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.

项目摘要 成功管理2型糖尿病（T2D）需要遵守饮食，体育锻炼和 药物计划在患者及其医疗保健提供者之间达成协议。生活方式的变化涉及 在这些协作的护理计划中，通常几乎没有短期福利，而是厌恶（例如， 热量限制和体育锻炼）。但是，这些变化将来为健康带来了关键的健康益处， 允许T2D患者停止或反向疾病进展，并避免与T2D相关的并发症（例如， 肾脏疾病或糖尿病性视网膜病）。因此，成功管理2型糖尿病需要现在 以未来结果为指导的行为。不幸的是，积累证据表明患有 2型糖尿病和有这种疾病风险的糖尿病显示延迟折现率升高（即贬值 延迟后果），这表明这有助于T2D的发展和发展。因此， 显示出可提高未来估值的干预措施可能会改善T2D管理。一个这样的 干预是情节的未来思维（EFT），这是参与者生动地想象事件的一种前提形式 那可能在他们的未来发生。调查团队的初步数据表明，EFT有助于体重 T2D患者的损失并改善血糖控制。在拟议的工作中，我们将适应这些方法 检查EFT远程交付和远程结果评估的可行性（例如，体重减轻， 在地理分布的城市和农村参与者中，血糖控制和延迟折现）。因为 远程交付和评估使参与者和实验者负担最小化，这些方法可能 增加干预措施的覆盖范围，传播和影响。特定目标1将检查8-和24-- T2D患者的远程递送EFT的一周疗效在体重减轻的远程测量中 控制和延迟打折。次要措施将包括饮食召回，体育锻炼和药物 坚持。参与者将产生生动的情节活动，并通过引导智能手机应用程序提示 24周在日常生活中参与EFT或控制条件。所有参与者（EFT和控制控制） 将获得饮食和体育锻炼支持，这是针对患者的协作护理计划个性化的。 Sub-aim 1A 将比较城市和农村人口之间的结果度量，以评估EFT的疗效是否是 对农村城市差异的强大。特定目标2将检查远程EFT的可接受性。对于一个 干预措施在临床环境中有效，应该易于使用，其帮助应该显而易见 患者。因此，参与者将对可接受性的两个维度进行EFT或控制条件进行评分： 可感知的有用性和易用性。参与者还将完成简短的半结构化访谈 干预后汇报阶段，以提供有关感知优势的反馈 干预的障碍和局限性。