A Reinforcement Approach to Improve Diabetes Management

改善糖尿病管理的强化方法

• 批准号: 8436683
• 负责人: NANCY M PETRY
• 金额: $ 221.57万
• 依托单位: UNIVERSITY OF CONNECTICUT SCH OF MED/DNT
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-21 至 2017-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8436683
• 关键词: Adherence; Adolescence; Adolescent; Adoption; Adult; Adverse effects; Aftercare; Age-Years; Alcohol or Other Drugs use; Anxiety; Behavior; Behavioral; Blood Glucose; Blood Glucose Self-Monitoring; Body Weight decreased; Cellular Phone; Child; Clinic; Clinical; Cognitive; Combined Modality Therapy; Complex; Costs and Benefits; Data; Decision Making; Diabetes Mellitus; Diet; Dose; Economics; Education; Effectiveness of Interventions; Evaluation; Exercise; Family; Feedback; Frequencies; Future; Glycosylated hemoglobin A; Guidelines; Home environment; Individual; Insulin; Insulin-Dependent Diabetes Mellitus; Intervention; Lead; Long-Term Effects; Longevity; Medical; Mental Depression; Metabolic Control; Motivation; Outcome; Patients; Persons; Population; Procedures; Process; Psychological reinforcement; Quality of life; Randomized; Registries; Reporting; Rest; Risk; Safety; Self Care; Self Efficacy; Self Management; Symptoms; Techniques; Testing; Text; Time; Weight; age group; base; behavior change; blood glucose regulation; college; cost effectiveness; design; diabetes management; efficacy testing; emerging adult; experience; follow-up; food consumption; glucose monitor; improved; intervention effect; medical complication; medication compliance; new technology; novel; outcome forecast; pilot trial; primary outcome; reinforcer; secondary outcome; standard care; success; theories; trait; treatment as usual; treatment duration; young adult

DESCRIPTION (provided by applicant): Glucose control is necessary to avoid the immediate and long-term adverse effects associated with type 1 diabetes (T1D), and frequent self-monitoring of blood glucose (SMBG) is the first important step to achieving glucose control. Data suggest that large proportions of adolescents and young adults fail to adhere to standard guidelines of SMBG testing and have hemoglobin A1c levels >7.5%. A finite period of poor metabolic control can lead to increased risk of medical complications over an individual's lifespan, necessitating novel interventions to improve SMBG testing and metabolic control in emerging adults with T1D. We have extensive experience designing, adapting and testing interventions based on behavioral economic principles to improve adherence and outcomes in a variety of clinical populations. Our treatment approach, which provides direct tangible reinforcement for objective evidence of behavior change, is efficacious in decreasing substance use, reducing weight, and improving medication adherence. The purpose of this project is to develop, pilot test, and refine an intervention based on behavioral economic principles for improving SMBG in young persons with T1D. Using well-established behavioral economic principles, the intervention will provide escalating financial reinforcement for SMBG. Initially, w will conduct a feasibility/pilot test of the intervention with 10 patients for 6 months. Patients wll send a text, via cell phones, each time they SMBG, and a return text will inform them of reinforcers earned. We will collect data on SMBG frequency and A1c levels preceding treatment initiation and throughout a 6 month treatment period. Based on experiences with the pilot, procedures may be adjusted before randomizing patients (N = 60) to one of two conditions for 6 months: standard care with diabetes self management education alone or with reinforcers. Primary outcomes will include SMBG frequencies and A1c levels. A 6- month follow-up will assess enduring effects. Data from this study will provide valuable information about the feasibility, safety, and acceptability of reinforcement-based interventions for improving adherence to SMBG and reducing A1c levels. If promising, this study will lead to larger scale evaluations of reinforcement interventions alone, or in combination with multimodal treatment approaches, and it may be applied to other clinical issues such as adherence to continuous glucose monitoring. Importantly, this intervention can be administered remotely and in an automated fashion, allowing for widespread adoption if efficacious. PUBLIC HEALTH RELEVANCE: Patients with type 1 diabetes in the 15-26 year age range have the highest mean A1c levels, necessitating novel interventions to improve outcomes in this group. Blood glucose monitoring is the diabetes self care activity with which patients report the lowest level of adherence, and the activity upon which all other diabetes management decisions rest. This study will test the efficacy of a new intervention integrating behavioral economic principles to increase glucose monitoring in these patients and reduce A1c.

描述（由申请人提供）：避免与1型糖尿病（T1D）相关的直接和长期不良反应以及频繁的血糖自我监测（SMBG）是必要的，这是实现葡萄糖控制的第一个重要步骤。数据表明，大量的青少年和年轻人无法遵守SMBG测试的标准准则，并且血红蛋白A1c水平> 7.5％。有限的新陈代谢控制时期可能会导致患者的寿命增加医疗并发症的风险，因此需要采取新的干预措施来改善T1D成年人的SMBG测试和代谢控制。我们具有基于行为经济原则的设计，适应和测试干预措施的丰富经验，以提高各种临床人群的依从性和结果。我们的治疗方法为客观的行为改变提供了直接的切实强化，可以有效地减少药物使用，减轻体重和改善药物依从性。 该项目的目的是根据行为经济原则进行开发，试点测试并完善干预措施，以改善T1D年轻人的SMBG。使用良好的行为经济原则，干预将为SMBG提供不断上升的财务增强。最初，W将对10名患者进行干预6个月的干预措施进行可行性/试验测试。每次SMBG时，患者都会通过手机发送文本，返回文字会告知他们获得的增强剂。我们将在治疗开始之前以及整个6个月的治疗期内收集有关SMBG频率和A1C水平的数据。根据飞行员的经验，可以在将患者随机分组（n = 60）到两个条件中的一个持续6个月之前进行调整：单独或糖尿病自我管理教育的标准护理。主要结果将包括SMBG频率和A1C水平。 6个月的随访将评估持久影响。这项研究的数据将提供有关基于增强的干预措施的可行性，安全性和可接受性的宝贵信息，以提高对SMBG的依从性和降低A1C水平。 如果有希望的话，这项研究将导致对仅加强干预措施或与多模式治疗方法的结合进行更大的评估，并且可以应用于其他临床问题，例如遵守连续的葡萄糖监测。 重要的是，这种干预措施可以远程和自动化的方式进行，如果有效的话，可以广泛采用。 公共卫生相关性：15-26岁年龄段的1型糖尿病患者的平均A1C水平最高，需要采取新颖的干预措施来改善该组的预后。血糖监测是糖尿病的自我护理活动，患者报告的依从性水平最低，以及所有其他糖尿病管理决策所依赖的活动。这项研究将测试新的干预措施的疗效，该干预措施整合行为经济原理以增加这些患者的葡萄糖监测并减少A1C。