Optimizing Use of Continuous Glucose Monitoring (CGM) to Advance Health Equity Among Youth with Type 1 Diabetes (T1D)

优化连续血糖监测 (CGM) 的使用以促进 1 型糖尿病 (T1D) 青少年的健康公平

• 批准号: 10664302
• 负责人: Elise Schlissel Tremblay
• 金额: $ 19.48万
• 依托单位: BOSTON CHILDREN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-01 至 2027-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10664302
• 关键词: Address; Adherence; Adolescent; Automobile Driving; Black race; Blood Glucose; Boston; Caregivers; Caring; Child; Childhood; Childhood diabetes; Climacteric; Clinic; Clinical; Clinical Trials; Continuous Glucose Monitor; Coupled; Data; Data Collection; Databases; Demographic Analyses; Development; Devices; Diabetes Mellitus; Diabetic Ketoacidosis; Disease; Disparate; Disparity; Education; Endocrinologist; Endocrinology; Enrollment; Ensure; Environment; Equity; Ethnic Origin; Ethnic Population; Evaluation; Event; Family; Foundations; Future; Glycosylated hemoglobin A; Goals; Grant; Health Insurance; Health Services Research; Hispanic; Hospitals; Household; Hybrids; Hypoglycemia; Income; Individual; Insulin; Insulin-Dependent Diabetes Mellitus; Insurance; Intervention; Low income; Measures; Medical Device; Medical center; Medicine; Mentored Patient-Oriented Research Career Development Award; Mentorship; Metabolic Control; Methods; Modernization; Morbidity - disease rate; National Health Insurance; Outcome; Patients; Pattern; Pediatric Hospitals; Physicians; Pilot Projects; Population; Positioning Attribute; Public Health; Public Health Education; Race; Research; Research Design; Research Methodology; Resources; Risk; Sampling; Scientist; Site; Socioeconomic Status; Source; Statistical Data Interpretation; Subgroup; System; Technology; Time; Training; Youth; acceptability and feasibility; acute care; biomedical referral center; burnout; care delivery; career; caregiver stress; clinical research site; cohort; disparity gap; disparity reduction; experience; glucose monitor; glycemic control; health care disparity; health equity; hospital care; improved; improved outcome; inner city; low socioeconomic status; marginalization; mortality; novel; outcome disparities; patient navigation; patient oriented; patient population; pediatric patients; programs; psychoeducational intervention; public health insurance; racial population; safety net; skills; socioeconomics; technological innovation; therapy design; uptake

PROJECT SUMMARY/ABSTRACT Use of continuous glucose monitors (CGM) has been shown to significantly improve glycemic control and decrease the risk of complications for pediatric patients with type 1 diabetes (T1D). However, despite the rapid advancements in technological capabilities over the past twenty years, access to and meaningful use of CGM are not distributed equitably across the population. The continued advancement in sophistication and potential for improved outcomes coupled with population-level increases in CGM use contributes to widening disparities in care and makes essential an improved understanding of optimizing use of personal medical devices for T1D. I am a public health trained pediatric endocrinologist; through this proposed K23 Award I aim to characterize disparities based on race/ethnicity and socioeconomic status (SES) in CGM use for children with T1D utilizing statistical analysis in disparate care settings and nationwide claims data. These analyses of the sources of disparities will inform my pilot clinic-based intervention to narrow gaps in CGM use. This project builds upon my research describing the experience of Hispanic caregivers of children with T1D, my analysis of demographic predictors of metabolic control in the T1D program at Boston Children’s Hospital (BCH), and my training in health services research and public health. This grant will enable my acquisition of new skills in time- to-event analysis, claims-based data use, and intervention design, implementation, and evaluation. Adding depth to my health services research methods and establishing a foundation in clinical trials, this grant, along with the unique environment and diverse mentorship at BCH, Department of Population Medicine (DPM), and Boston Medical Center (BMC) will position me well to begin an independent research program. In Aim 1, I will utilize a national health insurance plan claims database to analyze personal medical device use and acute care utilization among children with T1D with a focus on the impact of race/ethnicity and SES on CGM prescription and adherence. In my second aim I will employ a mixed methods approach to quantify CGM use among children with T1D cared for at a quaternary referral center (BCH) and a safety net hospital (BMC) and conduct a qualitative assessment of barriers to consistent CGM use in Black, Hispanic, and low SES patients at both sites to inform the development of a clinic-based intervention to improve CGM uptake and adherence in diverse, marginalized, and low resource patient populations. In Aim 3, I will develop and pilot the intervention informed by Aim 2 in a 6-month RCT at BCH and BMC to assess the impact of culturally effective education and patient navigation for CGM use on disparities in its uptake and associated clinical outcomes. I aim to establish a career as an independent physician-scientist with a background in the drivers of pediatric T1D care and outcomes, with the long-term goal of providing equitable access to rapidly improving technological innovations to better the lives of children with T1D. The mentorship, formal training, and research experience that this K23 will provide will position me well to begin an impactful independent research career.

项目摘要/摘要 使用连续葡萄糖监测器（CGM）已显示可显着改善血糖控制和 减少1型糖尿病（T1D）儿科患者并发症的风险。但是，dospite迅速 在过去的二十年中，技术能力的进步，访问CGM的有意义的使用 不是在整个人群中平等分布。社会化和潜力的持续发展 为了改善结局以及人口级别使用CGM使用的增加有助于扩大差异 在护理方面，使得对优化使用个人医疗设备的T1D进行了必不可少的理解。 我是一名受过公共卫生训练的小儿内分泌学家；通过提出的K23奖，我的目标是表征 基于种族/种族和社会经济地位（SES）CGM使用T1D使用的差异 在不同的护理环境和全国索赔数据中的统计分析。这些对来源的分析 差异将为我的基于飞行员诊所的干预提供信息，以缩小CGM使用的差距。这个项目建立在 我的研究描述了T1D儿童的西班牙裔护理人员的经历，我对 波士顿儿童医院（BCH）的T1D计划中代谢控制的人口预测因素，我 卫生服务研究和公共卫生培训。这笔赠款将使我能够及时获得新技能 - 事实分析，基于索赔的数据使用以及干预设计，实施和评估。添加 深入我的卫生服务研究方法并在临床试验中建立基础，这项赠款 在BCH，人口医学部（DPM）和 波士顿医疗中心（BMC）将使我很好地启动独立研究计划。 在AIM 1中，我将利用国家健康保险计划索赔数据库来分析个人医疗设备的使用 T1D儿童的急性护理利用，重点是种族/种族和SES的影响 CGM处方和依从性。在我的第二个目标中，我将采用混合方法来量化CGM 在第四纪推荐中心（BCH）和安全网医院（BMC）的T1D儿童中使用 并对在黑色，西班牙裔和低SES中使用CGM一致的障碍进行定性评估 这两个地点的患者都为开发基于诊所的干预措施的发展，以改善CGM摄取和 潜水员，边缘化和资源低的患者人群的依从性。在AIM 3中，我将开发并试行 AIM 2在BCH和BMC的6个月RCT中告知干预措施，以评估文化有效的影响 教育和患者导航，用于CGM在其吸收和相关临床结果中使用差异。 我的目标是建立具有独立身体科学家的职业 T1D护理和成果，其长期目标是为快速改善提供公平的访问权限 技术创新，以改善T1D儿童的生活。心态，正式培训和研究 这个K23将提供的经验将使我很好地开始有影响力的独立研究职业。