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

项目摘要/摘要 严格的血糖控制对1型糖尿病(T1D)的最佳结局至关重要，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，他们的血红蛋白A1c(A1c)水平一直是最高的 在全国范围内。在加利福尼亚州，拉丁裔青年是患有T1D的最大的边缘化种族群体，但他们 与他们的White同行相比，他们体验到的血糖控制不是很理想。连续血糖监测，胰岛素 泵和自动化胰岛素输送系统可以帮助实现目标A1c水平，但Latinx 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 改善拉美裔青年的患者参与度和糖尿病自我护理，初步数据表明VPG 可能会增加糖尿病技术在这一人群中的使用。医学博士Jenise Wong和Jennifer 雷蒙德，医学博士，MCR，提出这一项目赠款的目标是增加采用和持续使用 通过让患有T1D的拉美裔青少年及其家人参与糖尿病设备的发育来评估他们的糖尿病设备 以及评估旨在改善技术使用的VPG干预。该项目将涉及多个 来自加州三个诊所人群的利益相关者(患者、家庭、医护人员)(儿童 洛杉矶医院、加州大学戴维斯分校和加州大学旧金山分校)，并导致 梦想(通过教育和指导重新想象设备使用)计划。与 由儿科内分泌学家、心理学家和公共卫生专家组成的多学科团队，研究人员 提出一个具有以下目标的项目：(1)与利益相关者合作，使虚拟对等组模式适应 在患有T1D的拉美裔青少年中促进糖尿病技术的启动和继续使用，(2) 评估梦想在单臂、务实试验中的可行性和可接受性，以及(3)评估 梦想临床和以患者为中心的结果。这些目标将在形成阶段和 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解决目标1 以及半结构化访谈，以获得将直接为梦想的设计提供信息的定性数据 VPG和临床试验。一部分利益相关者将组成顾问委员会，他们将提供纵向的 在临床试验期间的投入。在第二阶段，研究小组将进行单臂、务实的 从3个儿童糖尿病招募的120名13岁至18岁患有T1D的拉丁裔青年的梦境干预 加州的诊所人口。为了达到目标2，研究人员将收集来自FOCUS的定性反馈 将VPG的可行性、适当性和可接受性作为主要结果的分组和量化数据。 关于A1C的临床结果和医院利用的初步数据，以及以患者为中心的结果将是 评估以解决目标3。这项研究的结果将导致一个新的，文化上合适的，VPG模式 对患有T1D的拉美裔青年增加糖尿病技术的使用，可能会进一步适应和传播 适用于其他年龄段、地理环境或种族/民族人口。

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.