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）：本研究的目的具体涉及 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，以提高生活质量。 NIDDK 认识到需要进行研究“开发行为方法来改善家庭功能，并最终控制患者的代谢”，并“确定最有效的方法将[提高依从性]策略转化为常规儿科护理。这项 K23 研究意义重大因为它解决了提高胰岛素泵依从性的迫切需要，因为不依从性会导致严重且可能危及生命的后果，从而损害 T1D 患者的健康以及医生提供有效治疗的能力。该项目实现后，本研究将通过提供与胰岛素泵使用相关的综合评估方法来改变胰岛素泵实践。此外，本研究使用高效的实验设计来确定有效。 干预措施应带来具有成本效益的、基于临床的干预措施，以提高胰岛素泵的依从性。该项目具有创新性，因为它：1）客观测量胰岛素泵依从性数据，这在现有糖尿病文献中很少见； 2) 开发胰岛素泵评估方案，针对可在临床环境中使用的胰岛素泵知识/技能和 BGM-BOLUS 依从行为； 3) 使用一种方法来优化在护理点提供的干预措施。这项研究还探讨了可能干扰胰岛素泵有效使用的可改变障碍，包括对低血糖的恐惧、青少年责任感和抑郁症，并可纳入未来的干预措施中。本研究的具体目标是：1）制定胰岛素泵评估方案，重点关注与 BGM-BOLUS 依从行为相关的知识/技能； 2) 使用高效的实验设计来确定 Pump It Up! 的两个组件是否有效。干预、个性化胰岛素泵反馈和胰岛素泵问题解决可有效改善 BGM-BOLUS 依从行为； 3) 确定与 BGM-BOLUS 依从行为相关的调节因素。我的总体目标是成为一名独立的、以患者为中心的 T1D 临床研究员，通过建立独立的研究路线，重点了解与次优 BGM 和胰岛素依从性相关的可改变障碍，这些障碍可以通过在常规治疗期间实施创新干预措施来改善T1D 患者的护理。我打算专注于儿科 使用胰岛素泵的患者，因为现有文献对这一人群的研究还不够充分。这个 K23 提案将为我过渡到 T1D 独立研究员提供必要的基础。我拥有多项资格，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，在循证治疗方面拥有强大的科学背景。我是 NIDDK 支持的 T32 博士后 NRSA 和 NIH 儿科贷款偿还计划的获得者。我完全致力于在 T1D 领域建立我的学术研究生涯，并为获得 K23 奖项做好充分准备。在担任教职的头几年，我设计并开展了 T1D 的初步研究，与内分泌学家建立了重要的合作关系，并发表了 T1D 的文章。我已经仔细 选择了一个指导/咨询团队，这将有助于我过渡到 T1D 的独立学术研究职业。我获得此奖项的主要导师是 Suzanne Bennett Johnson 博士，她是一位知名的儿科心理学家，在 T1D、依从性和临床试验方面拥有专业知识，并获得 NIH 资助 30 多年。联合导师拉里·迪布 (Larry Deeb) 博士是一位儿科内分泌学家，也是美国糖尿病协会前任主席。顾问包括 Roger Mazze 博士，他是 T1D 护理相关技术进步的专家； Linda Collins 博士，创新方法和干预技术专家； Daniel McGee 博士是复杂测量和统计模型以及纵向数据分析方面的专家。佛罗里达州立大学医学院的环境资源丰富，支持我早期的职业发展，包括进行研究的空间和研究人员的住宿、最先进的图书馆和信息技术设施，以及完成项目的额外资金如果需要的话。我系的教师在以下方面非常丰富 出版物并确保外部资金。我的培训计划中包含的目标包括： 1) 培养 T1D 病理生理学、医疗管理和心理社会因素方面的专业知识； 2) 发展客观衡量 T1D 治疗方案依从性的专业知识； 3) 扩展涉及 BGM 和胰岛素泵技术数据的创新统计方法的知识； 4）发展创新方法方面的专业知识； 5）增强科学写作技能。我的培训和研究计划以及拥有 NIH 资助历史的指导/合作团队相结合，确保了本申请的培训和科学目标得以实现，并且我将成为独立的学术 T1D 研究员。 公共健康相关性：该项目的总体目标是通过为使用胰岛素泵的 1 型糖尿病 (T1D) 青少年提供干预措施，满足改善胰岛素泵依从性的迫切需求，因为不依从性会造成严重且可能危及生命的后果。这项研究与公共健康相关，因为持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。如果该项目的目标得以实现，该研究将通过提供与胰岛素泵使用相关的综合评估方法来改变胰岛素泵的实践。