Reducing Disparities in Pediatric Diabetes: Building the Evidence Base to Inform Effective Diabetes Technology Interventions in Underrepresented Minorities

项目摘要/摘要 随着糖尿病技术在儿科类型的管理中变得更加创新和有效 1糖尿病(T1D)，研究和使用只在社会经济水平较高的人群中优先增加 状态(SES)。研究一致地表明，在青少年中，糖尿病技术的使用率降低了50% 较低的SES。尽管糖尿病技术有可能减少儿科T1D结局的差异， 不公平的入学机会导致低社会经济地位青年的T1D结果恶化。这项提案旨在建立 数据驱动干预的证据基础，旨在通过以下方式减少糖尿病创新方面的差异 解决糖尿病技术使用的障碍和支持推动者。 阿南塔·阿达拉，D.O.，M.P.H.是一名内科科学家，致力于独立研究人员的职业生涯 解决T1D管理和结果方面的差异。阿达拉博士的长期研究和临床 利益是促进对患有T1D的青少年的公平照顾。作为一个有儿科背景的内科医生 在内分泌学、流行病学和行为健康方面，阿达拉博士是唯一有资格解决 患有T1D的不同青年中的不平等。阿达拉博士招募了一个由多学科组成的指导团队 儿科T1D、健康差异、统计学和混合方法研究设计领域的专家 成功地执行这一建议，并开始在儿科T1D差异方面的独立研究事业。 这项建议的总体目标是找出青少年糖尿病技术使用差异的驱动因素 使用T1D和公共保险，并制定简短的干预措施，以此作为了解和解决 儿童T1D差异。这将通过两个目标来实现。在《目标1》中，聚焦于家庭，Dr。 阿达拉将建立一个阻碍和促进青少年使用糖尿病技术的证据基础， 公共保险，以便制定和测试旨在增加吸纳量的简短试点干预措施。在目标2中， 这一次，专注于提供者，阿达拉博士将构建关于障碍和推动者的证据基础，以 向有公共保险的年轻人推荐糖尿病技术，以制定和测试简短的试点 增加糖尿病技术提供者推荐的干预措施。 总而言之，目标1和目标2的调查结果将导致制定旨在 增加低社会经济和种族/少数民族青年对糖尿病技术的接受和获得 从而改善T1D结局。阿达拉博士将利用K23导师奖来执行一项深入的 培训计划，包括正式的课程和导师的有组织的指导，以促进她的进步 了解混合方法研究、干预开发和差异方面的专业知识。这项建议 是未来独立临床试验的基础，以评估开发的干预措施的有效性 T1D和公共保险的青少年糖尿病技术使用的推动者和障碍。

PROJECT SUMMARY/ABSTRACT As diabetes technologies have become more innovative and effective in the management of pediatric type 1 diabetes (T1D), research and usage has preferentially increased only in those of higher socioeconomic status (SES). Studies have consistently demonstrated 50% lower rates of diabetes technology use in youth of lower SES. Although diabetes technology has the potential to reduce disparities in pediatric T1D outcomes, inequitable access has resulted in worsening of T1D outcomes for low SES youth. This proposal aims to build an evidence base for data-driven interventions designed to reduce disparities in diabetes innovations by addressing barriers and supporting promoters of diabetes technology use. Ananta Addala, D.O., M.P.H, is a physician scientist committed to a career as an independent investigator addressing disparities in T1D management and outcomes. Dr. Addala’s longstanding research and clinical interests are to promote equitable care for youth with T1D. As a physician with a background in pediatric endocrinology, epidemiology, and behavioral health, Dr. Addala is uniquely qualified to address the drivers of inequities in diverse youth with T1D. Dr. Addala has enlisted a multi-disciplinary mentorship team comprised of experts in the fields of pediatric T1D, health disparities, statistics, and mixed method study design to successfully execute this proposal and launch an independent research career in pediatric T1D disparities. The overall objective of this proposal is to discover drivers of disparities in diabetes technology use in youth with T1D and public insurance and develop a brief intervention, as a means to understand and address pediatric T1D disparities. This will be accomplished through two aims. In aim 1, focusing on the family, Dr. Addala will construct an evidence base of barriers and promoters to diabetes technology use in youth with public insurance in order to formulate and test a brief pilot intervention aimed at increasing uptake. In aim 2, this time focusing on the providers, Dr. Addala will construct the evidence base on barriers and promoters to recommending diabetes technology to youth with public insurance in order to formulate and test a brief pilot intervention to increase provider recommendation of diabetes technology. Taken together, findings from Aims 1 and 2 will result in the development of an intervention aimed at increasing diabetes technology uptake and access in youth from low socioeconomic and racial/ethnic minority groups, thereby improving T1D outcomes. Dr. Addala will use the K23 mentored award to execute an in-depth training plan which includes formal coursework and structured mentorship by her mentors to advance her understanding of mixed methods research, intervention development, and expertise on disparities. This proposal is foundational to a future independent clinical trial to evaluate the efficacy of the interventions developed on promoters and barriers of diabetes technology use in youth with T1D and public insurance.