HOME DM-BAT: Home-based Diabetes-Modified Behavioral Activation Treatment for Low Income Seniors with T2DM

HOME DM-BAT：针对患有 T2DM 的低收入老年人的家庭糖尿病改良行为激活治疗

• 批准号: 10337201
• 负责人: Leonard E. Egede
• 金额: $ 64.75万
• 依托单位: MEDICAL COLLEGE OF WISCONSIN
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-04-01 至 2024-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10337201
• 关键词: Address; African American population; Area; Behavior; Behavior Therapy; Behavioral; Blood Glucose Self-Monitoring; Blood Pressure; Chronic; Chronic Disease; Clinical; Code; Cognitive Therapy; Complex; Complications of Diabetes Mellitus; Control Groups; Data; Diabetes Mellitus; Elderly; Ethnic Origin; Glycosylated hemoglobin A; Goals; Health; Healthcare; Home; Housing; Impaired cognition; Individual; Intervention; LDL Cholesterol Lipoproteins; Language; Latina; Life Style; Low income; Maintenance; Measures; Mediator of activation protein; Medical; Mental Depression; Mental Health; Meta-Analysis; Metabolic Control; Minority; Morbidity - disease rate; Non-Insulin-Dependent Diabetes Mellitus; Nursing Faculty; Outcome; Patients; Personal Satisfaction; Pilot Projects; Population; Psychosocial Factor; Psychosocial Influences; Quality of life; Race; Randomized; Recommendation; Resources; Role; SF-12; Schedule; Self Care; Social Environment; Social isolation; Socioeconomic Status; Stress and Coping; Supportive care; Testing; Training; Treatment Efficacy; Treatment Protocols; Underserved Population; United States; United States Agency for Healthcare Research and Quality; Walkers; base; behavioral adherence; behavioral health; behavioral outcome; cost effective; cost effectiveness; design; diabetes education; diabetes management; diabetes mellitus nursing; dietary adherence; disability; effectiveness evaluation; efficacy evaluation; efficacy testing; efficacy trial; ethnic minority; ethnic minority population; exercise adherence; experience; follow-up; food insecurity; glycemic control; health care disparity; health disparity; impaired functional status; improved; improved outcome; medication compliance; mortality; multiple chronic conditions; older patient; physical conditioning; premature; program costs; psychosocial; racial and ethnic; racial and ethnic disparities; social; social health determinants; social stigma; treatment comparison

Persistent disparities based on race/ethnicity and socioeconomic status in healthcare are well documented in the United States. Social determinants of health are key drivers of health disparities, especially in the elderly. Type 2 diabetes (T2DM) is a chronic disease that is highly prevalent in the elderly, associated with significant racial/ethnic disparities, and impacted by social determinants of health. Elderly individuals with diabetes have high multimorbidity, complex treatment regimens, impaired functional status and are often impacted by psychosocial determinants of health such as food insecurity, housing insecurity, competing needs, stress/coping, cognitive dysfunction, limited social and financial resources, and social isolation. Behavioral activation is a cognitive behavior therapy, originally developed to address depression, that has shown promise in individuals with chronic medical conditions, including T2DM. Therefore, especially among racial/ethnic minority elderly patients with diabetes, interventions that directly addresses psychosocial issues and social context factors that can influence lifestyle behaviors in the treatment and management of diabetes are likely to improve clinical outcomes and general well-being. Preliminary data from our group has demonstrated that 8 sessions of culturally-modified, manualized, diabetes-modified, behavioral activation treatment that incorporates: 1) diabetes education, 2) addresses social determinants of health (e.g. food insecurity, housing insecurity, competing needs, stress/coping etc.), and 3) brief behavioral activation treatment achieved maintenance of glycemic control in older adults with T2DM. This project will evaluate the efficacy and cost- effectiveness of 8 sessions of in-home, group-based, manualized diabetes-modified behavioral activation treatment (Home DM-BAT) delivered by trained diabetes nurse educators to low income, minority elders living in independent senior housing. The proposed study will test new strategies for improving clinical outcomes for T2DM in minority elders by addressing both diabetes-specific factors and social determinants of health.

医疗保健领域基于种族/民族和社会经济地位的持续差异在 美国。健康的社会决定因素是健康差异的关键驱动因素，尤其是老年人。 2 型糖尿病 (T2DM) 是一种在老年人中高度流行的慢性疾病，与显着的糖尿病相关 种族/民族差异，并受到健康社会决定因素的影响。老年糖尿病患者有 多发病率高，治疗方案复杂，功能状态受损，并且经常受到以下因素的影响 健康的社会心理决定因素，例如粮食不安全、住房不安全、相互竞争的需求、 压力/应对、认知功能障碍、有限的社会和经济资源以及社会孤立。行为方面 激活是一种认知行为疗法，最初是为了解决抑郁症而开发的，现已显示出希望 患有慢性疾病（包括 T2DM）的个体。因此，特别是在种族/族裔之间 少数民族老年糖尿病患者，直接解决心理社会问题和社会问题的干预措施 可以影响糖尿病治疗和管理中的生活方式行为的背景因素可能 改善临床结果和总体健康状况。我们小组的初步数据表明，8 文化改良、手动化、糖尿病改良、行为激活治疗课程 包括：1) 糖尿病教育，2) 解决健康的社会决定因素（例如粮食不安全、住房问题） 不安全感、竞争性需求、压力/应对等），以及 3）实现简短的行为激活治疗 维持老年 T2DM 患者的血糖控制。该项目将评估功效和成本 8 次家庭、小组、手动糖尿病修正行为激活课程的有效性 由经过培训的糖尿病护士教育工作者为低收入、少数族裔老年人提供治疗 (Home DM-BAT) 在独立的老年住房中。拟议的研究将测试改善临床结果的新策略 通过解决糖尿病特定因素和健康的社会决定因素来治疗少数民族老年人的 T2DM。