A number of devices, such as insulin pumps and continuous glucose monitoring devices, can assist people with type 1 diabetes (T1D) in keeping track of their blood glucose levels, dosing insulin, and understanding how everyday events impact their glucose control, which ultimately keeps them at lower risk for diabetes complications. However, many patients, especially adolescents, do not independently review their own diabetes data or use advanced features of their devices. The goals of this project are to identify the features of these devices that most influence glycemic control in adolescents with T1D, to understand the barriers and facilitators of use of these device features in adolescents, and to use this information in designing and pilot testing the feasibility of a novel intervention to improve knowledge and use of diabetes devices, thus contributing to improved education and clinical outcomes in T1D.
Intensive management of type 1 diabetes (T1D) is essential to prevent long-term complications caused by poor glycemic control. Diabetes technology, such as insulin pumps and continuous glucose monitoring (CGM), has been shown to improve glycemic control. However, a minority of patients use advanced features of devices or self-review data, since no formal guidelines exist to teach these skills. As a result, much patient-generated device data is ignored, and patients miss opportunities to fine-tune insulin regimens using advanced features and data review. If patient knowledge of device use and data could increase as children begin the transition to independence in early adolescence, these skills may be better sustained into adulthood, leading to improved glycemic control. To address this, Jenise Wong, MD PhD, proposes this career development award with the overall objective to understand and optimize the use of diabetes devices in early adolescents with T1D. With the assistance of a multidisciplinary mentoring team, she will use quantitative and qualitative methods to develop and examine the feasibility and preliminary outcomes of a digital educational intervention to increase patient use of device features and diabetes data. Dr. Wong proposes the following aims: (1) to determine the features of diabetes devices that are associated with improved glycemic control in adolescents with T1D; (2) to explore knowledge of, and perceived barriers to, using advanced features of diabetes devices in adolescents with T1D and their families; and (3) to design, develop, and assess the feasibility of an educational intervention on T1D devices and data tailored to early adolescents. In Aim 1, Dr. Wong will use data from a national T1D registry to look for the associations of use of advanced device features and data review with hemoglobin A1c, with a focus on adolescents. In Aim 2, she will obtain qualitative data on the barriers and facilitators of device use and data review in focus groups of early adolescents with T1D and their caregivers. In Aim 3, she will use conjoint analysis to ascertain adolescents' preferences for delivery of a digital intervention, and use this data and that from Aims 1 and 2 to design and pilot test an intervention for utilization of diabetes devices and data in a randomized controlled trial.