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

项目概要/摘要 严格的血糖控制对于1型糖尿病（T1 D）的最佳结局至关重要，但对于年轻人仍然具有挑战性 来自历史上被边缘化的种族群体，其中血红蛋白A1 c（A1 c）水平始终最高 在全国范围内。在加州，拉丁裔青年是最大的边缘化族裔群体与T1 D，但他们 与他们的白色同伴相比，他们的血糖控制效果较差。动态血糖监测，胰岛素 胰岛素泵和自动胰岛素输送系统可以帮助达到目标A1 c水平，但Latinx 与白色青年相比，青年糖尿病器械使用率较低。虚拟对等组（VPG）可以 改善拉丁裔青年患者参与度和糖尿病自我护理，初步数据表明， 可能会增加糖尿病技术在这一人群中的使用。Jenise Wong，医学博士和Jennifer 雷蒙德，医学博士MCR，提出这个项目赠款的目的是增加采用和持续使用 通过让他们及其家人参与开发， 和评估旨在改善技术使用的VPG干预措施。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弗朗西斯科分校），并导致 DREAM（Device Use Reimagined Through Education And Mentorship）计划。在与一个 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， 提出一个项目，目标如下：（1）与利益攸关方合作，采用虚拟同侪小组模式， 促进在患有T1 D的拉丁裔青少年中开始并继续使用糖尿病技术，（2） 评价DREAM在单组、实用性试验中的可行性和可接受性，以及（3）评估 梦想以临床和患者为中心的结果。这些目标将在形成阶段和 临床试验阶段。在第一阶段，研究小组将通过让利益相关者参加焦点小组来实现目标1 和半结构化的访谈，以获得定性数据，将直接告知梦想的设计 VPG和临床试验。一部分利益相关者将组成咨询委员会， 临床试验期间的输入。在第二阶段，研究小组将进行一项单臂，务实的试验， DREAM干预120名13至<18岁的T1 D拉丁裔青年，从3名儿童糖尿病患者中招募 加州的诊所人群。为了实现目标2，研究人员将收集来自焦点的定性反馈， VPG的可行性、适当性和可接受性作为主要结局的组和定量数据。 将提供有关A1 c临床结局和医院利用以及以患者为中心的结局的初步数据 评估目标3。这项研究的结果将导致一个新的，文化上适当的，VPG模型， 增加对拉丁裔T1 D青年糖尿病技术的使用，可进一步调整和传播 对于其他年龄组、地理环境或种族/民族人群。

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.