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.

项目概要/摘要 使用连续血糖监测仪（CGM）已被证明可以显着改善血糖控制和 降低 1 型糖尿病 (T1D) 儿科患者并发症的风险，尽管速度很快。 过去二十年来技术能力的进步、CGM 的获取和有意义的使用 复杂性和潜力的持续进步。 为了改善结果，加上人群中 CGM 使用量的增加，导致差距扩大 护理领域的发展，使人们对优化 T1D 个人医疗设备的使用有了更深入的了解。 我是一名经过公共卫生培训的儿科内分泌学家；我希望通过拟议的 K23 奖项来描述我的特点 针对 1 型糖尿病儿童使用动态血糖监测 (CGM) 时基于种族/族裔和社会经济地位 (SES) 的差异 对不同护理环境和全国索赔数据的统计分析。 差异将为我基于临床的试点干预措施提供信息，以缩小 CGM 使用的差距。 我的研究描述了 1 型糖尿病儿童的西班牙裔护理人员的经历，我的分析 波士顿儿童医院 (BCH) T1D 项目中代谢控制的人口统计预测因子，以及我的 卫生服务研究和公共卫生方面的培训。这笔赠款将使我能够及时获得新技能。 事件分析、基于索赔的数据使用以及干预设计、实施和评估。 深入了解我的健康服务研究方法并为临床试验奠定基础，这笔赠款以及 凭借 BCH、人口医学系 (DPM) 的独特环境和多元化指导，以及 波士顿医学中心 (BMC) 将为我做好开始独立研究项目的准备。 在目标 1 中，我将利用国民健康保险计划索赔数据库来分析个人医疗设备的使用情况 1 型糖尿病儿童的急性护理利用情况，重点关注种族/族裔和社会经济地位对 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。 在四级转诊中心 (BCH) 和安全网医院 (BMC) 护理的 T1D 儿童中使用 对黑人、西班牙裔和低社会经济地位群体持续使用 CGM 的障碍进行定性评估 两个地点的患者告知制定基于临床的干预措施，以提高 CGM 的采用率和 在目标 3 中，我将开发并试点该方法。 在 BCH 和 BMC 进行的为期 6 个月的随机对照试验中，根据目标 2 进行干预，以评估文化有效的影响 针对 CGM 使用差异和相关临床结果的教育和患者导航。 我的目标是成为一名具有儿科驾驶员背景的独立医师科学家 T1D 护理和结果，长期目标是提供公平的机会快速改善 技术创新，改善 T1D 儿童的生活 指导、正规培训和研究。 这台 K23 将为我提供良好的经验，让我能够开始有影响力的独立研究生涯。