Optimizing diabetes technology use for Latinx youth through DREAM (Device use Reimagined through Education And Mentorship) virtual peer groups

PROJECT SUMMARY/ABSTRACT Strict glycemic control is critical for optimal type 1 diabetes (T1D) outcomes but remains challenging for youth from historically marginalized ethnic groups, in whom hemoglobin A1c (A1c) levels are consistently the highest in the nation. In California, Latinx youth are the largest marginalized ethnic group with T1D, but they

experience less optimal glycemic control than their White counterparts. Continuous glucose monitoring, insulin pumps, and automated insulin delivery systems can assist with achievement of target A1c levels, but Latinx youth have lower rates of diabetes device use compared to White youth. Virtual peer groups (VPGs) can

improve patient engagement and diabetes self-care in Latinx youth, and preliminary data suggest that VPGs may increase the use of diabetes technology in this population. Jenise Wong, MD PhD, and Jennifer Raymond, MD MCR, propose this project grant with the objective to increase the adoption and sustained use

of diabetes devices in Latinx adolescents with T1D by engaging them and their families in the development and evaluation of a VPG intervention designed to improve technology use. This project will engage multiple stakeholders (patients, families, health care workers) from three clinic populations in California (Children’s

Hospital of Los Angeles, University of California Davis, and University of California San Francisco) and result in the DREAM (Device use Reimagined through Education And Mentorship) program. In collaboration with a multidisciplinary team of pediatric endocrinologists, psychologists, and public health experts, the researchers

propose a project with the following aims: (1) partner with stakeholders to adapt a virtual peer group model to promote the initiation and continued use of diabetes technology among Latinx adolescents with T1D, (2) evaluate the feasibility and acceptability of DREAM in a single arm, pragmatic trial, and (3) assess the effect of

DREAM on clinical and patient-centered outcomes. These aims will be addressed in a formative phase and a clinical trial phase. In Phase 1, the research team will address Aim 1 by engaging stakeholders in focus groups and semi-structured interviews to obtain qualitative data that will directly inform the design of the DREAM

VPGs and the clinical trial. A subset of stakeholders will form Advisory Councils who will provide longitudinal input during the clinical trial. In Phase 2, the research team will conduct a single arm, pragmatic trial of the DREAM intervention in 120 Latinx youth aged 13 to