Anna Kahkoska, MD, PhD | University of North Carolina at Chapel Hill; Kristen Hassmiller Lich, PhD | University of North Carolina at Chapel Hill; Michael Kosorok, PhD | University of North Carolina at Chapel Hill; John Batsis, MD | University of North Carolina at Chapel Hill
Competition Sponsor: US National Academy of Medicine
Awardee Year: 2022
As the population of older adults living with diabetes rapidly expands, technologic therapeutics have simultaneously become a central part of evidence-based, high-quality diabetes care. These intersecting trends underscore that we must find innovative and patient-centered ways to promote the effective use of diabetes technology over the lifespan. Despite significant potential benefits, integrating technology for diabetes management into daily routines can be complex for older adults, particularly in the context of unique biopsychosocial needs. Further, the system-level investments necessary to bolster technology use for individuals (i.e., additional provider time, diabetes education, peer support, behavioral health interventions) cannot realistically be made available to all patients due to operational and cost constraints.
Our overarching hypothesis is that providing evidence-based diabetes technology to heterogenous, complex population of older adults with T1D demands new approaches that consider a breadth of and differences in individual-level needs for patient-oriented onboarding and effective use in daily life. We propose a new approach to tailored diabetes care that leverages precision health analytics, informed by systems thinking and stakeholder engagement, to match patients with the personalized resources or “bolstering” interventions that they need to learn to use technology for diabetes management, integrate it into daily life, and ultimately experience the clinical benefits. We will integrate two scientific methodologies: (1) precision health statistical methods that can assign optimal therapies to individuals, based on their individual real-time data; and (2) systems thinking, a holistic way to investigate the factors and interactions that may contribute to complex outcomes. By using stakeholder-engaged methods, we will work with patients, caregivers, and providers to ensure we develop effective system-level interventions.
We will generate pilot data through an interdisciplinary scientific pipeline, focusing on continuous glucose monitoring, a technologic approach to glucose monitoring with potentially life-saving benefits for older adults, as a case study. If effective, this approach of providing an individualized and optimal, yet feasible, level of support for effective use of existing and emerging therapeutics to older adults with diabetes could transform how we offer evidence-based technology to older adults with diabetes, ensuring that they remain “patient-oriented” for diverse patients and their clinical benefits remain equitable over the lifespan.
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