Mindfulness-Based Diabetes Education for adults with elevated diabetes distress

摘要 这项K23提案的总体目标是为医学博士Caroline Presley、公共卫生硕士Caroline Presley提供必要的导师、职业生涯 成为一名独立调查员所需的开发和研究经验，其患者- 有针对性的研究将有助于改善弱势群体的情绪困扰、自我管理和结果 患有2型糖尿病的人。糖尿病痛苦-与糖尿病一起生活和管理的情感负担 每日一次-影响36%的2型糖尿病患者，并与糖尿病依从性差密切相关 自我管理行为，以及血糖控制不佳，存在心血管疾病风险 因素，和糖尿病并发症。低收入人群受这两种糖尿病的影响不成比例 和糖尿病痛苦。目前，缺乏同时帮助成人2型糖尿病患者的干预措施 改善糖尿病自我管理和血糖控制，减少糖尿病痛苦。在这 为期四年的K23项目，普雷斯利博士计划研究基于正念的糖尿病教育--一种干预 专为患有2型糖尿病和以减轻压力为目标的糖尿病痛苦升高的成年人而设计 改善糖尿病患者的自我管理行为和预后。在安全网医疗诊所，她 将进行一项试点随机对照试验(RCT)，将这种干预与标准的糖尿病自我干预进行比较 管理教育(DSME)在低收入成人2型糖尿病患者中的应用 评估中-重度糖尿病痛苦评估的可行性和可接受性。此外，普雷斯利博士将使用混合 评估与干预提供和实施相关的关键背景因素的方法获得投入 来自提供者和患者利益相关者。评估环境在设计实施过程中至关重要， 可持续发展。这些结果将为未来对安全网干预的全动力疗效研究提供参考 医疗保健系统。我们假设以正念为基础的糖尿病教育是可以接受和可行的 -通过这些具体目标进行测试。目标1：开展以正念为基础的糖尿病教育RCT试点 与标准DSME比较以确定次优控制型成人患者的可行性和可接受性 2糖尿病和中重度糖尿病困扰。目标2：描述与以下内容相关的背景因素 运用PRISM实施以正念为基础的糖尿病教育与此一起被指导的是 研究经验，为普雷斯利博士制定了职业发展计划，以获得技能和经验 在1)行为干预和试验中，2)基于正念的干预的临床应用，3)混合 方法通过专家指导、高级培训、课程作业和 会议，以及持续专业发展的机会。工程竣工后， 普雷斯利博士将准备对以正念为基础的糖尿病教育进行一项全面的疗效研究 R系列赠款支持的干预措施。

Abstract The overall goal of this K23 proposal is to provide Caroline Presley, MD, MPH the essential mentorship, career development, and research experience necessary to become an independent investigator whose patient- oriented research will contribute to improving emotional distress, self-management, and outcomes in vulnerable people with type 2 diabetes. Diabetes distress — the emotional burden of living with and managing diabetes on a daily basis — affects 36% of people with type 2 diabetes and is closely linked with poor adherence to diabetes self-management behaviors, as well as suboptimal glycemic control, the presence of cardiovascular disease risk factors, and diabetes complications. Low-income individuals are disproportionately affected by both diabetes and diabetes distress. Currently, interventions are lacking to simultaneously help adults with type 2 diabetes to improve their diabetes self-management and glycemic control, as well as to reduce diabetes distress. In this four-year K23 project, Dr. Presley plans to study Mindfulness-Based Diabetes Education — an intervention specifically adapted for adults with type 2 diabetes and elevated diabetes distress that targets stress reduction and improvement of diabetes self-management behaviors and outcomes. In safety-net healthcare clinics, she will conduct a pilot randomized controlled trial (RCT) comparing this intervention to standard Diabetes Self- Management Education (DSME) in low-income adults with suboptimally controlled type 2 diabetes and moderate-severe diabetes distress to assess feasibility and acceptability. Additionally, Dr. Presley will use mixed methods to evaluate key contextual factors related to intervention delivery and implementation obtaining input from provider and patient stakeholders. Assessing context is critical in designing for implementation and sustainability. These results will inform a future fully-powered efficacy study of the intervention in safety-net healthcare systems. We hypothesize that Mindfulness-Based Diabetes Education will be acceptable and feasible — tested through these specific aims. Aim 1: To conduct a pilot RCT of Mindfulness-Based Diabetes Education versus standard DSME to determine feasibility and acceptability among adults with suboptimally controlled type 2 diabetes and moderate-severe diabetes distress. Aim 2: To characterize the contextual factors relevant to delivery and implementation of Mindfulness-Based Diabetes Education using PRISM. Along with this mentored research experience, the career development plan has been created for Dr. Presley to gain skills and experience in 1) behavioral interventions and trials, 2) clinical application of mindfulness-based interventions, 3) mixed methods research and implementation science through expert mentorship, advanced trainings, coursework, and conferences, as well as opportunities for continued professional development. Upon completion of the project, Dr. Presley will be poised to conduct a fully-powered efficacy study of the Mindfulness-Based Diabetes Education intervention supported by an R-series grant.