Increasing Use of Continuous Glucose Monitors in Publicly-insured Youth With Type 1 Diabetes

Study Overview
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Brief Summary
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To use an enhanced continuous glucose monitor (CGM) experience, including an automated CGM-electronic health record (EHR) data integration system, proactive interventions, and gamification techniques, to increase CGM use among publicly-insured youth with type 1 diabetes (T1D).

Detailed Description
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The investigators will use an automated data integration system to monitor hours per week the CGM is worn and target interventions/troubleshooting techniques as needed. The investigators will use gamification techniques (i.e. ability to gain points and achieve small rewards) to help encourage CGM use and potentially improve glycemic control in this at-risk population.

Official Title
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Improving Adherence to Continuous Glucose Monitors in Publicly-insured Youth With Type 1 Diabetes

Conditions
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Type1diabetes

Intervention / Treatment
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* Behavioral: gamification
* Behavioral: Use of Dexcom G5


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: type 1 diabetes for more than 6 months on insulin pump or multiple daily injections without plans to change modality in next 6 months insured by CCS or Medi-Cal receiving care at Lucile Packard Children's Hospital or Stanford Children's Health outpatient clinics English or Spanish-speaking Exclusion Criteria: major illness or condition that may alter glucose control or ability to complete the study including pregnancy, cystic fibrosis, cancer, liver disease, history of transplant, or hemoglobinopathy current oral glucocorticoid use prior use of a CGM system hemoglobin A1C <7.5% or >12% no wireless internet access

Ages Eligible for Study
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Minimum Age: 13 Years
Maximum Age: 19 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Other
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Gamification<br>Use of continuous glucose monitor (Dexcom G5) with proactive intervention and incentives for time in use. | Behavioral: gamification<br>* incentives/rewards and contact between standard visits<br>Behavioral: Use of Dexcom G5<br>* Dexcom G5 continuous glucose monitor<br>|
| Active Comparator: Standard care<br>Use of continuous glucose monitor (Dexcom G5) per usual care. | Behavioral: Use of Dexcom G5<br>* Dexcom G5 continuous glucose monitor<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| CGM use | amount of time per week CGM is used | baseline to 6 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Hgb A1c | glycemic control as measured by Hgb A1c | baseline to 6 months |