Glucose Optimization Through Technology Assisted Management (GO TEAM!):Use of a diabetes dashboard and community health worker to decrease disparities in technology use in pediatric T1D

Case Western Reserve University, Cleveland OH

Investigators

Linked publications, trials & patents

Abstract

Socioeconomic disparities in glycemic control and diabetes technology use are widely recognized in patients with type 1 diabetes (T1D). Data shows that children in the US in households with the lowest income, lowest education level and public insurance have higher HbA1c’s, are half as likely to use insulin pumps, and over 3 times less likely to use a continuous glucose monitor (CGM) than those with the highest income, highest education, and private insurance. Automated insulin delivery (AID) systems, which require both a CGM and insulin pump, show greatest HbA1c improvement in those with baseline HbA1c over 8%, leading to concern that low use of AID in patients will further exacerbate existing health-care disparities. Therefore, novel interventions to reduce disparities in technology use among lower-income patients with T1D are critical to improving glycemic control, reducing microvascular complications and preventing early mortality in these children and young adults. We aim to reduce disparities with a 2-part intervention: a diabetes triage dashboard with interactive smartphone application and a community health worker (CHW) in the role of diabetes technology coach. An advisory group of stakeholders will define metrics of triage zones for the dashboard and frequency/content of messages from the application and will refine the specific role of the CHW. Our shared goals are to 1) identify patients who struggle to initiate or continue their device or do not meet glycemic goals and 2) utilize a CHW to act as a diabetes and technology coach, building trust with families so as to identify and overcome barriers to successful technology use. The specific aims are to: 1) Convene an advisory group of stakeholders to develop a protocol for a diabetes dashboard and smartphone application; 2) Develop a diabetes dashboard and interactive application using remote data capture from the cloud from CGM, insulin pumps, and AID systems; 3) Assess effectiveness and implementation of the bundled intervention with a 1:1 randomized controlled study of children and young adults with new onset and existing T1D who are not using AID; 4) Aim 4: Understand lived experience of diabetes management in context with 1:1 interviews, considering both perceptions regarding the intervention itself (vs. usual care) and organizational/secular characteristics influencing that experience.