Tech-Ex: A Peer Mentorship Program to Increase Equitable use of Continuous Glucose Monitoring Systems

青少年1型糖尿病(T1D)必须遵循复杂的治疗方案，以接近正常的血糖水平，并避免急性和长期的健康并发症。连续血糖监测(CGM)系统可以改善血糖控制。然而，患有T1D的黑人和西班牙裔青年的血糖控制比白人青年更差，也不太可能使用CGM。CGM的使用差异可能是糖尿病健康结局差异的原因之一。因此，减少CGM的使用差异可能是减少T1D青年健康差异的有希望的方法。当前提案的目标是完善和试点股权技术专家(Tech-Ex)，这是一种技术增强的干预措施，旨在增加患有T1D的黑人和西班牙裔青年对CGM的使用。在Tech-Ex，家庭将与其他有使用CGM(技术专家)经验的家庭合作，并通过Nemour App获得技术支持。在技术专家部分，青少年和他们的照顾者将与导师家庭合作，克服使用CGM的常见障碍。技术支持将包括获得文化定制的教育材料、数字期刊，以促进患者与提供者就CGM问题进行沟通，以及SDOH筛查和干预。在本提案的第一年，我们将与患者、护理者和医疗保健提供商利益相关者合作，完善技术指导计划和技术支持，制定提供干预措施的计划，完善测量战略，并招聘和培训导师家庭和护理经理。在纳入利益相关者的意见后，我们将在试点随机对照试验中测试Tech-Ex。家庭将在定期门诊期间或之后被招募，并随机(1：1)到Tech-Ex或为期6个月的等待名单对照。主要结果将是干预的可接受性和可行性、使用CGM的感知障碍和促进剂、CGM的使用以及血糖控制(即HbA1c，范围内时间)。目前的研究结果将为未来的研究提供信息，这些研究旨在通过更大规模的多点随机对照试验来测试干预的有效性。

Youth with type 1 diabetes (T1D) must follow a complex treatment regimen to approximate normal glycemic levels and avoid acute and long-term health complications. Continuous glucose monitoring (CGM) systems can improve glycemic control. However, Black and Hispanic youth with T1D have worse glycemic control than White youth and are less likely to use CGM. Disparities in the use of CGM may be one cause of disparities in diabetes health outcomes. Thus, reducing disparities in the use of CGM may be promising approach to reducing health disparities in youth with T1D. The objective of the current proposal is to refine and pilot-test Technology Experts for Equity (Tech-Ex), a technology-enhanced intervention to increase use of CGM among Black and Hispanic youth with T1D. In Tech-Ex, families will work with other families who have experience using CGM (Technology Experts) and also have access to technology supports through the Nemours App. In the Technology Expert components, youth and their caregivers will work with a mentor family to overcome common barriers to CGM use. The Technology Supports will include access to culturally-tailored educational materials, a digital journal to facilitate patient-provider communication around issues with CGM, and SDOH screening and intervention. During the first year of this proposal, we will work with patient, caregiver, and healthcare provider stakeholders to refine the technology coaching program and technology supports, develop plans to deliver the interventions, refine the measurement strategy, and recruit and train mentor families and a care manager. After incorporating stakeholder input, we will test Tech-Ex in a pilot randomized controlled trial. Families will be recruited during or after regularly scheduled clinic visits and randomized (1:1) to Tech-Ex or a 6-month waitlist control. Primary outcomes will be intervention acceptability and feasibility, perceived barriers and facilitators to using CGM, use of CGM, and glycemic control (i.e., HbA1c, time in range). Findings from the current study will inform future research aimed at testing the efficacy of the intervention in a larger, multisite randomized controlled trial.