# Precision Monitoring: Understanding Momentary Affect, Glucose, and Self-care Behaviors in Adolescents and Young Adults with type 1 diabetes > **NIH NIH K23** · JOSLIN DIABETES CENTER · 2024 · $190,263 ## Abstract PROJECT SUMMARY/ABSTRACT Adolescents and Young Adults (AYA) with type 1 diabetes (T1D) have the highest hemoglobin A1c values of all across the lifespan. Continuous Glucose Monitoring (CGM) is a modern approach to glucose assessment that provides in-the-moment information about glucose levels to help optimize time-in-range ([TIR] 70-180 mg/dL). Retrospective review of ambulatory glucose patterns is an essential component for improving diabetes self-care. However, many CGM users become overwhelmed by the voluminous CGM data and rarely review or download their CGM. Furthermore, interpretation of CGM data should not occur in a vacuum, rather one should consider contextual factors that impact self-care in order to improve glycemic regulation. Thus, to maximize the clinical value of CGM in AYA with T1D, a novel, ecologically grounded approach is needed to contextualize CGM data with information on the intra- and inter-personal context in which glucose regulation occurs. It is timely to pair ecological momentary assessment (EMA) with CGM to develop an intervention program to improve self-care, glycemia, and psychosocial outcomes. We will use rigorous methods to capture dynamic relationships between in-the-moment ratings of emotional and social experiences (using EMA) and CGM-recorded glucose values, which will be collectively displayed on a dashboard, encapsulating the emotional and social context of ambulatory glucose (psychosocial ambulatory glucose [PAG]). Tracking and reviewing of PAG patterns, along with ongoing structured support, within a multicomponent intervention, will help AYA with T1D to better interpret and behaviorally respond to out-of-range glucose values, and may serve as a catalyst to improve A1c, TIR, and self-care, as well as reduce diabetes distress. Amit Shapira, PhD, proposes a series of studies with an overarching goal of developing, iteratively refining, and testing a PAG intervention in AYA with T1D. The proposed 3 specific aims are: 1) to identify salient components of a PAG dashboard using EMA that will coordinate the display of emotional and social context coupled with CGM recorded data to enhance self-care of AYA with T1D above target A1c values using mixed methods; 2) to adapt and build upon the dashboard for use in a behavioral intervention through expert feedback and guidance from pertinent stakeholders; and 3) to examine if a pilot RCT of a refined PAG behavioral intervention will be acceptable, feasible, and satisfactory to participants and have potential to improve diabetes and psychosocial outcomes compared with PAG-alone. Results from these studies will inform a fully powered RCT for a future R01 application. Dr. Shapira’s career objective is to become an independent diabetes behavioral researcher focused on optimizing self-care, including use of CGM and other technologies, to improve outcomes for people with T1D. The 5-year, mentored career development program will provide her with necessary skills in diabetes car... ## Key facts - **NIH application ID:** 10909372 - **Project number:** 5K23DK134877-02 - **Recipient organization:** JOSLIN DIABETES CENTER - **Principal Investigator:** Amit Shapira - **Activity code:** K23 (R01, R21, SBIR, etc.) - **Funding institute:** NIH - **Fiscal year:** 2024 - **Award amount:** $190,263 - **Award type:** 5 - **Project period:** 2023-09-01 → 2028-07-31 ## Primary source NIH RePORTER: https://reporter.nih.gov/project-details/10909372 ## Citation > US National Institutes of Health, RePORTER application 10909372, Precision Monitoring: Understanding Momentary Affect, Glucose, and Self-care Behaviors in Adolescents and Young Adults with type 1 diabetes (5K23DK134877-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10909372. Licensed CC0. --- *[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*