GO TEAM: Glucose Optimization Through Technology Assisted Management

GO TEAM INTERVENTION PROTOCOL: GLUCOSE OPTIMIZATION THROUGH TECHNOLOGY ASSISTED MANAGEMENT: Use of a Diabetes Dashboard and Community Health Worker to Decrease Disparities in Technology Use in Pediatric T1D

Black/African American children and young adults with type 1 diabetes are less likely to use diabetes technologies, such as continuous glucose monitors, insulin pumps, and automated insulin delivery systems, compared to White children and young adults. The investigators are working to find ways to make sure that all patients with type 1 diabetes are equally able to use these technologies. The purpose of this study is to find out if a new computer program for the diabetes team, along with a smartphone app (called Glucosano) for patients/parents, as well as a community health worker, are accepted and used by Black/African American patients and parents living with type 1 diabetes, and if this can help decrease racial disparities in the use of diabetes technologies.

Participants diabetes technology devices will be linked to a remote patient monitoring dashboard and will have access to a Smartphone application, as well as scheduled and as needed visits with a community health worker.

Glucosano is a remote patient monitoring diabetes dashboard with a patient facing Smartphone application

Community Health Workers will work with participants as a diabetes technology coach during scheduled and as needed visits

Change in percentage of participants who start on automated insulin delivery (AID) as measured by medical records review

Change in patient endorsement of intervention as measured by the Acceptability of Intervention Measure (AIM)

4 item measure of acceptability using 5 point Likert scale, where 1 is completely disagree and 5 is completely agree

Change in patient endorsement of intervention as measured by Feasibility of Intervention Measure (FIM)

4 item measure of feasibility using 5 point Likert scale, where 1 is completely disagree and 5 is completely agree

Change in patient endorsement of intervention as measured by Intervention Appropriateness Measure (IAM)

4 item measure of appropriateness using 5 point Likert scale, where 1 is completely disagree and 5 is completely agree

Number of times a physician or diabetes nurse interacted with patient as measured by dashboard review

Change in percentage of participants using continuous glucose monitor (CGM) with at least 80% wear time as measured by CGM data

Psychosocial functioning of children/adolescents, as measured by the strengths and difficulties questionnaire given to parents

25-item questionnaire using a 3-point Likert scale, with one being not true and 3 being certainly true

Change in child/adolescent quality of life, as measured by PedsQL Type 1 diabetes module by parent-proxy

28-item questionnaire using 5-point Likert scale, where 0 is almost never a problem and 4 is almost always a problem

Change in parental burden related to diabetes, as measured by Problem Areas in Pediatric Diabetes - Parent Revised Version

12-item questionnaire using 5 point Likert scale, where 1 is strongly disagree and 5 is strongly agree

Change personal frequency of discrimination in healthcare, as measured by the Racism in Healthcare Index

7-item questionnaire regarding frequency of discrimination in healthcare ranging from never to 4 times or more in a lifetime

Change in diabetes specific attitudes towards technology as measured by the Diabetes Specific Technology Attitudes Scale

5-item questionnaire using 5 point Likert scale, where 1 is strongly disagree and 5 is strongly agree

37-item questionnaire using 5-point Likert scale, where 1 is strongly disagree and 5 is strongly agree

Change in diabetes management self-efficacy as measured by the Self-Efficacy for Diabetes Self-Management scale short version

10-item questionnaire using 6-point Likert scale, where 1 is "very sure I can't" and 6 is "very sure I can"

16-item questionnaire using 5-point Likert scale, where 1 is strongly disagree and 5 is strongly agree

DKA defined as presence of all of the following: 1) blood glucose greater than 250 mg/dL, 2) pH less than 7.3 OR bicarbonate less 15 mEq/L, 3)Moderate or large ketones in urine OR blood ketone >3 mmol/L, 4) Requiring treatment within a health care facility.

Inclusion Criteria: Self-reported as Non-Hispanic Black Clinical diagnosis of T1D requiring treatment with insulin at the time of consent Not currently (within the past 3 months) using an automated insulin delivery system \ Willingness to wear a continuous glucose monitor for 10 days at 3 different time points, and willingness to consider use of a personal continuous glucose monitor Exclusion Criteria: Clinical diagnosis of Type 2 or monogenic diabetes Completed high school Non-English speaking guardians Automated insulin delivery system use within the past 3 months Custody of children and family services