Dulce Digital-COVID Aware (DD-CA) discharge texting platform for US/Mexico border Hispanics with diabetes + COVID-19

项目摘要 西班牙裔，这是一个表现出较高的2型糖尿病(T2D)患病率和较差的自我管理和 临床结果，新冠肺炎已经不成比例地产生了不利影响。加利福尼亚州农业部 公共卫生报告说，拉美裔美国人占加州人口的39%，但史无前例地占到57% 确诊的新冠肺炎病例。这一毁灭性的发现在美国和墨西哥边境尤为明显。糖尿病 已成为严重新冠肺炎疾病导致住院的主要危险因素，与 更严重的疾病和更高的死亡率，是重症监护安置和 有创性通风。越来越清楚的是，保持良好的血糖控制可以改善预后 在既往存在T2D的人中，新冠肺炎的风险更高。然而，社交距离、隔离和停留- 家庭/禁闭指南可能会影响一个人维持足够的血糖控制的能力。研究是 需要评估灵活、易于采用的低成本数字干预的效果和临床结果 这改善了血糖漂移，并提供了急需的新冠肺炎缓解策略，其中包括 在美国/墨西哥边境社区，T2D控制不善的高危拉美裔群体迅速增加。 我们的母公司Grant Dulce Digital-Me提供了强有力的证据，支持使用技术(如文本 消息传递)单独或与教练干预相结合，作为一种可行和理想的交付方法 为高危人群量身定做的糖尿病自我管理教育和COVID意识宣传 以一种对患者和工作人员都更方便的方式，同时具有以下附加好处 对卫生系统具有成本效益，特别是在资源匮乏的情况下。然而，有效的 干预措施可能会遇到障碍，妨碍在实际实施时保证成功 世界。该项目发生在圣地亚哥/提华纳边境，历史上是最繁忙的陆路入境口岸 在西半球，将评估提供增强的数字短信干预的效果-Dulce 数字冠状病毒感知(DD-CA)到N=172名西班牙裔T2D患者从最近的 住院治疗。关键结果将评估DD-CA对30天和90天再次住院的影响 出院后，血糖控制和患者在出院后90天报告的结果，同时还评估 COVID的状态和实施过程。鉴于DD-CA提供了解决许多 在额外提供COVID的同时，获取和扩大糖尿病服务覆盖范围的实际障碍 意识支持，它提供了一个理想的低成本和灵活的解决方案，以减少住院人数和重新 美国/墨西哥边境社区的入学人数同时受到新冠肺炎和T2D的显著影响。 在典型的医院和出院后环境中实施，它增强了现有的护理团队流程，从而 提供了对现实世界有效性的有价值的测试。更重要的是，通过帮助减少现有的不平等 在获得糖尿病和新冠肺炎护理方面，该方案旨在更大范围内改善健康结果。

Project Summary Hispanics, a group that shows higher type 2 diabetes (T2D) prevalence, and poor self-management and clinical outcomes, have been disproportionally adversely impacted by COVID-19. The California Department of Public Health reports that Hispanics make up 39% of California’s population but an unprecedented 57% of the confirmed COVID-19 cases. This devastating finding is especially notable on the US/Mexico border. Diabetes has emerged as a leading risk factor for severe COVID-19 illness leading to hospitalization, is associated with greater disease severity and mortality and is an independent predictor of intensive care placement and invasive ventilation. It is becoming increasingly clear that maintaining good glucose control improves prognosis of COVID-19 among people with pre-existing T2D. However, social distancing, quarantine, and stay-at- home/lockdown guidelines may impact one’s ability to maintain adequate glycemic control. Research is needed to evaluate the effect and clinical outcomes of a flexible, easily adopted low cost digital intervention that improves glucose excursions and provides urgently needed COVID-19 mitigation strategies, among rapidly rising groups of high-risk Hispanics with poorly controlled T2D in US/Mexico border communities. Strong evidence from our parent grant Dulce Digital-Me, supports the use of technology (such as text messaging) alone or in combination with coaching interventions as a viable and desired method of delivering tailored diabetes self-management education and COVID awareness messaging to high-risk, underserved populations in a manner that is more convenient for both patients and staff while having the added benefit of being cost-effective for health systems, especially within low resource settings. However, effective interventions may encounter barriers which preclude guaranteed success upon implementation in the real world. This project, taking place along the San Diego/Tijuana border, historically the busiest land port of entry in the Western Hemisphere, will assess the effect of providing an enhanced digital texting intervention-Dulce Digital-COVID Aware (DD-CA) to N = 172 Hispanic patients with T2D upon discharge from a recent hospitalization. Key outcomes will assess the impact of DD-CA on hospital readmissions at 30 and 90 days post-discharge, glucose control and patient reported outcomes at 90 days post-discharge while also assessing COVID status and the implementation process. Given that DD-CA offers the potential to address many of the practical barriers to access and extend the reach of diabetes services, while additionally providing COVID awareness support, it offers an ideal low-cost and flexible solution to reduce hospital admissions and re- admissions in US/Mexico border communities significantly and simultaneously affected by COVID-19 and T2D. Implemented in a typical hospital and post-discharge setting, it augments existing care team processes, thus providing a valuable test of real-world effectiveness. More importantly, by helping to reduce existing inequities in access to diabetes and COVID-19 care, this program aims to improve health outcomes on a larger scale.