Optimizing diabetes technology use for Latinx youth through DREAM (Device use Reimagined through Education And Mentorship) virtual peer groups

通过 DREAM（通过教育和指导重新构想设备使用）虚拟同伴小组，优化拉丁裔青少年的糖尿病技术使用

• 批准号: 10708963
• 负责人: Jennifer K Raymond
• 金额: $ 49.95万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 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/10708963
• 关键词: Achievement; Address; Adolescent; Adolescent and Young Adult; Adoption; Attitude; Black race; California; Caring; Childhood; Childhood diabetes; Clinic; Clinical; Clinical Trials; Collaborations; Communities; Complications of Diabetes Mellitus; Continuous Glucose Monitor; Data; Development; Device Designs; Devices; Diabetes Mellitus; Doctor of Philosophy; Education; Endocrinologist; Ethnic Population; Evaluation; Family; Feedback; Focus Groups; Geography; Glycosylated hemoglobin A; Goals; Grant; Happiness; Health; Health Personnel; Insulin; Insulin Infusion Systems; Insulin-Dependent Diabetes Mellitus; Intervention; Interview; Knowledge; Latinx; Latinx population; Los Angeles; Maintenance; Measures; Medical; Mentorship; Modeling; Outcome; Participant; Patient Outcomes Assessments; Patient-Focused Outcomes; Patients; Pediatric Hospitals; Peer Group; Persons; Phase; Population; Population Heterogeneity; Process Measure; Provider; Psychologist; Public Health; Pump; Quality of life; Race; Randomized; Randomized, Controlled Trials; Readiness; Reporting; Research; Research Personnel; San Francisco; Structure; System; Technology; Universities; Visit; Work; Youth; acceptability and feasibility; adverse outcome; age group; aged; blood glucose regulation; clinical center; comparison control; design; diabetes distress; diabetes risk; diabetes self-management; ethnic diversity; experience; feasibility testing; future implementation; glycemic control; group intervention; health care service utilization; high risk; hospital utilization; improved; marginalization; medical appointment; member; monitoring device; multidisciplinary; novel; optimism; patient engagement; peer; peer support; pilot test; prevent; primary outcome; programs; randomized, clinical trials; recruit; satisfaction; social; stakeholder perspectives; standard care; telehealth; therapy design; uptake; virtual

PROJECT SUMMARY/ABSTRACT Strict glycemic control is critical for optimal type 1 diabetes (T1D) outcomes but remains challenging for youth from historically marginalized ethnic groups, in whom hemoglobin A1c (A1c) levels are consistently the highest in the nation. In California, Latinx youth are the largest marginalized ethnic group with T1D, but they experience less optimal glycemic control than their White counterparts. Continuous glucose monitoring, insulin pumps, and automated insulin delivery systems can assist with achievement of target A1c levels, but Latinx youth have lower rates of diabetes device use compared to White youth. Virtual peer groups (VPGs) can improve patient engagement and diabetes self-care in Latinx youth, and preliminary data suggest that VPGs may increase the use of diabetes technology in this population. Jenise Wong, MD PhD, and Jennifer Raymond, MD MCR, propose this project grant with the objective to increase the adoption and sustained use of diabetes devices in Latinx adolescents with T1D by engaging them and their families in the development and evaluation of a VPG intervention designed to improve technology use. This project will engage multiple stakeholders (patients, families, health care workers) from three clinic populations in California (Children’s Hospital of Los Angeles, University of California Davis, and University of California San Francisco) and result in the DREAM (Device use Reimagined through Education And Mentorship) program. In collaboration with a multidisciplinary team of pediatric endocrinologists, psychologists, and public health experts, the researchers propose a project with the following aims: (1) partner with stakeholders to adapt a virtual peer group model to promote the initiation and continued use of diabetes technology among Latinx adolescents with T1D, (2) evaluate the feasibility and acceptability of DREAM in a single arm, pragmatic trial, and (3) assess the effect of DREAM on clinical and patient-centered outcomes. These aims will be addressed in a formative phase and a clinical trial phase. In Phase 1, the research team will address Aim 1 by engaging stakeholders in focus groups and semi-structured interviews to obtain qualitative data that will directly inform the design of the DREAM VPGs and the clinical trial. A subset of stakeholders will form Advisory Councils who will provide longitudinal input during the clinical trial. In Phase 2, the research team will conduct a single arm, pragmatic trial of the DREAM intervention in 120 Latinx youth aged 13 to <18 years with T1D, recruited from three pediatric diabetes clinic populations in California. To address Aim 2, the researchers will collect qualitative feedback from focus groups and quantitative data on VPG feasibility, appropriateness, and acceptability as primary outcomes. Preliminary data on clinical outcomes of A1c and hospital utilization, and patient-centered outcomes will be assessed to address Aim 3. The results of this study will result in a novel, culturally appropriate, VPG model to increase use of diabetes technology for Latinx youth with T1D that may be further adapted and disseminated for other age groups, geographic settings, or racial/ethnic populations.

项目概要/摘要 严格的血糖控制对于 1 型糖尿病 (T1D) 的最佳结果至关重要，但对年轻人来说仍然具有挑战性 来自历史上被边缘化的种族群体，其中糖化血红蛋白 (A1c) 水平始终最高 在全国。在加利福尼亚州，拉丁裔青年是患有 T1D 的最大边缘化族群，但他们 与白人相比，他们的血糖控制效果较差。连续血糖监测、胰岛素 泵和自动胰岛素输送系统可以帮助实现目标 A1c 水平，但拉丁裔 与白人青年相比，青年糖尿病设备的使用率较低。虚拟对等组 (VPG) 可以 提高拉丁裔青少年的患者参与度和糖尿病自我护理，初步数据表明 VPG 可能会增加该人群中糖尿病技术的使用。 Jenise Wong，医学博士和 Jennifer MCR 医学博士雷蒙德 (Raymond) 提出该项目拨款，旨在提高采用率和持续使用率 通过让患有 T1D 的拉丁裔青少年及其家人参与开发，为他们提供糖尿病设备 以及评估旨在改善技术使用的 VPG 干预措施。该项目将吸引多个 来自加州三个诊所人群（儿童医院）的利益相关者（患者、家庭、医护人员） 洛杉矶医院、加州大学戴维斯分校和加州大学旧金山分校）并得出结果 DREAM（通过教育和指导重新想象设备使用）计划。与合作 由儿科内分泌学家、心理学家和公共卫生专家、研究人员组成的多学科团队 提出一个具有以下目标的项目：（1）与利益相关者合作，调整虚拟同行小组模型 促进患有 T1D 的拉丁裔青少年开始并继续使用糖尿病技术，(2) 评估 DREAM 在单组、实用性试验中的可行性和可接受性，以及 (3) 评估 对临床和以患者为中心的结果的梦想。这些目标将在形成阶段和后续阶段得到解决 临床试验阶段。在第一阶段，研究团队将通过让利益相关者参与焦点小组来实现目标 1 和半结构化访谈，以获得定性数据，直接为 DREAM 的设计提供信息 VPG 和临床试验。一部分利益相关者将组成咨询委员会，提供纵向咨询服务 临床试验期间的输入。在第二阶段，研究团队将进行单臂、实用的试验 DREAM 对 120 名 13 岁至 18 岁以下患有 T1D 的拉丁裔青少年进行干预，这些青少年来自三名糖尿病儿童 加利福尼亚州的诊所人群。为了实现目标 2，研究人员将从焦点收集定性反馈 组和有关 VPG 可行性、适当性和可接受性的定量数据作为主要结果。 有关 A1c 临床结果和医院利用率以及以患者为中心的结果的初步数据将 评估以解决目标 3。本研究的结果将产生一种新颖的、适合文化的 VPG 模型 增加针对患有 T1D 的拉丁裔青少年的糖尿病技术的使用，该技术可进一步调整和传播 对于其他年龄组、地理环境或种族/民族人口。