Glu-COACH: a peer-mentoring intervention to reduce disparities in CGM use in adolescents with type 1 diabetes

Glu-COACH：一种同伴指导干预措施，旨在减少 1 型糖尿病青少年 CGM 使用差异

基本信息

批准号：
10583326
负责人：
STUART ALAN WEINZIMER
金额：
$ 31.32万
依托单位：
YALE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-09-21 至 2026-07-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10583326
关键词：
AIDS prevention Address Adolescent Adoption Age Alcohol consumption Attitude Behavior Black race Blood Glucose Caring Chronic Chronic Disease Clinical Clinical Management Clinical Trials Collaborations Communication Conduct Clinical Trials Control Groups Development Devices Diabetes Mellitus Disease Management Distress Emotional Enrollment Ethnic group Evaluation Studies Feasibility Studies Feeling Frustration Future Glucose Health Health Personnel Hypoglycemia Insulin-Dependent Diabetes Mellitus Insurance Coverage Intervention Latinx Life Style Maintenance Metabolic Modeling Monitor Multi-Institutional Clinical Trial Outcome Parents Participant Patients Pattern Persons Phase Pilot Projects Population Privatization Problem Solving Process Protocols documentation Quality of life Race Randomized Randomized Controlled Trials Reduce health disparities Reporting Research Research Design Sampling Self Efficacy Self Management Site Socioeconomic Factors Structure Supervision Technology Teenagers Time Training Validation Work Youth age group behavioral health behavioral outcome care outcomes clinical care diabetes distress diabetes management disparity reduction drug abuse prevention efficacy evaluation experience glucose monitor glycemic control health disparity health inequalities health related quality of life improved innovation meetings monitoring device peer coaching peer support primary outcome programs racial and ethnic disparities racial disparity response role model scale up secondary outcome smoking cessation social media social situation socioeconomics standard care standard of care trend uptake young adult

项目摘要

PROJECT SUMMARY Adolescents with type 1 diabetes struggle more than any other age group to meet recommended glycemic targets. Continuous glucose monitoring devices, which enable real-time determination and communication of blood glucose levels, identification of trends, alerts, and alarms, and remote communication and monitoring, have improved metabolic and lifestyle outcomes and have markedly transformed the clinical management of diabetes in youth. However, these technological improvements have not benefited all populations similarly: lower rates of uptake and continued use of these devices in Black and Latinx young people have exacerbated pre- existing racial disparities in diabetes care and outcomes. Beyond socioeconomic issues such as access, developmentally and culturally specific factors relating to burden, diabetes distress, and self-efficacy are modifiable targets for specific and innovative interventions. Structured peer mentoring programs have been successfully employed in other chronic illness models to improve attitudes and behaviors around disease management. Using a stakeholder engagement approach, we will develop, optimize, and evaluate a peer- support intervention, Glu-COACH, to improve the uptake and maintenance of CGM use in Black and Latinx adolescents with type 1 diabetes. The input from a stakeholder panel representing patients, parents, and clinicians will inform each phase of the study. In Phase 1, we will collaboratively develop Glu-COACH and finalize study protocols with our stakeholders. In Phase 2, we will conduct a randomized controlled pilot study (n=50) comparing Glu-COACH to an enhanced standard care control group, convening quarterly research progress meetings with our stakeholders for ongoing collaboration. We hypothesize that the support, validation, identification, vicarious experience, and role modeling provided by trained peer mentors of the same cultural identity will significantly improve our primary aim of CGM use in Glu-COACH participants compared to the control group. We will also examine the effects of the Glu-COACH intervention on glycemic outcomes, such as time in range, mean glucose, and A1c, and behavioral outcomes, such as diabetes-related self-efficacy and distress, as well as benefits and burdens related to CGM use. Finally, we will critically examine the feasibility, acceptability, and implementation of the Glu-COACH intervention. This intervention will be upscaled and evaluated in a subsequent multi-site randomized controlled trial if proven effective.

项目概要患有 1 型糖尿病的青少年比任何其他年龄段的人更难以达到推荐的血糖水平目标。连续血糖监测设备，可实时确定和通信血糖水平、趋势识别、警报和警报以及远程通信和监控，改善了代谢和生活方式结果，并显着改变了临床管理青少年患糖尿病。然而，这些技术进步并没有让所有人群都受益：黑人和拉丁裔年轻人对这些设备的接受和持续使用率加剧了糖尿病护理和结果方面现有的种族差异。除了准入等社会经济问题之外，与负担、糖尿病困扰和自我效能相关的发展和文化特定因素是针对具体和创新干预措施的可修改目标。结构化的同伴指导计划已经成功应用于其他慢性疾病模型，以改善人们对疾病的态度和行为管理。使用利益相关者参与方法，我们将开发、优化和评估同行支持干预措施 Glu-COACH，以提高黑人和拉丁裔对 CGM 使用的接受和维持患有 1 型糖尿病的青少年。代表患者、家长和患者的利益相关者小组的意见临床医生将告知研究的每个阶段。在第一阶段，我们将合作开发Glu-COACH并最终确定与我们的利益相关者一起研究协议。在第二阶段，我们将进行随机对照试点研究（n=50）将 Glu-COACH 与强化标准护理对照组进行比较，召开季度研究进展会议与我们的利益相关者举行会议以进行持续合作。我们假设支持、验证、由受过相同文化训练的同伴导师提供的认同、替代经验和角色示范与对照相比，身份将显着改善我们在 Glu-COACH 参与者中使用 CGM 的主要目标团体。我们还将研究 Glu-COACH 干预对血糖结果的影响，例如用药时间范围、平均血糖和 A1c 以及行为结果，例如糖尿病相关的自我效能和痛苦，以及与 CGM 使用相关的益处和负担。最后，我们将严格审查可行性、可接受性、并实施 Glu-COACH 干预。这种干预措施将在以下范围内扩大和评估：如果证明有效，则进行后续的多中心随机对照试验。