Adherence intervention to promote optimal use of insulin pumps in adolescents wit

依从性干预促进青少年胰岛素泵的最佳使用

• 批准号: 8382765
• 负责人: Kimberly Driscoll
• 金额: $ 15.47万
• 依托单位: FLORIDA STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-01 至 2016-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8382765
• 关键词: Address; Adherence; Adolescent; Adult; American; Award; Behavior; Behavioral; Behavioral Research; Blood Glucose; Bolus Infusion; Caring; Child; Childhood; Clinic; Clinical; Clinical Research; Clinical Trials; Commit; Communities; Comorbidity; Consult; Data; Data Analyses; Decision Making; Development; Diabetes Mellitus; Endocrinologist; Environment; Evaluation; Evidence based intervention; Evidence based treatment; Experimental Designs; Extramural Activities; Faculty; Family; Feedback; Florida; Foundations; Frequencies; Fright; Functional disorder; Funding; Future; Goals; Gold; Health; Housing; Hypoglycemia; Information Technology; Insulin; Insulin Infusion Systems; Insulin-Dependent Diabetes Mellitus; Intervention; Knowledge; Lead; Libraries; Licensing; Life; Literature; Measurement; Measures; Medical; Medicine; Mental Depression; Mentored Patient-Oriented Research Career Development Award; Mentors; Mentorship; Metabolic Control; Methodology; National Institute of Diabetes and Digestive and Kidney Diseases; National Research Service Awards; Patient Self-Report; Patients; Performance; Physicians; Population; Positioning Attribute; Problem Solving; Protocols documentation; Psychologist; Psychosocial Factor; Public Health; Publications; Publishing; Pump; Quality of life; Reading; Recording of previous events; Reporting; Research; Research Personnel; Research Training; Resources; Secure; Statistical Models; Strategic Planning; Summary Reports; Techniques; Technology; Time; Training; Translating; Translational Research; Treatment Protocols; United States National Institutes of Health; Universities; Wit; Writing; base; career; career development; college; cost effective; depressive symptoms; design; diabetes management; effective intervention; effective therapy; flexibility; glucose monitor; glycemic control; improved; innovation; meetings; new technology; novel; patient oriented; point of care; programs; psychosocial; routine care; skills; statistics; user-friendly

DESCRIPTION (provided by applicant): The aims of this study specifically address two of the research objectives outlined in NIDDK's Strategic Plan for the Scientific Community: 1) combine new technology for diabetes management with behavioral and translational research; and 2) mitigate psychosocial complications and comorbidities of diabetes to improve quality of life. NIDDK recognizes that research is needed to "develop behavioral approaches to improve family function, and ultimately metabolic control in the patient" and to "determine the most effective ways to translate strategies [to improve adherence] into routine pediatric care. This K23 study is significant because it addresses the critical need for improving insulin pump adherence where non-adherence has severe and potentially life threatening consequences. Continued misuse of insulin pumps compromises the health of patients with T1D and the ability of physicians to provide effective treatment. If the aims of this project are achieved, this study will change insuln pump practices by providing a comprehensive assessment approach relevant to insulin pump use. In addition, this study's use of a highly efficient experimental design to determine effective intervention components should lead to a cost-effective, clinic-based intervention to improve insulin pump adherence. This project is innovative because it: 1) objectively measures insulin pump adherence data, which is rare in the extant diabetes literature; 2) develops an insulin pump assessment protocol that targets insulin pump knowledge/skills and BGM-BOLUS adherence behaviors that can be used in the clinical setting; and 3) uses a methodological approach for optimizing intervention components to be delivered at point of care. This study also explores modifiable barriers that could potentially interfere with effective insulin pump use including fear of hypoglycemia, adolescent responsibility, and depression, and could be incorporated into future interventions. The specific aims of this study are: 1) develop an insulin pump assessment protocol focused on knowledge/skills relevant to BGM-BOLUS adherence behaviors; 2) use a highly efficient experimental design to determine whether the two components of the Pump It Up! Intervention, Personalized Insulin Pump Feedback and Insulin Pump Problem-Solving, are effective at improving BGM-BOLUS adherence behaviors; and 3) identify moderators associated with BGM- BOLUS adherence behaviors. My overall goal is to become an independent, patient-oriented clinical researcher in T1D by establishing an independent line of research focused on understanding the modifiable barriers associated with suboptimal BGM and insulin adherence, which can be improved through the implementation of innovative interventions during the routine care of patients with T1D. I plan to focus on pediatric patients who use insulin pumps as this population has been understudied in the extant literature. This K23 proposal will provide the necessary foundation for my transition to an independent researcher in T1D. I have several qualifications that make me an ideal Candidate for a K23 Mentored Patient-Oriented Research Career Development Award. I am a licensed clinical psychologist with a strong scientific background in evidence-based treatments. I was a recipient of an NIDDK supported T32 postdoctoral NRSA and the NIH Pediatric Loan Repayment Program. I am fully committed to establishing my academic research career in T1D and am well-prepared to capitalize on a K23 award. I have spent the first years of my faculty position designing and conducting preliminary studies in T1D, establishing important collaborative relationships with endocrinologists, and publishing articles in T1D. I have carefully chosen a mentorship/consulting team that will facilitate my transition to an independent academic research career in T1D. My primary mentor on this award is Dr. Suzanne Bennett Johnson, a well- established pediatric psychologist with expertise in T1D, adherence, and clinical trials with more than 30 years of NIH funding. Dr. Larry Deeb, co-Mentor, is a pediatric endocrinologist and past President of the American Diabetes Association. Consultants include Dr. Roger Mazze, an expert in technological advancements associated with T1D care; Dr. Linda Collins, an expert in innovative methodologies and intervention techniques; and Dr. Daniel McGee, an expert in sophisticated measurement and statistical models and longitudinal data analysis. The environment at the Florida State University College of Medicine is rich in resources that support my early career development including space to conduct research and house research staff, state-of-the-art library and information technology facilities, and additiona funds to complete the project if necessary. The faculty in my department is prolific with regard to publications and securing extramural funding. The goals contained in my training plan include: 1) develop expertise in the pathophysiology, medical management, and psychosocial factors of T1D; 2) develop expertise in the objective measurement of T1D treatment regimen adherence; 3) extend knowledge of innovative statistical approaches involving BGM and insulin pump technology data; 4) develop expertise in innovative methodological approaches; and 5) augment scientific writing skills. The combination of my training and research plan and mentoring/collaborative team who have a long history of NIH funding assures that the training and scientific goals of this application will be met and that I will become and independent academic T1D researcher. PUBLIC HEALTH RELEVANCE: The overall goal of this project is to address the critical need for improving insulin pump adherence where non- adherence has severe and potentially life threatening consequences by providing intervention to adolescents with type 1 diabetes (T1D) who use insulin pumps. This study is relevant to public health because continued misuse of insulin pumps compromises the health of patients with T1D and the ability of physicians to provide effective treatment. If the aims of this project are achieved, this study will change insuln pump practices by providing a comprehensive assessment approach relevant to insulin pump use.

描述（由申请人提供）：本研究的目的专门针对NIDDK科学界战略计划中概述的两个研究目标：1）将糖尿病管理的新技术与行为和转化研究相结合； 2）减轻糖尿病的社会心理并发症和合并症，以改善生活质量。 NIDDK认识到需要进行研究，以“开发行为方法来改善家庭功能，并最终在患者中进行代谢控制”，并“确定将[改善依从性]转化为常规的策略的最有效方法。这项K23的研究非常重要。由于它可以解决胰岛素泵的临床效果的重要性，因此它解决了严重的胰岛素泵的影响，这是一种重要的需求。在T1D的患者和医生提供有效治疗的能力中。 干预组件应导致基于诊所的成本效益，以提高胰岛素泵的依从性。该项目具有创新性，因为它：1）客观地测量胰岛素泵的依从性数据，这在现存的糖尿病文献中很少见； 2）开发一种胰岛素泵评估方案，该协议针对胰岛素泵知识/技能和BGM - 网状粘附行为，可用于临床环境； 3）使用一种方法学方法来优化在护理点上交付的干预组件。这项研究还探索了可修改的障碍，可能会干扰有效的胰岛素泵的使用，包括担心低血糖，青少年责任和抑郁症，并可以纳入将来的干预措施。这项研究的具体目的是：1）制定胰岛素泵评估方案，重点是与BGM-Bolus依从性行为相关的知识/技能； 2）使用高效的实验设计来确定泵的两个组件是否将其提高！干预，个性化的胰岛素泵反馈和胰岛素泵解决问题，有效地改善了BGM粘液粘附行为； 3）识别与BGM-Los-粘附行为相关的主持人。我的总体目的是通过建立一个独立的研究线来成为T1D中的独立，以患者为导向的临床研究人员，该研究重点是了解与次优的BGM和胰岛素依从性相关的可修改障碍，可以通过在常规T1D患者的常规护理期间实施创新的干预措施来改善这种障碍。我打算专注于小儿 使用胰岛素泵作为该人群的患者在现有文献中已经研究了。该K23提案将为我过渡到T1D独立研究人员的必要基础。我有几项资格，使我成为K23指导的以患者为导向的研究职业发展奖的理想候选人。我是一名有执照的临床心理学家，在循证治疗方面具有强大的科学背景。我是NIDDK支持T32 T32博士后NRSA和NIH儿科贷款还款计划的接受者。我完全致力于在T1D建立我的学术研究生涯，并准备好获得K23奖。我已经在教师职位的头几年设计和进行了T1D的初步研究，与内分泌学家建立了重要的合作关系，并在T1D上发布文章。我仔细 选择了一个指导/咨询团队，该团队将有助于我过渡到T1D独立的学术研究生涯。我在该奖项上的主要导师是苏珊娜·贝内特·约翰逊（Suzanne Bennett Johnson）博士，他是一位知名的儿科心理学家，拥有T1D，依从性和临床试验的专业知识，拥有超过30年的NIH资助。联合学的拉里·迪布（Larry Deeb）博士是儿科内分泌学家兼美国糖尿病协会的前任主席。顾问包括与T1D护理相关的技术进步专家Roger Mazze博士；创新方法和干预技术专家Linda Collins博士；以及丹尼尔·麦吉（Daniel McGee）博士，他是复杂测量和统计模型以及纵向数据分析的专家。佛罗里达州立大学医学学院的环境丰富地支持我的早期职业发展，包括开展研究和众议院研究人员，最先进的图书馆和信息技术设施的空间，以及在必要时完成该项目的补充资金。我部门的教师关于 出版物和获得校外资金。我的培训计划中包含的目标包括：1）在T1D的病理生理学，医疗管理和社会心理因素方面发展专业知识； 2）在客观测量T1D治疗方案依从性方面发展专业知识； 3）扩展了涉及BGM和胰岛素泵技术数据的创新统计方法的知识； 4）发展创新方法论方法的专业知识； 5）增强科学写作技巧。我的培训和研究计划与指导/协作团队的结合，他们拥有NIH资金的悠久历史，确保了该应用程序的培训和科学目标，我将成为我和独立的学术T1D研究人员。 公共卫生相关性：该项目的总体目标是解决改善胰岛素泵的依从性的关键需求，而在不存在的情况下，通过向使用胰岛素泵的1型糖尿病（T1D）的青少年提供干预，从而具有严重且潜在的威胁生命的后果。这项研究与公共卫生有关，因为继续滥用胰岛素泵会损害T1D患者的健康以及医生提供有效治疗的能力。如果实现了该项目的目的，则该研究将通过提供与胰岛素泵使用相关的全面评估方法来改变胰岛泵实践。