It’s well known that using diabetes technology—continuous glucose monitoring and insulin pumps—can lead to better glycemic control. But not all patients are using these devices equally.
“Latinx youth, as well as other young people of color, have much lower rates of diabetes technology use,” says Jennifer Raymond, MD, MCR, Chief of the Center for Endocrinology, Diabetes and Metabolism at Children’s Hospital Los Angeles. “They also routinely have less optimal diabetes outcomes than their white peers. It’s a significant disparity.”
To address this gap, Dr. Raymond is co-leading an innovative multicenter study with Jenise Wong, MD, PhD, from the University of California, San Francisco, and Stephanie Crossen, MD, MPH, from the University of California, Davis.
Funded by a four-year R01 grant from the National Institutes of Health, the study is testing a unique intervention: virtual peer groups. The groups have been co-designed with input and feedback from Latinx youth and their families.
“It’s an education and mentorship model that’s based on peer-to-peer support and interaction,” she says. “What we’ve found is that young people and families often want to know how peers with similar lived experiences use these devices. Learning from those who share your language and culture is more powerful than just hearing a physician’s advice in clinic.”
Identifying barriers
The study, which began in 2023, builds on data from Dr. Raymond’s prior research into virtual peer group models for youth with diabetes.
For example, last year her team published findings from a separate study showing that youth with Type 1 diabetes who participated in virtual peer groups saw their hemoglobin A1C levels go down by 1.1%. In addition, the percentage of group participants using continuous glucose monitoring shot up from 11% to 47%.
While that research had a 50% Latinx population, this new study focuses entirely on Latinx adolescents—with the specific goal of improving diabetes technology use.
To do this, the multicenter team conducted online focus groups with Latinx adolescents with Type 1 diabetes and their families from across the state. Researchers also met with clinicians, as well as stakeholders from California Children’s Services, a state program for children with chronic health conditions.
From those conversations, investigators identified multiple barriers to diabetes device use among this group, including:
- Technology connectivity issues
- Stigma—teens do not like the visibility of the device
- Cost (smartphones and data plans)
- Not understanding the technology
- Lack of community. Families feel a lack of connection to others from their culture with Type 1 diabetes.
How the intervention will work
The team is now getting ready to enroll 120 Latinx adolescents and their families across the three study sites. Researchers have designed a series of monthly virtual peer group sessions centered around specific themes, including:
- Basics of diabetes technology and how it works
- Family relationships around diabetes management (avoiding blame or shame and decreasing conflict)
- How to handle eating in different activities and situations
- Dealing with diabetes stress, stigma, and burnout
- Available support resources (for school, work, travel, etc.)
The intervention will also feature a unique element: spiritual care. After engaging with Latinx families in focus groups, Megan Visser, PhD—a postdoctoral fellow and chaplain researcher at the Institute for Nursing and Interprofessional Research at Children’s Hospital Los Angeles—noticed that spirituality was important to this community.
Dr. Visser is designing a spiritual care component for the intervention, in partnership with other facilitators and stakeholders, including youth and their families. She will also participate in the groups—along with the Spiritual Care and Clinical Pastoral Education team at CHLA—and offer support to teens and families.
“This came directly out of our discussions with families,” Dr. Raymond explains. “Spirituality is not something we typically talk about in clinic. But we found many of our families view diabetes and diabetes devices in spiritual terms. They expressed a real need for spiritual care to be part of their support system.”
Although the groups will take place online, the intervention will also include an opportunity for families to meet in person. The in-person aspect was added based on focus group feedback from youth and their families.
Improving support systems
In addition, the team is creating an advisory board of clinicians and Latinx families to give feedback and guidance throughout the intervention.
“That community input is the foundation of all our research now,” Dr. Raymond says. “We learn and gain so much from giving people space to tell us their experiences and what they want and need.”
She adds that she hopes the virtual peer groups will not only increase diabetes technology uptake, but also improve diabetes distress and mental health for this vulnerable group.
“My hope is that better support for patients and families can eventually be built into the standard model of care, rather than needing a special grant to do this work,” Dr. Raymond says. “We want young people from all backgrounds to be able to access these devices and have the support they need to better manage their diabetes.”
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