Precision Monitoring: Understanding Momentary Affect, Glucose, and Self-care Behaviors in Adolescents and Young Adults with type 1 diabetes

精确监测：了解患有 1 型糖尿病的青少年和年轻人的瞬时情绪、血糖和自我保健行为

• 批准号: 10746032
• 负责人: Amit Shapira
• 金额: $ 19.19万
• 依托单位: JOSLIN DIABETES CENTER
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2028-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10746032
• 关键词: Adolescent; Adolescent and Young Adult; Affect; Area; Behavior; Behavior Therapy; Behavioral; Behavioral Sciences; Blood Glucose; Caring; Clinical; Complement; Continuous Glucose Monitor; Control Groups; Coupled; Data; Data Collection; Development Plans; Diabetes Mellitus; Distress; Doctor of Philosophy; Ecological momentary assessment; Emotional; Encapsulated; Evaluation; Feedback; Fingers; Future; Glucose; Glycosylated hemoglobin A; Goals; Insulin-Dependent Diabetes Mellitus; Intervention; Interview; Investigation; Longevity; Mentors; Methods; Modality; Modernization; Monitor; Outcome; Participant; Pattern; Persons; Program Development; Protocols documentation; Qualitative Research; Randomized; Randomized, Controlled Trials; Regulation; Research; Research Personnel; Risk; Sampling; Self Care; Series; Social Environment; Standardization; Statistical Methods; Structure; Surveys; Technology; Testing; Time; Vacuum; Visual; acceptability and feasibility; aged; blood glucose regulation; career; career development; catalyst; contextual factors; dashboard; diabetes distress; diabetes self-management; emotional distress; experience; group intervention; human centered design; improved; improved outcome; innovation; intervention program; meetings; multi-component intervention; multidisciplinary; novel; peer; pilot test; post intervention; precision medicine; programs; psychosocial; research study; satisfaction; skills; social; tool; trend; usability; vulnerable adolescent; willingness

PROJECT SUMMARY/ABSTRACT Adolescents and Young Adults (AYA) with type 1 diabetes (T1D) have the highest hemoglobin A1c values of all across the lifespan. Continuous Glucose Monitoring (CGM) is a modern approach to glucose assessment that provides in-the-moment information about glucose levels to help optimize time-in-range ([TIR] 70-180 mg/dL). Retrospective review of ambulatory glucose patterns is an essential component for improving diabetes self-care. However, many CGM users become overwhelmed by the voluminous CGM data and rarely review or download their CGM. Furthermore, interpretation of CGM data should not occur in a vacuum, rather one should consider contextual factors that impact self-care in order to improve glycemic regulation. Thus, to maximize the clinical value of CGM in AYA with T1D, a novel, ecologically grounded approach is needed to contextualize CGM data with information on the intra- and inter-personal context in which glucose regulation occurs. It is timely to pair ecological momentary assessment (EMA) with CGM to develop an intervention program to improve self-care, glycemia, and psychosocial outcomes. We will use rigorous methods to capture dynamic relationships between in-the-moment ratings of emotional and social experiences (using EMA) and CGM-recorded glucose values, which will be collectively displayed on a dashboard, encapsulating the emotional and social context of ambulatory glucose (psychosocial ambulatory glucose [PAG]). Tracking and reviewing of PAG patterns, along with ongoing structured support, within a multicomponent intervention, will help AYA with T1D to better interpret and behaviorally respond to out-of-range glucose values, and may serve as a catalyst to improve A1c, TIR, and self-care, as well as reduce diabetes distress. Amit Shapira, PhD, proposes a series of studies with an overarching goal of developing, iteratively refining, and testing a PAG intervention in AYA with T1D. The proposed 3 specific aims are: 1) to identify salient components of a PAG dashboard using EMA that will coordinate the display of emotional and social context coupled with CGM recorded data to enhance self-care of AYA with T1D above target A1c values using mixed methods; 2) to adapt and build upon the dashboard for use in a behavioral intervention through expert feedback and guidance from pertinent stakeholders; and 3) to examine if a pilot RCT of a refined PAG behavioral intervention will be acceptable, feasible, and satisfactory to participants and have potential to improve diabetes and psychosocial outcomes compared with PAG-alone. Results from these studies will inform a fully powered RCT for a future R01 application. Dr. Shapira’s career objective is to become an independent diabetes behavioral researcher focused on optimizing self-care, including use of CGM and other technologies, to improve outcomes for people with T1D. The 5-year, mentored career development program will provide her with necessary skills in diabetes care (e.g., diabetes technologies), advanced statistical methods, and usability and qualitative research to launch her independence in diabetes behavioral investigation.

项目摘要/摘要 具有1型糖尿病（T1D）最高血红蛋白A1C值的青少年和年轻人（AYA） 在整个救生员中，连续葡萄糖监测（CGM）是一种现代的葡萄糖评估 提供有关葡萄糖水平的动作信息，以帮助优化时间范围（[TIR] 70-180 MG/DL）。 但是，自我保健。许多CGM用户被大量的CGM数据所淹没 下载他们的CGM。 展示会考虑影响自我保健以改善血糖调节的上下文因素 使用T1D在AYA中最大化CGM的临床价值，需要一种新型的生态扎根方法 将CGM数据与葡萄糖调节的内部和内部个人上下文的信息相关化。 发生。 改善自我护理，血糖和心理社会成果的计划。 情感和社会经验的主体内评分（使用EMA）和 CGM录制的葡萄糖值将集体显示在仪表板上，封装了您 门诊葡萄糖的情感和社会背景 以及在多组分中审查PAG模式以及指责的支持， 将帮助AYA更好地解释和行为对量程外葡萄糖值做出反应，并且可能 作为改善A1C，TIR和自我护理的催化剂，并减少糖尿病的痛苦。 提出了一系列研究，具有开发，iTerav的总体目的和测试PAG的总体目标 用T1D进行干预。 使用EMA的仪表板将与CGM协调表现的情感和社交环境 记录数据以增强目标A1C值的自我护理 通过专家反馈和指导，适应仪表板并在仪表板上用于行为国际 从相关的利益相关者和3）检查是否将 可以接受，可行和熟悉的参与者，并有可能改善糖尿病和社会心理 与PAG-ORO的结果相比。 R01应用程序。 专注于优化自我保健，包含CGM和其他技术的使用，以改善人们的预后 T1D。 护理（例如糖尿病技术），高级统计方法以及可用性和定性研究 在糖尿病行为调查中启动她的独立性。