Minimizing Hypoglycemia in Adults with Type 1 Diabetes through an Integrated Mobile Health and Continuous Glucose Monitoring System

项目摘要/摘要 2级低血糖(血糖54 mg/dL)是一种医疗紧急情况，可导致混乱，心脏 心律失常，甚至死亡。这种危险的情况经常发生在1型糖尿病患者身上。 (T1D)，包括使用连续血糖监测系统(CGMS)的那些。在先前对患者的研究中没有 使用CGMS，研究人员确定了干扰低血糖治疗的患者信念。然而， CGM使用者的治疗干预信念仍有待评估，并采取干预措施有效解决 CGM用户需要这些信念。这个项目的目标是全面评估人们对 干预成人T1D CGM使用者的降糖治疗，并开发一种新的行为干预方法 计划，以解决这些信念和最大限度地减少低血糖。混合方法技术可以指导 确定低血糖治疗的干扰信念，并确定那些预测水平2的信念 用于靶向干预开发的低血糖。移动健康(MHealth)技术可以链接到 CGM数据，开发可广泛访问的、以患者为中心的实时干预措施，以解决治疗问题 相互干扰的信仰。中心假设：mHealth-CGM行为干预计划可以减轻信念 干扰低血糖治疗并减少T1D CGM使用者的低血糖。目标：(1)收购 深入了解CGM使用者干扰低血糖治疗的信念；(2)开发 一个mHealth短信程序，可生成自动、实时的行为干预，以缓解 干扰低血糖治疗的信念；(3)评估其可行性、可接受性和初步 MHealth-CGM行为干预计划对降低飞行员行为低血糖的疗效 临床试验。候选人：余桂林，医学博士，内分泌学家和早期职业研究人员 成为独立调查员的目标，确定和制定干预措施以减少障碍 糖尿病患者低血糖的管理与预防。他有成功的设计和设计历史 进行低血糖调查研究和生物医学临床试验，但需要更多高级培训 行为科学研究。这个K-23奖项将为他提供识别障碍所需的独特技能 管理或预防低血糖，开发和评估以患者为中心的有针对性的干预措施 通过mHealth提供的方案旨在优化低血糖的管理和预防。培训 目标：(1)获得进行定性和混合方法研究的技能；(2)获得 开发mHealth行为干预措施；(3)开发进行行为临床试验的专业知识。Dr。 林的培训将得到经验丰富、互为补充的导师和顾问的支持，高级 讲授课程，参加研究和职业发展研讨会和会议 足智多谋，训练环境丰富。NIDDK K-23获奖将为林博士提供受保护的时间和 需要进行培训，以帮助所有糖尿病患者将低血糖降至最低，并改善健康状况。

Project Summary / Abstract Level 2 hypoglycemia (blood glucose <54 mg/dL) is a medical emergency that can lead to confusion, cardiac arrhythmias, and even death. This dangerous condition occurs frequently in patients with type 1 diabetes (T1D), including those using continuous glucose monitoring systems (CGMs). In prior studies of patients not using CGMs, researchers identified patient beliefs that interfere with hypoglycemia treatment. However, treatment interfering beliefs in CGM users remain to be evaluated, and an intervention to impactfully address these beliefs among CGM users is needed. The goal of this project is to comprehensively evaluate beliefs that interfere with hypoglycemia treatment in adult T1D CGM users, and to develop a novel behavioral intervention program to address these beliefs and minimize hypoglycemia. Mixed methods techniques can guide identification of hypoglycemia treatment interfering beliefs, and determine those predictive of level 2 hypoglycemia for targeted intervention development. Mobile health (mHealth) technology can be linked to CGM data to develop widely accessible, patient-centered, real-time interventions to address treatment interfering beliefs. Central hypothesis: An mHealth-CGM behavioral intervention program can mitigate beliefs that interfere with hypoglycemia treatment and reduce hypoglycemia in T1D CGM users. Aims: (1) Acquire an in-depth understanding of CGM users’ beliefs that interfere with hypoglycemia treatment; (2) Develop an mHealth text messaging program that generates automated, real-time behavioral interventions to mitigate beliefs that interfere with hypoglycemia treatment; (3) Assess the feasibility, acceptability and preliminary efficacy of the mHealth-CGM behavioral intervention program in reducing hypoglycemia in a pilot behavioral clinical trial. Candidate: Yu Kuei Lin, MD is an endocrinologist and early career investigator with the career goal of becoming an independent investigator, identifying and developing interventions to mitigate barriers to hypoglycemia management and prevention in diabetes patients. He has a successful history of designing and conducting hypoglycemia survey studies and biomedical clinical trials, but needs more training in advanced behavioral science research. This K-23 award will provide him with unique skills necessary to identify barriers to managing or preventing hypoglycemia, and to develop and evaluate patient-centered, targeted intervention programs delivered through mHealth aimed at optimizing hypoglycemia management and prevention. Training Objectives: (1) Acquire skills in conducting qualitative and mixed methods research; (2) Gain skills in developing mHealth behavioral interventions; (3) Develop expertise in conducting behavioral clinical trials. Dr. Lin’s training will be supported by highly experienced, complementary mentors and advisors, advanced didactic coursework, and participation in research and career development seminars and meetings within a resourceful, enriching training environment. An NIDDK K-23 award will provide Dr. Lin the protected time and training needed to help all patients with diabetes minimize hypoglycemia and improve health outcomes.