Reducing Distress And Improving Glycemic Control In Adults With Type 1 Diabetes.

减轻成人 1 型糖尿病患者的痛苦并改善血糖控制。

• 批准号: 8782480
• 负责人: LAWRENCE FISHER
• 金额: $ 64.19万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-12-31 至 2015-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8782480
• 关键词: Accounting; Address; Adolescence; Adult; Area; Autoimmune Diseases; Behavior; Behavioral; Childhood; Chronic Care; Chronic Disease; Clinical; Clinical Trials; Cognition; Cognitive; Cost Measures; Diabetes Mellitus; Diagnosis; Disease; Disease Management; Distress; Effectiveness; Elderly; Electronics; Emotional; Emotions; Evidence based intervention; Evidence based program; Future; Genetic Predisposition to Disease; High Prevalence; Incidence; Injection of therapeutic agent; Insulin; Insulin Resistance; Insulin-Dependent Diabetes Mellitus; Intervention; Joints; Knowledge; Learning; Link; Maintenance; Major Depressive Disorder; Manuals; Measurement; Measures; Mediating; Metabolic Diseases; Modality; Motivation; Non-Insulin-Dependent Diabetes Mellitus; Obesity; Online Systems; Outcome; Patients; Population; Populations at Risk; Prevalence; Principal Investigator; Public Health; Quality of Care; Quality of life; Relative (related person); Research; Risk; Self Care; Self Efficacy; Self Management; Telephone; Testing; Time; Titrations; arm; base; clinical care; comparative effectiveness; cost; diabetes education; experience; glycemic control; high risk; improved; inclusion criteria; innovation; middle age; neglect; patient population; primary outcome; problem solving therapy; programs; prospective; public health relevance; remediation; sedentary lifestyle; social; standard of care; theories; tool; type I and type II diabetes; young adult

DESCRIPTION (provided by applicant): Diabetes distress (DD) refers to the unique emotional burdens, worries and concerns that are part of the spectrum of patient experience when managing a severe, demanding chronic disease like diabetes. High DD is very common and persistent over time among those with diabetes, and it has been significantly associated with poor glycemic control, poor self-care, low diabetes self-efficacy, and poor quality of life, even after controlling for clinical depression. The vast majority of research in DD has focused on adults with type 2 diabetes, a metabolic disease based on genetic predisposition, obesity, sedentary lifestyle and insulin resistance. Far less research has focused on the very different experiences of DD among adults with type 1 diabetes: an autoimmune disease that requires much more intensive and intrusive management than type 2. The proposed research addresses two major gaps in the clinical care of adult patients with type 1 diabetes and DD: to develop a practical, reliable and valid measure of DD for adult patients with type 1 diabetes, with empirically defined cut- points for high DD; and to test a unique, pragmatic, theory based program to reduce high DD among at-risk, poorly controlled type 1 adults. Following a brief measurement study to establish reliable cut-points for high DD, we propose a 2-arm clinical trial to test the comparative effectiveness of an adaptation of Problem Solving Therapy, which now includes a comprehensive focus on emotion, behavior and cognition, with a current standard of care - enhanced diabetes education. Primary outcomes are reduced DD and improved glycemic control. The innovative intervention uses a variety of modalities, some based on electronic and social media (e.g., real time web-based group calls, web-based blogging, personal telephone contact) to enhance participation and retention, and reduce patient burden. We will also assess the impact of selective mediating and moderating variables, collect measures of cost, and will link the findings to dissemination and implementation using RE-AIM.

描述（由申请人提供）：糖尿病困扰（DD）是指在管理严重，苛刻的慢性疾病（如糖尿病）时，是患者体验的一部分的独特情感负担，担忧和关注点。在患有糖尿病患者中，高DD非常普遍且持久，并且即使在控制临床抑郁症之后，它也与血糖控制不良，自我护理，低糖尿病自我效能和生活质量差的差异很大。 DD的绝大多数研究都集中在2型糖尿病的成年人上，这是一种基于遗传易感性，肥胖，久坐的生活方式和胰岛素抵抗的代谢疾病。研究的研究少得多，而是在患有1型糖尿病的成年人中的DD经历截然不同的经验：一种自身免疫性疾病，需要比第2型需要更深入和侵入性的管理。拟议的研究解决了1型糖尿病和DD的成年患者的临床护理中的两个主要差距：对于成年患者的一定程度，可用于成年患者的DD型，并有效地指出了DD，该级别的DD型均为1型型型型糖尿病患者，该级别的型号是Dy-Prive type dia type typer typire dy Dypir，该型号均可使用DD DIA型，并且需要进行1型糖尿病患者，并需要进行1型糖尿病患者，并需要进行。并测试一个独特的，务实的基于理论的计划，以减少处于风险，控制不良的1型成人中的高DD。经过一项简短的测量研究，为高DD建立了可靠的切点，我们提出了一项2臂临床试验，以测试适应问题疗法的比较有效性，现在包括对情绪，行为和认知的全面关注，并具有当前的护理标准的护理标准 - 增强的糖尿病教育。主要结果减少了DD并改善血糖控制。创新的干预措施采用了各种方式，其中一些基于电子和社交媒体（例如，基于Web的小组呼叫，基于Web的博客，个人电话联系）来增强参与和保留，并减轻患者负担。我们还将评估选择性调解和调节变量的影响，收集成本度量，并将发现与使用RE-AIM进行传播和实施联系起来。