An interactive mHealth app for better glycemic control in families of young kids with T1D

 描述(申请人提供)：要达到良好的血糖控制，患有1型糖尿病(T1D)的幼儿家庭必须坚持精心设计和严格的治疗方案。不幸的是，我们的研究项目公布的数据显示，许多幼儿的血糖水平超过了儿科目标，并显示出很高的血糖变异率。由于他们的年龄、体型和发育状况，患有T1D的幼儿面临着许多独特的坚持挑战(例如，胰岛素敏感性增加，不可预测的体力活动和食物摄入量，对立行为)。我们还发现了良好血糖控制的其他障碍，包括用餐行为问题、儿童挑衅、父母压力和对低血糖的恐惧。为了解决这些障碍并改善儿童的血糖控制，我们创建并测试了一种基于父母的行为营养干预-最佳膳食。初步结果表明，幼儿每天的血糖水平平均降低26毫克/分升，而不会增加低血糖。在这一成功的基础上，并回应父母要求以灵活的形式提供更多帮助以适应他们忙碌的生活的请求，在这项新的研究中，我们建议通过三个新的设计特征大幅推进我们最好的膳食干预：1)新的治疗内容解决了T1D自理的更多领域(即，胰岛素使用，父母低血糖恐惧)，2)新的以儿童为中心和发展目标的治疗内容，允许采取以家庭为中心的方法和学习活动，与每个幼儿的发育阶段和准备参与学习T1D(即，帮助T1D自理)相匹配，以及3)mHealth提供格式，使用基于视频的微讲座，可通过互联网访问，以提高可扩展性和个性化的每周进度报告，通过电子邮件发送给家庭，以加强他们对孩子的T1D自我护理和血糖水平的积极变化。因此，我们目前的目标包括：1)开发Dipper Academy(学龄前儿童父母的糖尿病信息)，这是一种以家庭为中心的mHealth行为干预措施，以促进幼儿的血糖控制和依从性；2)通过以家庭为中心的迭代设计方案评估Dipper Academy的相关性、参与度、可行性和可接受性；以及3)使用随机的等待名单对照设计来探索Dipper Academy的初步疗效。该项目意义重大，因为它直接解决了针对患有T1D幼儿的家庭可获得的针对发育的行为干预措施有限的问题，并建议使用mHealth提供Dipper Academy，从而使家庭更容易获得治疗并更容易传播到其他糖尿病中心。除了家长治疗内容之外，它的计划还包括以儿童为重点和以发展为目标的治疗内容，基于儿童年龄的两个治疗轨道(3岁儿童和3-5岁儿童的Li‘l Dipper和3-5岁的Big Dipper)，以及使用mHealth提供形式的计划，这是一项创新。我们预计，在这项研究中开发和试点测试的北斗七星学院将通过改善患有T1D的幼儿的健康状况而具有公共卫生意义。

 DESCRIPTION (provided by applicant): To achieve good glycemic control families of young children with type 1 diabetes mellitus (T1D) must adhere to a well-designed and rigorous treatment regimen. Unfortunately, our research program has published data showing that many young children have glucose levels that exceed pediatric targets and show a high rate of glucose variability. By virtue of their age, size, and developmental status, young children with T1D face many unique challenges to adherence (i.e., increased insulin sensitivity, unpredictable physical activity and food intake, oppositional behavior). We've also identified other barriers to good glycemic control, including mealtime behavior problems, child defiance, and parental stress and fear of hypoglycemia. In order to address these barriers and improve children's glycemic control, we created and tested a parent-based behavioral-nutrition intervention, BEST MEALS. Initial results suggest a mean decrease of 26 mg/dl in young children's daily glycemic levels without increasing hypoglycemia. Building on this success and in response to parents' requests for more assistance delivered in a flexible format that matches their busy lives, in this new study we propose to substantially advance our BEST MEALS intervention through three new design features: 1) new treatment content addressing additional domains of T1D self-care (i.e., insulin use, parental hypoglycemia fear), 2) new child-focused and developmentally targeted treatment content allowing for a family-focused approach and learning activities appropriately matched to each young child's stage of development and readiness to engage in learning about T1D (i.e., helping out with T1D self-care), and 3) a mHealth delivery format using video-based microlectures accessible via the internet to increase scalability and personalized weekly progress reports emailed to families to reinforce the positive changes they make to their child's T1D self-care and glycemia. Thus, our current aims include: 1) to develop DIPPer Academy (Diabetes Information for Parents of Preschoolers), a family-focused mHealth behavioral intervention to promote glycemic control and adherence in young children, 2) to assess relevance, engagement, feasibility, and acceptability of DIPPer Academy through a family-centered iterative design scheme, and 3) to explore the initial efficacy of DIPPer Academy using a randomized, wait-list control design. The project is significant because it directly addresses the limited availability of developmentally-targeted behavioral interventions for families of young children with T1D and proposes to use mHealth to deliver DIPPer Academy thereby making it easier for families to access the treatment and easier to disseminate to other diabetes centers. It is innovative in its plan to include child- focused and developmentally-targeted treatment content in addition to parent treatment content, two treatment tracks based on child age (Li'l DIPPer for children <3 years old and Big DIPPer for 3-5 year olds), and in its plan to use a mHealth delivery format. We expect DIPPer Academy, developed and pilot-tested in this study, will have public health significance by improving health outcomes for young children with T1D.