Innovating Education in Pediatric Diabetes: the CGM Academy Virtual Curriculum
by Rebecca Barber
Coauthors: Troy Zeier, MS - Biostatistician John Pemberton, RD - UK Collaborator Lily Chao, MD - Research Mentor
Background: Youth with type 1 diabetes (T1D) are at increased risk for kidney failure, vision loss, heart disease, and premature mortality due to challenges with glycemic excursions. Continuous glucose monitoring (CGM) systems represent an important advance in diabetes technology with significant advantages over self monitored blood glucose and the potential to optimize glycemic management. Despite these advances, youth with T1D, including patients at Children’s Hospital Los Angeles (CHLA), fail to achieve recommended glycemic targets, highlighting the opportunity for testing innovative diabetes education programs aimed at increased technology uptake such as the CGM Academy intervention. Aims: (A1) To determine the feasibility of the CHLA CGM Academy education curriculum to teach youth with T1D from diverse linguistic and cultural backgrounds dynamic glucose management strategies. We hypothesize the CHLA CGM Academy curriculum will be well-accepted by participants. (A2) To evaluate the effect of CHLA CGM Academy on the change from baseline to 6 months in hemoglobin A1c (HbA1c). We hypothesize participants in CHLA CGM Academy will attain the same or better % change in HbA1c as the standard diabetes education (SDE) group, while requiring fewer hours of 1:1 diabetes education. (A3) To explore relationships between participants’ glycemic outcomes with diabetes distress, diabetes family responsibilities, and the number of hours of diabetes education. Methods: A single institution, randomized controlled trial is proposed for youth with T1D ages 8-18 years eligible for CGM therapy. Youth (N=70), English and Spanish speaking, will be randomized 1:1 to receive CHLA CGM Academy or SDE for a total of 4 weeks followed by a 6-month clinical review. Participants in CGM Academy arm will have access to an online workbook and videos, in addition to in-depth virtual sessions with a diabetes care and education specialist to discuss dynamic glucose management strategies informed by CGM data. A subsample (n=10) of CGM Academy arm will participate in qualitative interviews. All participants will complete measures on diabetes family responsibility and diabetes distress and the study team will collect the number of hours of diabetes education at baseline, Week 4,
and 6 months. Study team will collect demographic characteristics, diabetes history at baseline and 6 months, and CGM metrics from chart review at week 1, 2, 4, and 6 months. Analysis: To evaluate A1, we will report attrition rates, and thematic analysis on qualitative interview data. To evaluate A2, we will construct a 95% CI for the difference in change in HbA1C to determine if change in the CGM academy group is not inferior, by more than our pre specified non inferiority margin, to the change in the SDE group. To evaluate A3, we will use generalized linear models to explore the effect of covariates on change in HbA1C and CGM metrics. To determine the time (baseline, 4 weeks, 6 months) and group (CGM vs SDE) effect on perceived diabetes distress and perceived diabetes family responsibility, we will use repeated measures ANOVA.