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。

基本信息

批准号：
8601699
负责人：
LAWRENCE FISHER
金额：
$ 66.17万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
依托单位国家：
美国
项目类别：
财政年份：
2012
资助国家：
美国
起止时间：
2012-12-31 至 2017-11-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8601699
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 Endogenous depression 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 Life Style Link Maintenance 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 social standard of care theories tool type I and type II diabetes young adult

项目摘要

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) 是指在治疗糖尿病等严重、要求较高的慢性疾病时，患者所经历的一系列独特的情绪负担、忧虑和担忧。高 DD 在糖尿病患者中非常常见，并且随着时间的推移持续存在，它与血糖控制不佳、自我保健能力差、糖尿病自我效能低和生活质量差显着相关，即使在控制临床抑郁症后也是如此。 DD 的绝大多数研究都集中在患有 2 型糖尿病的成人身上，这是一种基于遗传倾向、肥胖、久坐生活方式和胰岛素抵抗的代谢疾病。关注 1 型糖尿病成人患者 DD 的不同经历的研究要少得多：这是一种自身免疫性疾病，需要比 2 型糖尿病更加强化和侵入性的管理。拟议的研究解决了 1 型糖尿病成人患者临床护理中的两个主要差距1 糖尿病和 DD：为成年 1 型糖尿病患者制定实用、可靠且有效的 DD 测量方法，并根据经验确定高 DD 的切点；并测试一个独特的、务实的、基于理论的计划，以减少高危、控制不良的 1 型成人的高 DD。在进行了一项简短的测量研究以建立高 DD 的可靠切点之后，我们提出了一项 2 组临床试验，以测试问题解决疗法改编的相对有效性，该疗法现在包括全面关注情绪、行为和认知，以及当前的护理标准——加强糖尿病教育。主要结果是减少 DD 和改善血糖控制。创新干预措施使用多种方式，其中一些基于电子和社交媒体（例如基于网络的实时群组通话、基于网络的博客、个人电话联系），以增强参与和保留，并减轻患者负担。我们还将评估选择性中介和调节变量的影响，收集成本衡量标准，并将研究结果与 RE-AIM 的传播和实施联系起来。