Episodic Future Thinking to Improve Management of Type 2 Diabetes in Rural and Urban Patients: Remote Delivery and Outcomes Assessment to Increase Reach and Dissemination

改善农村和城市患者 2 型糖尿病管理的情景未来思考：远程交付和结果评估以扩大覆盖范围和传播

• 批准号: 10280621
• 负责人: Jeffrey Scott Stein
• 金额: $ 34.25万
• 依托单位: VIRGINIA POLYTECHNIC INST AND ST UNIV
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-12 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10280621
• 关键词: Adherence; Behavior; Behavioral; Body Weight decreased; Caloric Restriction; Clinical; Clinical Trials; Complications of Diabetes Mellitus; Consumption; Data; Development; Diabetic Retinopathy; Diet; Dimensions; Disease; Disease Management; Disease Progression; Event; Feedback; Food; Future; Geography; Glycosylated hemoglobin A; Goals; Health Benefit; Health Personnel; Health Services Accessibility; Health behavior; Individual; Intervention; Interview; Kidney Diseases; Knowledge; Laboratories; Life Style; Measures; Mediating; Methods; Mission; Morbidity - disease rate; National Institute of Diabetes and Digestive and Kidney Diseases; Non-Insulin-Dependent Diabetes Mellitus; Obesity; Outcome; Outcome Assessment; Outcome Measure; Outcome Study; Participant; Patients; Pharmaceutical Preparations; Phase; Physical activity; Prediabetes syndrome; Psyche structure; Research; Rural; Rural Population; Structure; Thinking; Time; Urban Population; Weight; Weights and Measures; Work; base; collaborative care; cost; design; diabetes education; diabetes management; diet and exercise; dietary; discounting; disorder risk; efficacy evaluation; glycemic control; healthy lifestyle; improved; intervention effect; medication compliance; mortality; obesogenic; patient population; post intervention; prevent; primary outcome; prospective; remote delivery; remote intervention; response; rural patients; simulation; smartphone Application; therapeutic target; treatment adherence; two-dimensional; urban disparity; week trial

PROJECT SUMMARY Successful management of type 2 diabetes (T2D) requires adherence to a dietary, physical activity, and medication plan agreed upon between a patient and their healthcare providers. The lifestyle changes involved in these collaborative care plans often provide little to no short-term benefit and may instead be aversive (e.g., caloric restriction and physical activity). However, these changes provide critical health benefits in the future, allowing patients with T2D to halt or reverse disease progression and avoid T2D-related complications (e.g., renal disease or diabetic retinopathy). Thus, successful management of type 2 diabetes requires one's present behavior to be guided by future outcomes. Unfortunately, accumulating evidence indicates that individuals with type 2 diabetes and those at risk for this disorder show elevated rates of delay discounting (i.e., devaluation of delayed consequences), which prior data suggest contribute to development and progression of T2D. Thus, interventions shown to increase valuation of the future are likely to improve T2D management. One such intervention is episodic future thinking (EFT), a form of prospection in which participants vividly imagine events that might occur in their future. Preliminary data from the investigative team suggests that EFT facilitates weight loss and improves glycemic control in patients with T2D. In the proposed work, we will adapt these methods to examine the feasibility of both remote delivery of EFT and remote outcomes assessment (e.g., weight loss, glycemic control, and delay discounting) in geographically distributed urban and rural participants. Because remote delivery and assessment minimize both participant and experimenter burden, these methods may increase the reach, dissemination, and impact of the intervention. Specific Aim 1 will examine the 8- and 24- week efficacy of remotely delivered EFT in patients with T2D on remote measures of weight loss, glycemic control, and delay discounting. Secondary measures will include dietary recalls, physical activity, and medication adherence. Participants will generate vivid, episodic events and be prompted via a guided smartphone app for 24 weeks to engage in EFT or a control condition in their daily lives. All participants (EFT and control control) will receive diet and physical activity support, individualized for patients' collaborative care plans. Sub-aim 1a will compare outcome measures between urban and rural populations to evaluate whether EFT's efficacy is robust against rural-urban disparities. Specific Aim 2 will examine the acceptability of remote EFT. For an intervention to be effective in clinical settings, it should be easy to use and its helpfulness should be apparent to patients. Thus, participants will rate the EFT or control conditions along two dimensions of acceptability: perceived helpfulness and ease of use. Participants will also complete brief, semi-structured interviews during a post-intervention debriefing phase to provide feedback regarding perceived strengths, as well as possible barriers and limitations, of the intervention.

项目概要 2 型糖尿病 (T2D) 的成功管理需要坚持饮食、身体活动和 患者与其医疗保健提供者之间商定的药物治疗计划。涉及生活方式的改变 在这些协作护理计划中，短期利益通常很少甚至没有，反而可能令人厌恶（例如， 热量限制和体力活动）。然而，这些变化在未来提供了重要的健康益处， 允许 T2D 患者停止或逆转疾病进展并避免 T2D 相关并发症（例如， 肾病或糖尿病视网膜病变）。因此，成功管理 2 型糖尿病需要个人的参与 行为以未来结果为指导。不幸的是，越来越多的证据表明，患有这种疾病的人 2 型糖尿病和有患这种疾病风险的人表现出较高的延迟贴现率（即， 延迟后果），先前的数据表明这有助于 T2D 的发生和进展。因此， 能够提高未来估值的干预措施可能会改善 T2D 管理。这样的一位 干预是情景未来思维（EFT），一种参与者生动地想象事件的展望形式 这可能会发生在他们的未来。研究小组的初步数据表明 EFT 有助于减轻体重 改善 T2D 患者的血糖控制。在拟议的工作中，我们将调整这些方法以适应 检查远程提供 EFT 和远程结果评估（例如减肥、 血糖控制和延迟贴现）在地理分布的城市和农村参与者中。因为 远程交付和评估最大限度地减少了参与者和实验者的负担，这些方法可以 扩大干预的范围、传播和影响。具体目标 1 将检查 8- 和 24- 远程 EFT 对 2 型糖尿病患者的远程体重减轻、血糖测量的每周疗效 控制并延迟折扣。次要措施包括饮食回忆、身体活动和药物治疗 坚持。参与者将生成生动的情景事件，并通过引导式智能手机应用程序进行提示 24 周内进行 EFT 或日常生活中的控制条件。所有参与者（EFT 和控制控制） 将获得针对患者协作护理计划的个性化饮食和身体活动支持。分目标 1a 将比较城市和农村人口之间的结果指标，以评估 EFT 的功效是否有效 有力地消除了城乡差距。具体目标 2 将检查远程 EFT 的可接受性。对于一个 干预要在临床环境中有效，它应该易于使用，并且其帮助应该是显而易见的 患者。因此，参与者将沿着可接受性的两个维度对 EFT 或控制条件进行评级： 感知的帮助和易用性。参与者还将在一次简短的半结构化访谈中完成 干预后汇报阶段，提供有关感知优势以及可能的反馈 干预的障碍和限制。