Joint Patient and Caregiver Intervention for Older African Americans with Poorly Controlled Type 2 Diabetes (Joint Home-DM-BAT)

针对 2 型糖尿病控制不佳的老年非裔美国人的患者和护理人员联合干预 (Joint Home-DM-BAT)

• 批准号: 10644727
• 负责人: Aprill Dawson
• 金额: $ 59.7万
• 依托单位: MEDICAL COLLEGE OF WISCONSIN
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-11 至 2026-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10644727
• 关键词: Address; Adherence; Adult; African American population; Age; Behavior; Behavioral; Blood Pressure; Caregiver Burden; Caregivers; Caring; Chronic; Clinical; Cognitive Therapy; Complex; Complications of Diabetes Mellitus; Control Groups; Data; Diabetes Mellitus; Elderly; Feedback; Focus Groups; Funding; Glycosylated hemoglobin A; High Prevalence; Home; Hour; Housing; Impaired cognition; Individual; Intervention; Joints; LDL Cholesterol Lipoproteins; Learning Module; Life Style; Literature; Low income; Manuals; Mediator; Medical; Mental Depression; Mental Health; Morbidity - disease rate; Non-Insulin-Dependent Diabetes Mellitus; Nursing Faculty; Outcome; Participant; Patient-Focused Outcomes; Patients; Pilot Projects; Quality of life; Randomized; Recommendation; Resources; Risk Factors; SF-12; Schedule; Self Care; Shapes; Social isolation; Social support; Stress; Stress and Coping; Telephone; Testing; Training; Treatment Protocols; United States National Institutes of Health; care coordination; care costs; caregiver interventions; comparison control; cost effectiveness; diabetes education; diabetes management; diabetes mellitus nursing; diabetes risk; disability; efficacy evaluation; efficacy trial; ethnic minority; experience; follow-up; food insecurity; health determinants; impaired functional status; improved; informal caregiver; informal support; intervention effect; intervention mapping; loved ones; mortality; multiple chronic conditions; perceived stress; physical conditioning; pressure; psychosocial; social; social health determinants; telephone delivery; therapy development; treatment as usual

Older African Americans (AAs) have higher prevalence of type 2 diabetes (T2DM) and increased risk of diabetes related complications and mortality. In addition, older AAs are more likely to require help from caregivers to manage their diabetes and caregivers provide numerous hours of costly care daily providing physical and social support, and care coordination. However, informal/unpaid caregivers frequently have little or no formal training on managing diabetes or addressing the social risk factors associated with patient outcomes. Therefore, there is an urgent need to provide informal caregivers with appropriate training and strategies for diabetes management to reduce caregiver burden and improve their quality of life, so they can continue to care for older AAs with T2DM. Behavioral activation is a cognitive behavior therapy, originally developed to address depression, that has shown promise in individuals with chronic medical conditions, including T2DM. We are currently completing an NIH funded RCT (R01DK118038) to evaluate the efficacy and cost-effectiveness of 8 sessions of in-home, telephone-delivered, behavioral activation treatment for older adults with diabetes (Home DM-BAT). 40% of AAs in the study have informal caregivers. Caregivers have requested formal training on managing diabetes in the form of joint training sessions with participants. We conducted focus groups with participant-caregiver dyads and their feedback has guided the decision to conduct this R21 study and shaped the proposed intervention. The proposed study will test the preliminary efficacy of home-based, joint patient and caregiver intervention (Joint Home-DM-BAT) on patient clinical outcomes (hemoglobin A1c, blood pressure, and LDL-Cholesterol) and quality of life and caregiver quality of life and caregiver burden. This study fills a gap in the literature by combining diabetes education with brief behavioral activation treatment, addressing social determinants of health, and incorporating training and support for informal caregivers. Finally, this study is responsive to patient and caregiver feedback and allows incorporation of the lived experience into intervention development for older AAs with T2DM.

老年非裔美国人 (AA) 的 2 型糖尿病 (T2DM) 患病率较高，并且患糖尿病的风险也较高 糖尿病相关并发症和死亡率。此外，年龄较大的 AA 更有可能需要以下人员的帮助： 护理人员每天提供大量时间的昂贵护理，以管理他们的糖尿病 身体和社会支持以及护理协调。然而，非正式/无酬的护理人员往往没有什么 或没有关于管理糖尿病或解决与患者相关的社会风险因素的正式培训 结果。因此，迫切需要为非正式护理人员提供适当的培训和 糖尿病管理策略，以减轻护理人员的负担并提高他们的生活质量，以便他们能够 继续护理患有 T2DM 的老年 AA。行为激活疗法是一种认知行为疗法，最初 开发用于治疗抑郁症，这在慢性病患者中显示出希望， 包括 T2DM。我们目前正在完成 NIH 资助的随机对照试验 (R01DK118038)，以评估疗效和 为老年人提供 8 次家庭电话行为激活治疗的成本效益 成人糖尿病患者（Home DM-BAT）。研究中 40% 的 AA 有非正式的看护人。照顾者有 要求以与参与者联合培训课程的形式进行关于管理糖尿病的正式培训。我们 与参与者-照顾者二人组进行焦点小组讨论，他们的反馈指导了以下决定： 进行这项 R21 研究并制定拟议的干预措施。拟议的研究将测试初步结果 以家庭为基础的患者和护理人员联合干预（Joint Home-DM-BAT）对患者临床的疗效 结果（血红蛋白 A1c、血压和低密度脂蛋白胆固醇）以及生活质量和护理人员质量 生活和照顾者的负担。这项研究将糖尿病教育与简短的研究相结合，填补了文献空白。 行为激活治疗，解决健康的社会决定因素，并将培训和 对非正式护理人员的支持。最后，这项研究对患者和护理人员的反馈做出了回应，并允许 将生活经验纳入针对患有 T2DM 的老年 AA 的干预措施开发中。