Putting Telehealth to the Test: An Evaluation of the Use of Telehealth to Increase the Population-Level Impact of an Employer-Based Diabetes Prevention Program

项目总结 最近关于2型糖尿病(T2 DM)作为SARS-CoV-2感染的急性后遗症的报道(PASC，临床 发现感染持续30天以上)强调公共卫生迫切需要更好地了解和 描述新冠肺炎与T2 DM之间的潜在关联。PASC相关的T2 DM的研究进展 居住在美国的成年人分析了种族/民族多样性有限的人群的数据，做出了 结果很难推广到黑人和西班牙裔社区，这些社区经历了不成比例的高 美国的SARS-CoV-2感染率、与新冠肺炎相关的发病率和死亡率以及T2 DM。晋级 我们对少数民族社区感染SARS-CoV-2后T2 DM风险的了解，我们将 使用临床研究网络(CRN)One佛罗里达+数据信托进行回溯性队列研究 在以患者为中心的国家临床研究网络(PCORnet)内，该网络包含患者级别 1920万寻求各种主要医疗服务的美国人的电子健康记录(EHR)数据 佛罗里达州的大都会地区(该州的COVID病例数量在美国排名第三)以及 佐治亚州亚特兰大和亚拉巴马州伯明翰SARS-CoV-2感染与2型糖尿病发病的关系尚未见报道 使用严格的方法和相关变量按种族和/或民族进行经验性量化(社会 不同人群的脆弱性和个人易感因素)，尽管 新冠肺炎和T2 DM在少数民族社区的流行。我们将使用一种严格的分析方法，利用高 在One佛罗里达+数据中提供个人易感性和社会脆弱性因素的高质量数据 TRUST，一个包括很大比例的少数族裔群体(24%西班牙裔，18%黑人)的数据集，以解决这个问题 知识上的严重差距。除了标准EHR数据，如诊断/程序代码、实验室 价值、药物、患者人口统计和生命体征，One佛罗里达+数据信托包括以下链接 暴露有关自然、建筑和社会环境的数据。One佛罗里达+数据的其他优势 对该项目的信任包括用于糖尿病的有效可计算表型(CP)的可用性，以减少 结果错误分类的机会；医疗保健遭遇类型的差异；年轻人比例较大 成人和女性比先前对PASC相关的T2 DM的研究；不同的支付者来源；以及 跨One佛罗里达+数据信托贡献站点链接患者记录。我们的具体目标是：(1)评估 使用One佛罗里达+的回溯性队列研究中PASC相关T2 DM发病率的种族/民族差异 数据信任和(2)比较SARS-CoV-2感染后心脏代谢危险因素的变化 使用One佛罗里达+数据信托基金的回溯性队列中的种族/民族。这项研究将填补批判性知识 少数民族人群中新冠肺炎与新发T2 DM潜在关联性的研究 社区。这一发现将直接为快速增长的糖尿病筛查建议提供信息 经历PASC的患者群体。

PROJECT SUMMARY Recent reports of type 2 diabetes (T2DM) as a post-acute sequela of SARS-CoV-2 infection (PASC, clinical findings lasting beyond 30 days of infection) highlight the urgent public health need to better understand and characterize the potential association between COVID-19 and T2DM. Prior studies of PASC-associated T2DM among adults living in the US have analyzed data from populations with limited racial/ethnic diversity, making the results difficult to generalize to Black and Hispanic communities that experience disproportionately higher rates of SARS-CoV-2 infection, COVID-19-related morbidity and mortality, and T2DM in the US. To advance our understanding of T2DM risk after SARS-CoV-2 infection in racial and ethnic minority communities, we will conduct a retrospective cohort study using the OneFlorida+ Data Trust, a Clinical Research Network (CRN) within the National Patient-Centered Clinical Research Network (PCORnet) that contains patient-level electronic health record (EHR) data for a diverse population of 19.2 million Americans seeking care in all major metropolitan regions in Florida (the state with the 3rd highest number of COVID cases in the US) as well as Atlanta, GA and Birmingham, AL. The association between SARS-CoV-2 infection and incident T2DM has yet to be empirically quantified by race and/or ethnicity using rigorous methods and relevant variables (social vulnerability and individual susceptibility factors) for diverse populations, despite the markedly higher rates of COVID-19 and T2DM in minority communities. We will employ a rigorous analytic approach that utilizes high- quality data available for both individual susceptibility and social vulnerability factors in the OneFlorida+ Data Trust, a dataset that includes large proportions of minority groups (24% Hispanic, 18% Black), to address this critical gap in knowledge. In addition to standard EHR data such as diagnosis/procedure codes, laboratory values, medications, patient demographics, and vital signs, the OneFlorida+ Data Trust includes linkages to exposome data on the natural, built, and social environments. Additional strengths of the OneFlorida+ Data Trust for this project include availability of validated computable phenotypes (CPs) for diabetes to reduce the chance of outcome misclassification; differentiation of healthcare encounter types; larger proportions of young adults and women than prior studies of PASC-associated T2DM; diverse payer sources; and the capacity to link patient records across OneFlorida+ Data Trust contributing sites. Our specific aims are (1) to assess racial/ethnic differences in PASC-associated T2DM incidence in a retrospective cohort using the OneFlorida+ Data Trust and (2) to compare changes in cardiometabolic risk factors following SARS-CoV-2 infection by race/ethnicity in a retrospective cohort using the OneFlorida+ Data Trust. This study will fill critical knowledge gaps in the potential association between COVID-19 and new-onset T2DM in racial and ethnic minority communities. The findings will directly inform diabetes screening recommendations in the rapidly growing population of patients experiencing PASC.