Glucose Optimization Through Technology Assisted Management (GO TEAM!):Use of a diabetes dashboard and community health worker to decrease disparities in technology use in pediatric T1D

项目总结/摘要 血糖控制和糖尿病技术使用的差异现在被广泛认识到在所有社会经济 非西班牙裔黑人（NHB）1型糖尿病（T1 D）患者的水平。最近的数据显示，NHB儿童 不太可能开始和继续使用动态葡萄糖监测仪（CGM）， 可能使用胰岛素泵。自动胰岛素输注（AID）系统，需要CGM和胰岛素 胰岛素泵，在基线HbA 1c超过8%的患者中显示出最大的HbA 1c改善， 在NHB患者中使用AID将进一步加剧现有的卫生保健差距。因此，新的干预措施 减少T1 D NHB患者在技术使用方面的差异对于改善血糖控制至关重要， 减少NHB患者的微血管并发症和预防早期死亡。 我们的目标是通过两部分干预来减少差异：带有交互式智能手机的糖尿病分诊仪表板 应用和社区卫生工作者（CHW）在糖尿病技术教练的作用。多元化咨询 一组利益相关者将定义仪表板的分类区指标和消息的频率/内容 我们的共同目标是：1）确定符合以下条件的患者： 难以启动或继续使用其器械或不符合血糖目标，以及2）使用来自相同器械的CHW 种族背景和社区作为糖尿病和技术教练，建立与家庭的信任， 确定并克服成功使用技术的障碍。 具体目标是：1）召集一个由利益攸关方组成的多元化咨询小组， 糖尿病仪表板和智能手机应用程序; 2）开发糖尿病仪表板和交互式应用程序 使用来自CGM、胰岛素泵和AID系统的云的远程数据捕获; 3）评估有效性 和实施捆绑干预与1：1随机对照研究的NHB儿童和 新发和胰岛素泵初治的T1 D年轻成人; 4）目的4：了解 1：1访谈背景下的糖尿病管理，考虑有关干预的两种看法 本身（与通常的护理）和组织/世俗特征影响的经验。

Project Summary/Abstract Disparities in glycemic control and diabetes technology use are now widely recognized at all socioeconomic levels in Non-Hispanic Black (NHB) patients with type 1 diabetes (T1D). Recent data shows that NHB children are less likely to start and less likely to continue use of a continuous glucose monitor (CGM), and are also less likely to use an insulin pump. Automated insulin delivery (AID) systems, which require both CGM and insulin pump, show greatest HbA1c improvement in those with baseline HbA1c over 8%, leading to concern that low use of AID in NHB patients will further exacerbate existing health-care disparities. Therefore, novel interventions to reduce disparities in technology use among NHB patients with T1D are critical to improving glycemic control, reducing microvascular complications and preventing early mortality in NHB patients. We aim to reduce disparities with a 2-part intervention: a diabetes triage dashboard with interactive smartphone application and a community health worker (CHW) in the role of diabetes technology coach. A diverse advisory group of stakeholders will define metrics of triage zones for the dashboard and frequency/content of messages from the application and will refine the specific role of the CHW, Our shared goals are to 1) identify patients who struggle to initiate or continue their device or do not meet glycemic goals and 2) utilize a CHW from the same racial background and community to act as a diabetes and technology coach, building trust with families so as to identify and overcome barriers to successful technology use. The specific aims are to: 1) Convene a diverse advisory group of stakeholders to develop a protocol for a diabetes dashboard and smartphone application; 2) Develop a diabetes dashboard and interactive application using remote data capture from the cloud from CGM, insulin pumps, and AID systems; 3) Assess effectiveness and implementation of the bundled intervention with a 1:1 randomized controlled study of NHB children and young adults with new onset and insulin pump naïve existing T1D; 4) Aim 4: Understand lived experience of diabetes management in context with 1:1 interviews, considering both perceptions regarding the intervention itself (vs. usual care) and organizational/secular characteristics influencing that experience.