Home Telemedicine to Optimize Health Outcomes in High-Risk Youth with Type 1 Diabetes

联系PD/PI：Driscoll，Kimberly A 项目摘要/摘要 T1D并发症的严重性迫切需要改善血糖控制，因为22%和 患有T1D的儿童和青少年中，分别有17%的A1C和GT；9.5%的A1C和GT；低于最佳水平。此外，T1D 最近的数据显示，13-17岁青少年的平均糖化血红蛋白水平为9%，并不比糖化血红蛋白低多少 在30多年前的DCCT开始时，同一年龄组的平均发病率为9.5%。事实上，年轻人 2-17岁儿童的平均A1C为8.6%。此外，儿童DKA的比率高得令人震惊 美国有7%的18岁青年因DKA住院。NIDDK认识到糖尿病 酮症酸中毒(DKA)是青年的一种严重的急性并发症，必须加以解决并采取相应的策略来减少。 发展起来，包括显著减少花在高血糖上的时间。 对关键的T1D管理行为(例如，血糖监测、胰岛素)的遵守不够理想 单独使用或与心理社会应激源联合使用)，可能会导致血糖控制不佳。 事实上，患有T1D和精神健康合并症的人处于次优血糖的可能性是普通人的2倍 然而，30%的T1D护理团队无法获得现场精神卫生服务。此外，精神上的 健康合并症与不断恶化的长期并发症有关。一种可能的途径是 改善血糖控制是增加通过家庭远程保健获得的机会这项研究是新颖的，因为它将使用家庭 远程健康干预，通过整合医疗服务来解决T1D管理和血糖控制不佳的问题 和行为健康(即心理)干预，以减少负面和昂贵的身体健康 患有T1D的高危青年的结局。 这项研究的主要目标是解决向高危人群提供干预的迫切需要。 (A1C=9-12%)青年T1D。如果实现，T1D护理做法将通过为高危青少年提供 T1D和他们的父母通过家庭远程健康干预提供医疗和行为健康支持，这具有 有可能显著改变获得T1D护理的机会，减少花在高血糖上的时间，减少 减少住院次数，改善血糖控制。此外，使用多阶段优化 战略(MOST)，一种用于确定有效干预成分的高效实验战略， 应该推广到所有患有T1D的人，从而实现经济高效的家庭远程健康干预 程序。创新方面包括：1)评估身体和行为健康特征 与高危状态有关；2)提供家庭远程保健，包括：2)医疗和行为 由内分泌学家和行为健康专家共同提供的医疗保健服务 青年；2b)个性化干预，以改善T1D依从性和T1D临床健康结果；2c) 个性化干预以改善精神健康合并症和T1D临床健康结局；以及3)和 未充分利用的方法学方法，用于优化在护理点提供的干预组件。 项目摘要/摘要第6页

Contact PD/PI: Driscoll, Kimberly A Project Summary/Abstract The severity of T1D complications warrants an urgent need to improve glycemic control since 22% and 17% of children and adolescents with T1D, respectively, have suboptimal A1C >9.5%. Moreover, the T1D Exchange recently showed that an average A1C of 9% in 13-17 year olds is not much lower than the A1C average of 9.5% seen in the same age group at the beginning of the DCCT over 30 years ago. In fact, youth ages 2-17 years have an average A1C of 8.6%. In addition, there is an alarmingly high rate of pediatric DKA in the United States, with 7% of youth <18 years of age hospitalized for DKA. NIDDK recognizes that diabetic ketoacidosis (DKA), a serious acute complication, in youth must be addressed and strategies to reduce it developed, including significantly reducing time spent in hyperglycemia. Suboptimal adherence to critical T1D management behaviors (e.g., blood glucose monitoring, insulin dosing), either alone or in combination with psychosocial stressors, may lead to suboptimal glycemic control. Indeed, individuals with T1D and mental health comorbidities are 2x as likely to be in suboptimal glycemic control, yet 30% of T1D care teams do not have access to onsite mental health services. Moreover, mental health comorbidities are associated with worsening long-term complications. One possible pathway to improving glycemic control is to increase access via home telehealth This study is novel as it will use home telehealth intervention to address suboptimal T1D management and glycemic control by integrating medical and behavioral health (i.e., psychological) interventions to reduce negative and costly physical health outcomes in high-risk youth with T1D. The primary objective of this study is to address the critical need of providing intervention to high-risk (A1C=9-12%) youth with T1D. If achieved, T1D care practices will change by providing high-risk youth with T1D and their parents medical and behavioral health support via home telehealth intervention, which has the potential to significantly change access to T1D care, decrease time spent in hyperglycemia, reduce the frequency of hospital admissions, and improve glycemic control. In addition, use of Multiphase Optimization Strategy (MOST), a highly efficient experimental strategy to determine effective intervention components, should be generalizable to all individuals with T1D, leading to cost-effective, home telehealth intervention programs. Innovative aspects include: 1) assessment of physical and behavioral health characteristics associated with high-risk status; 2) delivery of home telehealth that incorporates: 2a) medical and behavioral health care delivered with the endocrinologist and behavioral health specialist working together with high-risk youth; 2b) personalized intervention to improve T1D adherence and T1D clinical health outcomes; 2c) personalized intervention to improve mental health comorbidities and T1D clinical health outcomes; and 3) an underused methodological approach for optimizing intervention components to be delivered at point of care. Project Summary/Abstract Page 6