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

家庭远程医疗可优化 1 型糖尿病高危青少年的健康结果

基本信息

批准号：
9302223
负责人：
Kimberly Driscoll
金额：
$ 79.48万
依托单位：
UNIVERSITY OF COLORADO DENVER
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-04-01 至 2019-06-01
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9302223
关键词：
17 year old 18 year old Acute Address Adherence Admission activity Adolescent Age Amputation Appointment Appointments and Schedules Behavior Biological Markers Blindness Blood Glucose Caring Characteristics Child Childhood Clinic Clinic Visits Clinical Comorbidity Complication Complications of Diabetes Mellitus Diabetic Ketoacidosis Dose Effectiveness of Interventions Employment Endocrinologist Frequencies Goals Health Healthcare Heart Diseases Home environment Hospitals Hyperglycemia Individual Injection of therapeutic agent Insulin Insulin Infusion Systems Insulin-Dependent Diabetes Mellitus Intervention Kidney Failure Lead Life Longitudinal Studies Maintenance Medical Mental Health Mental Health Services Methodology Modality Myocardial Infarction National Institute of Diabetes and Digestive and Kidney Diseases Outcome Parents Pathway interactions Persons Physical assessment Pilot Projects Provider Public Health Research Schools Severities Specialist Stroke Telemedicine Time Travel United States Visit Work Youth age group behavioral health behavioral health intervention cost cost effective design diabetes management effective intervention effective therapy flexibility follow-up glucose monitor glycemic control high risk high-risk adolescents improved improved outcome innovation intervention program novel pediatric patients personalized care personalized intervention physical conditioning point of care psychologic psychosocial stressor telehealth young adult

项目摘要

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.

项目摘要/摘要 T1D并发症的严重程度值得迫切需要改善22％以来的血糖控制和 T1D的儿童和青少年中有17％的A1C> 9.5％。而且，T1D Exchange最近显示，13-17岁的年龄在13-17岁的平均A1C不比A1C低得多 30年前，在DCCT开始时，同一年龄段的平均年龄为9.5％。实际上，青年 2-17岁的年龄平均A1C为8.6％。此外，在美国，有7％的年轻人<18岁的DKA住院。 NIDDK认识到糖尿病酮症酸中毒（DKA）是一种严重的急性并发症，必须在青年中解决并减少它的策略开发的，包括大大减少高血糖所花费的时间。对关键T1D管理行为的次优（例如，血糖监测，胰岛素）单独或与社会心理压力源结合使用的剂量）可能会导致次优血糖控制。实际上，具有T1D和心理健康合并症的人的可能性为2倍控制，但是30％的T1D护理团队无法获得现场心理健康服务。而且，精神健康合并症与长期并发症的恶化有关。一条可能的途径改善血糖控制是通过家庭远程医疗来增加访问权限这项研究是新颖的，因为它将使用家庭远程医疗干预措施通过整合医学来解决次优的T1D管理和血糖控制和行为健康（即心理）干预措施，以减少负面和昂贵的身体健康 T1D高风险青年的结果。这项研究的主要目的是解决为高风险提供干预的关键需求（A1C = 9-12％）T1D的青年。如果实现了，T1D护理惯例将通过为高风险青年提供 T1D及其父母通过家庭远程医疗干预措施的医疗和行为健康支持有明显改变获得T1D护理的潜力，减少高血糖中所花费的时间，减少住院频率并改善血糖控制。此外，使用多相优化策略（大多数），一种高效的实验策略，用于确定有效的干预组件，应该推广到所有具有T1D的人，从而导致具有成本效益的家庭远程医疗干预程序。创新方面包括：1）评估身体和行为健康特征与高风险状态相关； 2）交付包括：2A）医疗和行为的远程医疗与内分泌学家和行为健康专家一起提供的医疗保健与高危青年; 2B）个性化干预措施，以提高T1D依从性和T1D临床健康结果； 2C）个性化干预措施以改善心理健康合并症和T1D临床健康成果； 3）用于优化干预组件的方法学方法未使用的方法。