Awardee Molly Tanenbaum, PhD
Pediatrics (Endocrinology & Diabetes)
Instructor K Support (2019)
Total Award Amount: $150,000
MCHRI Impact: Earlier this year, Dr. Tanenbaum successfully competed for a K23 award through the National Institute of Diabetes and Digestive and Kidney Diseases. Her K award will provide salary support, while funds from SDRC and MCHRI will be critical in implementing her ONBOARD program to improve diabetes device use and adoption.
The Pilot & Feasibility grant and Instructor K Support will go toward data collection and management as well as supporting a research coordinator to help recruit and manage participants for the ONBOARD program.
Genesis of the ONBOARD program: Diabetes device design is improving on the finger stick. Continuous glucose monitors (CGM) provide real-time measurements of blood glucose through a small subcutaneous sensor.
In recent clinical guidelines released in Diabetes Care, the American Diabetes Association recommends CGM as a “useful tool to lower A1c in adults with type 1 diabetes who are not meeting glycemic targets.” The ADA also suggests robust diabetes education, training, and support are necessary for optimal implementation and ongoing use of CGM.
“We know that these devices can be really helpful. They can improve diabetes management and also take some of the burden off of people, which can have quality of life benefits,” Dr. Tanenbaum explains.
There are, however, significant barriers to use, and many people with diabetes stop using the devices within a year. Dr. Tanenbaum wanted to know why.
With her primary mentor Korey Hood, PhD, she analyzed data from a large national survey of people with Type 1 diabetes and found the biggest deterrents were the cost of the devices, supplies, and insurance issues.
The survey also revealed plenty of issues with the device itself. Some people didn’t like wearing the CGM on their bodies; they found it to be unsightly, uncomfortable, or painful. Others mentioned not trusting the devices, being overwhelmed by the amount of data and annoyed by the number of alarms alerting them to any glucose reading out of range. Adolescents and young adults who were surveyed expressed anxiety about what others would think if they noticed them wearing the devices.
Armed with a litany of concerns, Dr. Tanenbaum designed an onboarding program. She wanted to ease the learning curve for new users who are just starting out using CGM. Troubleshooting issues at the start, she reasoned, may prevent problems down the line and help retain users.
To that end, Dr. Tanenbaum has created videos featuring first-person narratives of people who are CGM users. They talk about the things they like about the technology and speak candidly about the difficulties they’ve encountered and how they’ve overcome them.
“I’m hoping that hearing those stories might be even more powerful and useful than straight-up education,” Dr. Tanenbaum says.
She is calling her program ONBOARD, or OvercomiNg Barriers & Obstacles to Adopting Diabetes Devices. Recruitment is underway. Using qualitative and quantitative methodologies, Dr. Tanenbaum will measure the impact the program has on 40 participants who are trying CGM for the first time. Feedback from the pilot will help refine the intervention, leading to a randomized controlled trial with a larger sample.
Another goal will involve tailoring the materials to people using a what’s called a closed loop system. The closed loop system is the latest in diabetes technology. It uses an algorithm to determine insulin dosing based on CGM measurements.
The results of the ONBOARD study, while intended adults with Type 1 diabetes, will help in the development of educational materials for children and adolescents in the future.
A psychologist’s approach to diabetes research: As a doctoral student at Yeshiva University, Dr. Tanenbaum was involved in a study to assess and treat depression in adults with Type 1 diabetes. It was then that she first became aware of the burden of diabetes—just how much cognitive and emotional work goes into managing this chronic condition.
“I became interested in whether/how participants talked about diabetes when asked about depressive symptoms,” she says. She recalls one of the study participants said: “You can’t ask me a question about my life and have diabetes not be part of it.”
“I try to focus my work on ways to acknowledge and lessen some of that burden,” she says.
BY LAURA HEDLI
Laura Hedli is a writer for the Division of Neonatal and Developmental Medicine in the Department of Pediatrics and contributes stories to the Stanford Maternal and Child Health Research Institute.