Precision Monitoring: Understanding Momentary Affect, Glucose, and Self-care Behaviors in Adolescents and Young Adults with type 1 diabetes

精确监测：了解患有 1 型糖尿病的青少年和年轻人的瞬时情绪、血糖和自我保健行为

• 批准号: 10746032
• 负责人: Amit Shapira
• 金额: $ 19.19万
• 依托单位: JOSLIN DIABETES CENTER
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2028-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10746032
• 关键词: Adolescent; Adolescent and Young Adult; Affect; Area; Behavior; Behavior Therapy; Behavioral; Behavioral Sciences; Blood Glucose; Caring; Clinical; Complement; Continuous Glucose Monitor; Control Groups; Coupled; Data; Data Collection; Development Plans; Diabetes Mellitus; Distress; Doctor of Philosophy; Ecological momentary assessment; Emotional; Encapsulated; Evaluation; Feedback; Fingers; Future; Glucose; Glycosylated hemoglobin A; Goals; Insulin-Dependent Diabetes Mellitus; Intervention; Interview; Investigation; Longevity; Mentors; Methods; Modality; Modernization; Monitor; Outcome; Participant; Pattern; Persons; Program Development; Protocols documentation; Qualitative Research; Randomized; Randomized, Controlled Trials; Regulation; Research; Research Personnel; Risk; Sampling; Self Care; Series; Social Environment; Standardization; Statistical Methods; Structure; Surveys; Technology; Testing; Time; Vacuum; Visual; acceptability and feasibility; aged; blood glucose regulation; career; career development; catalyst; contextual factors; dashboard; diabetes distress; diabetes self-management; emotional distress; experience; group intervention; human centered design; improved; improved outcome; innovation; intervention program; meetings; multi-component intervention; multidisciplinary; novel; peer; pilot test; post intervention; precision medicine; programs; psychosocial; research study; satisfaction; skills; social; tool; trend; usability; vulnerable adolescent; willingness

PROJECT SUMMARY/ABSTRACT Adolescents and Young Adults (AYA) with type 1 diabetes (T1D) have the highest hemoglobin A1c values of all across the lifespan. Continuous Glucose Monitoring (CGM) is a modern approach to glucose assessment that provides in-the-moment information about glucose levels to help optimize time-in-range ([TIR] 70-180 mg/dL). Retrospective review of ambulatory glucose patterns is an essential component for improving diabetes self-care. However, many CGM users become overwhelmed by the voluminous CGM data and rarely review or download their CGM. Furthermore, interpretation of CGM data should not occur in a vacuum, rather one should consider contextual factors that impact self-care in order to improve glycemic regulation. Thus, to maximize the clinical value of CGM in AYA with T1D, a novel, ecologically grounded approach is needed to contextualize CGM data with information on the intra- and inter-personal context in which glucose regulation occurs. It is timely to pair ecological momentary assessment (EMA) with CGM to develop an intervention program to improve self-care, glycemia, and psychosocial outcomes. We will use rigorous methods to capture dynamic relationships between in-the-moment ratings of emotional and social experiences (using EMA) and CGM-recorded glucose values, which will be collectively displayed on a dashboard, encapsulating the emotional and social context of ambulatory glucose (psychosocial ambulatory glucose [PAG]). Tracking and reviewing of PAG patterns, along with ongoing structured support, within a multicomponent intervention, will help AYA with T1D to better interpret and behaviorally respond to out-of-range glucose values, and may serve as a catalyst to improve A1c, TIR, and self-care, as well as reduce diabetes distress. Amit Shapira, PhD, proposes a series of studies with an overarching goal of developing, iteratively refining, and testing a PAG intervention in AYA with T1D. The proposed 3 specific aims are: 1) to identify salient components of a PAG dashboard using EMA that will coordinate the display of emotional and social context coupled with CGM recorded data to enhance self-care of AYA with T1D above target A1c values using mixed methods; 2) to adapt and build upon the dashboard for use in a behavioral intervention through expert feedback and guidance from pertinent stakeholders; and 3) to examine if a pilot RCT of a refined PAG behavioral intervention will be acceptable, feasible, and satisfactory to participants and have potential to improve diabetes and psychosocial outcomes compared with PAG-alone. Results from these studies will inform a fully powered RCT for a future R01 application. Dr. Shapira’s career objective is to become an independent diabetes behavioral researcher focused on optimizing self-care, including use of CGM and other technologies, to improve outcomes for people with T1D. The 5-year, mentored career development program will provide her with necessary skills in diabetes care (e.g., diabetes technologies), advanced statistical methods, and usability and qualitative research to launch her independence in diabetes behavioral investigation.

项目概要/摘要 患有 1 型糖尿病 (T1D) 的青少年和年轻人 (AYA) 的糖化血红蛋白值最高为 整个生命周期。连续血糖监测 (CGM) 是一种现代的血糖评估方法 提供有关血糖水平的即时信息，以帮助优化范围内的时间 ([TIR] 70-180 毫克/分升）。动态血糖模式的回顾性审查是改善糖尿病的重要组成部分 自理。然而，许多 CGM 用户对大量的 CGM 数据感到不知所措，很少查看或查看 下载他们的 CGM。此外，CGM 数据的解释不应在真空中进行，而应在 应考虑影响自我护理的背景因素，以改善血糖调节。因此，为了 为了最大限度地提高 CGM 在 T1D AYA 中的临床价值，需要一种新颖的、基于生态的方法 将 CGM 数据与个人内部和人际背景信息结合起来，其中血糖调节 发生。及时将生态瞬时评估 (EMA) 与 CGM 结合起来制定干预措施 改善自我护理、血糖和心理社会结果的计划。我们将用严谨的方法去捕捉 情绪和社交体验的即时评级之间的动态关系（使用 EMA）和 CGM 记录的血糖值将集中显示在仪表板上，封装了 动态血糖的情绪和社会背景（心理社会动态血糖[PAG]）。追踪 审查 PAG 模式以及持续的结构化支持，在多组成部分的干预措施中， 将帮助患有 T1D 的 AYA 更好地解释超出范围的血糖值并对其做出行为反应，并且可能 作为改善 A1c、TIR 和自我护理以及减少糖尿病困扰的催化剂。阿米特·夏皮拉博士， 提出了一系列研究，其总体目标是开发、迭代完善和测试 PAG 对患有 T1D 的 AYA 进行干预。提议的 3 个具体目标是：1) 确定 PAG 的显着组成部分 使用 EMA 的仪表板将与 CGM 相结合来协调情感和社交背景的显示 使用混合方法记录数据，以增强 T1D 高于目标 A1c 值的 AYA 的自我护理； 2）到 通过专家反馈和指导，对仪表板进行调整和构建，以便用于行为干预 来自相关利益相关者； 3) 检查改进的 PAG 行为干预的试点随机对照试验是否会 参与者可以接受、可行和满意，并且有可能改善糖尿病和社会心理 与单独使用 PAG 相比的结果。这些研究的结果将为未来的全面随机对照试验提供信息 R01应用。 Shapira 博士的职业目标是成为一名独立的糖尿病行为研究员 专注于优化自我护理，包括使用 CGM 和其他技术，以改善人们的治疗结果 患有 T1D。这个为期 5 年的指导职业发展计划将为她提供必要的糖尿病技能 护理（例如糖尿病技术）、先进的统计方法以及可用性和定性研究 启动她在糖尿病行为调查中的独立性。