Glu-COACH: a peer-mentoring intervention to reduce disparities in CGM use in adolescents with type 1 diabetes

项目摘要 青少年1型糖尿病患者比其他任何年龄组都更难达到推荐的血糖水平 目标的动态葡萄糖监测设备，能够实时确定和通信 血糖水平、趋势识别、警告和警报，以及远程通信和监测， 改善了代谢和生活方式的结果，并显着改变了临床管理， 青年糖尿病然而，这些技术进步并没有同样地惠及所有人口： 在黑人和拉丁裔年轻人中，这些设备的使用率和持续使用率加剧了 糖尿病护理和结果中存在的种族差异。除了社会经济问题，如访问， 与负担、糖尿病困扰和自我效能有关的发展和文化特定因素是 具体和创新干预措施的可修改目标。结构化的同伴指导计划已经 成功应用于其他慢性病模型，以改善对疾病的态度和行为 管理使用利益相关者参与的方法，我们将开发，优化和评估同行- 支持干预，Glu-COACH，以改善黑人和拉丁裔的CGM使用的吸收和维持 1型糖尿病的治疗方法来自代表患者、父母和 临床医生将告知研究的每个阶段。在第一阶段，我们将合作开发Glu-COACH，并最终确定 与我们的利益相关者一起研究协议。在第2阶段，我们将进行一项随机对照初步研究（n=50） 将Glu-COACH与增强标准护理对照组进行比较， 与我们的利益相关者举行会议，以进行持续的合作。我们假设支持，验证， 认同，替代经验，和角色模型提供的培训同侪导师相同的文化 与对照组相比，同一性将显著改善我们在Glu-COACH参与者中使用CGM的主要目的 组我们还将研究Glu-COACH干预对血糖结果的影响，例如 范围、平均血糖和A1 c，以及行为结果，如糖尿病相关的自我效能和痛苦， 以及与CGM使用相关的益处和负担。最后，我们将严格审查的可行性，可接受性， 和实施Glu-COACH干预措施。这项干预措施将在2010年12月15日至2011年12月31日期间得到扩大和评估。 随后的多中心随机对照试验，如果证明有效。

PROJECT SUMMARY Adolescents with type 1 diabetes struggle more than any other age group to meet recommended glycemic targets. Continuous glucose monitoring devices, which enable real-time determination and communication of blood glucose levels, identification of trends, alerts, and alarms, and remote communication and monitoring, have improved metabolic and lifestyle outcomes and have markedly transformed the clinical management of diabetes in youth. However, these technological improvements have not benefited all populations similarly: lower rates of uptake and continued use of these devices in Black and Latinx young people have exacerbated pre- existing racial disparities in diabetes care and outcomes. Beyond socioeconomic issues such as access, developmentally and culturally specific factors relating to burden, diabetes distress, and self-efficacy are modifiable targets for specific and innovative interventions. Structured peer mentoring programs have been successfully employed in other chronic illness models to improve attitudes and behaviors around disease management. Using a stakeholder engagement approach, we will develop, optimize, and evaluate a peer- support intervention, Glu-COACH, to improve the uptake and maintenance of CGM use in Black and Latinx adolescents with type 1 diabetes. The input from a stakeholder panel representing patients, parents, and clinicians will inform each phase of the study. In Phase 1, we will collaboratively develop Glu-COACH and finalize study protocols with our stakeholders. In Phase 2, we will conduct a randomized controlled pilot study (n=50) comparing Glu-COACH to an enhanced standard care control group, convening quarterly research progress meetings with our stakeholders for ongoing collaboration. We hypothesize that the support, validation, identification, vicarious experience, and role modeling provided by trained peer mentors of the same cultural identity will significantly improve our primary aim of CGM use in Glu-COACH participants compared to the control group. We will also examine the effects of the Glu-COACH intervention on glycemic outcomes, such as time in range, mean glucose, and A1c, and behavioral outcomes, such as diabetes-related self-efficacy and distress, as well as benefits and burdens related to CGM use. Finally, we will critically examine the feasibility, acceptability, and implementation of the Glu-COACH intervention. This intervention will be upscaled and evaluated in a subsequent multi-site randomized controlled trial if proven effective.