REDEEM: A Pragmatic Trial to Reduce Diabetes Distress
REDEEM: A Pragmatic Trial to Reduce Diabetes Distress
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DOI：
10.2337/dc12-2493
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发表时间：
2013-09-01
期刊：
影响因子：
16.2
通讯作者：
Strycker, Lisa A.
中科院分区：
文献类型：
--
作者：
Fisher, Lawrence;Hessler, Danielle;Strycker, Lisa A.
目的比较非临床抑郁的成人2型糖尿病(T2 DM)患者减少糖尿病困扰(DD)和改善自我管理的3种干预措施。研究设计与方法将392例成人T2 DM合并DD患者随机分为计算机辅助自我管理(CASM)、CASM+DD特定问题解决(CAPS)和计算机辅助最小支持性干预(CAPS)。主要结果是糖尿病苦恼量表(DDS)总分、情绪负担(EB)和生活方式苦恼(RD)DDS子量表，以及饮食、运动和药物依从性。结果在所有三种情况下，DD(DDS、EB和RD)和自我管理行为均显著减少(P<；0.001)，组间无显著差异。然而，存在显著的x组基线窘迫交互作用(P<；0.02)，其中在CAPS条件下高基线RD的患者比在其他两种情况下表现出显著更大的RD减少。RD产生的苦恼最多，干预后的苦恼减少最多。DD减少的速度因患者年龄的不同而不同：老年患者在干预早期表现出显著的DD减少，而年轻人在以后表现出类似的减少。DD的减少伴随着健康饮食、体力活动和服药依从性的显著改善，尽管HBA(1c)没有改变。结论DD具有可塑性，对干预具有高度的响应性。加强自我管理的干预措施也可以显著减少DD，但对于最初DD水平较高的患者，针对DD的特定干预可能是必要的。未来的研究应该确定最小、最具成本效益的干预措施，以减少DD并改善自我管理。
OBJECTIVE To compare three interventions to reduce diabetes distress (DD) and improve self-management among non-clinically depressed adults with type 2 diabetes mellitus (T2DM).RESEARCH DESIGN AND METHODS In REDEEM, 392 adults with T2DM and DD were randomized to computer-assisted self-management (CASM), CASM plus DD-specific problem solving (CAPS), or a computer-administered minimal supportive intervention. Primary outcomes were Diabetes Distress Scale (DDS) total, the Emotional Burden (EB) and Regimen Distress (RD) DDS subscales, and diet, exercise, and medication adherence.RESULTS Significant and clinically meaningful reductions in DD (DDS, EB, and RD) and self-management behaviors occurred in all three conditions (P < 0.001), with no significant between-group differences. There was, however, a significant group x baseline distress interaction (P < 0.02), in which patients with high baseline RD in the CAPS condition displayed significantly larger RD reductions than those in the other two conditions. RD generated the most distress and displayed the greatest distress reduction as a result of intervention. The pace of DD reduction varied by patient age: older patients demonstrated significant reductions in DD early in the intervention, whereas younger adults displayed similar reductions later. Reductions in DD were accompanied by significant improvements in healthy eating, physical activity, and medication adherence, although not by change in HbA(1c).CONCLUSIONS DD is malleable and highly responsive to intervention. Interventions that enhance self-management also reduce DD significantly, but DD-specific interventions may be necessary for patients with high initial levels of DD. Future research should identify the minimal, most cost-effective interventions to reduce DD and improve self-management.