Intervention to Reduce Fear of Hypoglycemia and Optimize Type 1 Diabetes Outcomes

减少对低血糖的恐惧并优化 1 型糖尿病结局的干预措施

• 批准号: 9284451
• 负责人: Kimberly Driscoll
• 金额: $ 7.78万
• 依托单位: UNIVERSITY OF COLORADO DENVER
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-08-01 至 2020-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9284451
• 关键词: Acute; Adaptive Behaviors; Address; Adherence; Adolescent; Adopted; Adverse effects; Anxiety; Artificial Pancreas; Awareness; Behavior; Blindness; Blood Glucose; Brain; Carbohydrates; Caring; Child; Clinical; Coma; Complications of Diabetes Mellitus; Data; Devices; Diabetes Mellitus; Disease Management; Evidence based intervention; Fright; Future; Glucose; Goals; Grant; Health; Heart; Heart Diseases; Hyperglycemia; Hypoglycemia; Impaired cognition; Injection of therapeutic agent; Insulin; Insulin Infusion Systems; Insulin-Dependent Diabetes Mellitus; Intervention; Intervention Trial; Kidney Failure; Lead; Life; Longitudinal Studies; Measures; Mentored Patient-Oriented Research Career Development Award; National Institute of Diabetes and Digestive and Kidney Diseases; Outcome; Palpitations; Parents; Patients; Physicians; Provider; Public Health; Questionnaires; Randomized; Randomized Clinical Trials; Risk; Seizures; Surveys; Sweat; Sweating; Techniques; Technology; Testing; Training; Treatment Protocols; Unconscious State; Youth; avoidance behavior; boys; clinical care; diabetes control; effective therapy; experience; follow-up; glucose monitor; glycemic control; improved; innovation; insulin secretion; meetings; pediatric patients; personalized intervention; physical symptom; prevent; programs; psychologic; tool; uptake

Project Summary/Abstract NIDDK describes hypoglycemia as “an Achilles heel in therapy to prevent diabetes complications.” Hypoglycemia causes “difficulties with meeting blood glucose targets because [patients' and parents'] immediate fear of hypoglycemia overshadows their fear of long-term complications.” Hypoglycemia is the most common acute side effect (e.g., unpleasant physical symptoms such as sweating and heart palpitations) of intensive insulin therapy and it significantly interferes with achieving optimal glycemic control in patients with type 1 diabetes (T1D). Severe hypoglycemia is life-threatening and occurs when a shortage of glucose in the brain results in cognitive impairment, unconsciousness, or seizure. The experience of hypoglycemic episodes as a patient or a parent of a child with T1D can be psychologically traumatizing. Many studies have documented that fear of hypoglycemia increases anxiety about the T1D treatment regimen leading to engagement in “hypoglycemia avoidance behaviors,” including over-vigilant blood glucose monitoring, treating low blood glucose levels with excessive amounts of carbohydrates, and maintaining high blood glucose by intentionally withholding insulin. Ultimately, inappropriate behaviors to counteract hypoglycemia can lead to poor glycemic control and long-term complications. Thus, it is critically important to assist patients with T1D and their parents to adopt adaptive behaviors to counteract hypo- and hyperglycemia. The overall objective and Primary Aim of this project is to address the critical need of identifying and providing intervention for fear of hypoglycemia, which will be accomplished by conducting a pilot, randomized clinical trial to evaluate the efficacy of Blood Glucose Awareness Training, which has been adapted for, but never evaluated in adolescents with T1D who use insulin pumps and their parents. In addition, we will establish cutoff scores that may increase the clinical utility of the Child and Parent Versions of the Hypoglycemia Fear Survey, the only existing questionnaires to assess fear of hypoglycemia. If the aims of this project are achieved clinical care of pediatric patients with T1D and their parents will be substantially improved by 1) establishing an evidence-based intervention to treat fear of hypoglycemia; and 2) improving the clinical utility of the Hypoglycemia Fear Survey. This project is innovative and significant because it will test an intervention specifically developed for those with high fear of hypoglycemia, a potential cause of insulin pump nonadherence and a significant impediment to full utilization of the technological advances insulin pumps offer. This intervention has the potential to become more widely disseminated into a manualized treatment and training materials so that a variety of diabetes care providers will be able to implement the intervention techniques with patients with T1D and their parents.

项目摘要/摘要 NIDDK将低血糖描述为“预防糖尿病并发症的治疗中的跟腱脚跟”。 低血糖导致“满足血糖靶标的困难，因为[患者和父母] 对低血糖的直接恐惧掩盖了他们对长期并发症的恐惧。 常见的急性副作用（例如，不愉快的身体症状，例如出汗和心pal） 强化胰岛素疗法及其在患有最佳血糖控制的患者中显着干扰 1型糖尿病（T1D）。严重的低血糖症正在威胁生命，并在葡萄糖短缺中发生 大脑会导致认知障碍，无意识或癫痫发作。 作为患者或患有T1D的孩子的父母降血糖发作的经历可以是 心理创伤。许多研究表明，恐惧对低血糖会增加焦虑 关于T1D治疗方案，导致参与“低血糖避免行为”，包括 过度耐血的血糖监测，治疗低血糖水平过多 碳水化合物，并通过有意扣留胰岛素来维持高血糖。最终， 抵消低血糖的不当行为会导致血糖控制差，并且长期 并发症。这是至关重要的 抵消低血糖的行为。 该项目的总体目标和主要目的是解决识别和 为了害怕低血糖而提供干预措施，这将通过进行飞行员，随机进行 临床试验评估血糖意识训练的效率，该培训已适应，但 从未在使用胰岛素泵及其父母的T1D的青少年中评估。此外，我们将建立 截止分数可能会增加儿童和父母的临床效用 调查，唯一评估对低血糖恐惧的现有问卷。如果实现了该项目的目标 小儿T1D及其父母的临床护理将大大改善1） 基于循证的干预措施治疗对低血糖的恐惧； 2）改善 低血糖恐惧调查。该项目具有创新性和重要意义，因为它将测试干预措施 专门针对那些高度糖节恐惧的人开发的，这是胰岛素泵的潜在原因 胰岛素泵提供的完全利用技术进步的不遵守和严重障碍。 这种干预措施有可能更广泛地传播到手动治疗和 培训材料，以便各种糖尿病护理提供者能够实施干预措施 T1D患者及其父母的技术。