The purpose of this Funding Opportunity Announcement (FOA) is to support pilot and feasibility trials of interventions designed to improve technology adoption in individuals from underrepresented backgrounds with type 1 diabetes mellitus (T1D). Through successful execution, these pilot and feasibility trials should provide feasibility data for larger, pragmatic trials with the overarching goal of reducing health disparity in T1D through improving technology usage in individuals from minority racial and ethnic backgrounds.
Type 1 diabetes mellitus (T1D) is a significant chronic health burden with 1.6 million affected individuals across the US. Furthermore, incidence rates are increasing with the greatest increase being noted in racial and ethnic underrepresented minority populations. Recently, major technological advances in the treatment of T1D, including insulin analogues, insulin pumps, continuous glucose monitoring (CGM) and closed loop systems have provided the potential to dramatically improve outcomes in individuals with T1D. However, glycemic control remains suboptimal for many individuals in the U.S., particularly youth, and especially racial/ethnic minority individuals. Health outcomes data indicate that individuals with T1D from underrepresented backgrounds have worse glycemic control and increased morbidity and acute complications from their diabetes than peers of non-underrepresented backgrounds. This is paired with the growing awareness that individuals with T1D from underrepresented minority groups are less likely to use diabetes technology. For example, T1D Exchange data indicated 50% less use of CGM in Black patients compared to White patients. Similar statistics exist for the use of insulin pump technology.
The barriers contributing to the inequitable use of diabetes technology are numerous and likely emanate from all social-ecological layers. For example, health systems may have pragmatic biases in access to technology such as the time of day technology courses are offered. There may also be provider and care team biases influencing prescribing habits based on preconceived notions of who will accept and who will benefit from technology prescriptions. Barriers within families of and the patient themselves may include various social determinants of health, literacy, preconceived attitudes about technology and personal engagement with the healthcare system. Also, not withstanding, is the barrier of general healthcare access. Healthcare access is a demonstrated contributor but not a sole driver for poor technology uptake in individuals with T1D from underrepresented backgrounds in preliminary and observational studies.
Thus, given the multitude of potential barriers impacting technology use in individuals with T1D from underrepresented backgrounds and the known benefits of technology adoption for individuals with T1D, there is a critical need to develop interventions to improve technology use in this population.
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Filed Under: Funding Opportunities