Type 1 Together: A Peer Mentorship Program to Bolster use of Continuous Glucose Monitoring Systems among Adolescents with Type 1 Diabetes

Youth with type 1 diabetes (T1D) must follow a complex treatment regimen to approximate normal glycemic levels and avoid acute and long-term health complications. Continuous glucose monitoring (CGM) systems can improve glycemic control. However, many adolescents with T1D have elevated glycemic levels, putting them at risk for adverse health outcomes. These same youth are less likely to use CGM consistently. Thus, bolstering use of CGM may be a promising approach to improve short- and long-term health outcomes in youth with T1D. The objective of the current proposal is to refine and pilot-test Type 1 Together, a technology-enhanced intervention to increase use of CGM among adolescents with T1D. In Type 1 Together, families will work with other families who have experience using CGM (Peer Mentors), have access to technology supports through the Nemours App, and will consult with a community health worker. In the Peer Mentor component, youth and their caregivers will work with a mentor family to overcome common barriers to CGM use. The Technology Supports will include access to family-centered educational materials and a digital journal to facilitate patient-provider communication around issues with CGM. Finally, they will receive support from a community health worker with expertise in pediatric diabetes. During the first year of this proposal, we will work with patient, caregiver, and healthcare provider stakeholders to refine the peer mentor program and technology supports, develop plans to deliver the interventions, refine the measurement strategy, and recruit and train mentor families and a community health worker. After incorporating stakeholder input, we will test Type 1 Together in a pilot randomized controlled trial. Youth who are using CGM inconsistently (i.e., < 80% of the time) or whose most recent HbA1c was ≥ 9% will be recruited during or after regularly scheduled clinic visits and randomized (1:1) to Type 1 Together or a 6-month waitlist control. Primary outcomes will be intervention acceptability and feasibility, perceived barriers and facilitators to using CGM, use of CGM, and glycemic levels (i.e., HbA1c, time in range). Findings from the current study will inform future research aimed at testing the efficacy of the intervention in a larger, multisite randomized controlled trial.