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

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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.