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

Tech-Ex：一项旨在提高连续血糖监测系统公平使用的同行指导计划

• 批准号: 10797425
• 负责人: MELISSA A. ALDERFER
• 金额: $ 15.68万
• 依托单位: ALFRED I. DU PONT HOSP FOR CHILDREN
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-03-01 至 2027-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10797425
• 关键词: Acute; Black race; Caregivers; Case Manager; Child Health; Clinic Visits; Complex; Continuous Glucose Monitor; Diabetes Mellitus; Disparity; Educational Materials; Enhancement Technology; Equity; Family; Glycosylated hemoglobin A; Health; Health Personnel; Hispanic; Insulin-Dependent Diabetes Mellitus; Intervention; Journals; Measurement; Mentors; Mentorship; Outcome; Patients; Randomized; Randomized, Controlled Trials; Reduce health disparities; Research; Schedule; Site; System; Technology; Testing; Time; Training; Treatment Efficacy; Treatment Protocols; Waiting Lists; Work; Youth; acceptability and feasibility; digital; disparity reduction; efficacy testing; experience; glycemic control; improved; patient-clinician communication; peer; pilot test; primary outcome; programs; recruit; screening

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.

患有 1 型糖尿病 (T1D) 的青少年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能力比白人青年差，并且不太可能使用 CGM。 CGM 使用的差异可能是糖尿病健康结果差异的原因之一。因此，减少 CGM 使用差异可能是减少 T1D 青少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公平技术专家 (Tech-Ex)，这是一项技术增强干预措施，旨在增加患有 T1D 的黑人和西班牙裔青年使用 CGM。在 Tech-Ex 中，家庭将与具有 CGM（技术专家）使用经验的其他家庭合作，并且还可以通过 Nemours 应用程序获得技术支持。在技​​术专家部分，青少年及其照顾者将与导师家庭合作，克服使用 CGM 的常见障碍。技术支持将包括访问根据文化定制的教育材料、促进患者与提供者围绕 CGM 问题进行沟通的数字期刊以及 SDOH 筛查和干预。在该提案的第一年，我们将与患者、护理人员和医疗保健提供者利益相关者合作，完善技术辅导计划和技术支持，制定实施干预措施的计划，完善测量策略，并招募和培训导师家庭和技术支持人员。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。将在定期就诊期间或之后招募家庭，并随机 (1:1) 分配到 Tech-Ex 或 6 个月的候补名单对照中。主要结果将是干预措施的可接受性和可行性、使用 CGM 的感知障碍和促进因素、CGM 的使用以及血糖控制（即 HbA1c、范围内的时间）。当前研究的结果将为未来的研究提供信息，这些研究旨在在更大规模的多中心随机对照试验中测试干预措施的有效性。