHB children are less likely to start and less likely to continue use of a continuous glucose monitor (CGM), and are also less likely to use an insulin pump. Automated insulin delivery (AID) systems, which require both CGM and insulin pump, show greatest HbA1c improvement in those with baseline HbA1c over 8%, leading to concern that low use of AID in NHB patients will further exacerbate existing health-care disparities. Therefore, novel interventions to reduce disparities in technology use among NHB patients with T1D are critical to improving glycemic control, reducing microvascular complications and preventing early mortality in NHB patients. We aim to reduce disparities with a 2-part intervention: a diabetes triage dashboard with interactive smartphone application and a community health worker (CHW) in the role of diabetes technology coach. A diverse advisory group of stakeholders will define metrics of triage zones for the dashboard and frequency/content of messages from the application and will refine the specific role of the CHW, Our shared goals are to 1) identify patients who struggle to initiate or continue their device or do not meet glycemic goals and 2) utilize a CHW from the same racial background and community to act as a diabetes and technology coach, building trust with families so as to identify and overcome barriers to successful technology use. The specific aims are to: 1) Convene a diverse advisory group of stakeholders to develop a protocol for a diabetes dashboard and smartphone application; 2) Develop a diabetes dashboard and interactive application using remote data capture from the cloud from CGM, insulin pumps, and AID systems; 3) Assess effectiveness and implementation of the bundled intervention with a 1:1 randomized controlled study of NHB children and young adults with new onset and insulin pump naïve existing T1D; 4) Aim 4: Understand lived experience of diabetes management in context with 1:1 interviews, considering both perceptions regarding the intervention itself (vs. usual care) and organizational/secular characteristics influencing that experience.

项目摘要/摘要 血糖控制和糖尿病技术的差异现在在所有社会经济上都被广泛认可 1型糖尿病（T1D）的非西班牙裔黑（NHB）患者的水平。最近的数据显示NHB儿童 不太可能启动，并且不太可能继续使用连续的葡萄糖监测器（CGM），并且也较少 可能使用胰岛素泵。自动胰岛素输送（AID）系统，需要CGM和胰岛素 泵，在基线HBA1C超过8％的人中显示出最大的HBA1C，导致人们担心很低 在NHB患者中使用援助将进一步加剧现有的医疗保健分配。因此，新颖的干预措施 为了减少NHB T1D患者中技术使用的分布，对于改善血糖控制至关重要， 减少微血管并发症并防止NHB患者的早期死亡率。 我们旨在通过两部分干预减少分布：糖尿病仪表板和互动智能手机 应用和社区卫生工作者（CHW）在糖尿病技术教练的角色中。多元化的咨询 一组利益相关者将定义仪表板的分类区指标和消息的频率/内容 从应用程序中，将完善CHW的具体作用，我们的共同目标是1）确定患者 努力启动或继续其设备或不符合血糖目标，2）从同一目标中使用CHW 种族背景和社区充当糖尿病和技术教练，与家庭建立信任 识别并克服成功使用技术的障碍。 具体目的是：1）召集一个利益相关者的潜水咨询小组，以制定一个协议 糖尿病仪表板和智能手机应用程序； 2）开发糖尿病仪表板和交互式应用程序 使用CGM，胰岛素泵和AID系统从云中捕获的远程数据捕获； 3）评估有效性 并通过对NHB儿童的1：1随机对照研究的捆绑干预措施实施 具有新发作和胰岛素泵的年轻人幼稚的现有T1D； 4）目标4：了解现场经验 糖尿病管理以1：1访谈，考虑到干预的两种看法 本身（相对于通常的护理）和组织/世俗的特征会影响体验。