Mindfulness-Based Diabetes Education for adults with elevated diabetes distress

摘要 这个K23提案的总体目标是为Caroline Presley，MD，MPH提供必要的指导，职业生涯 发展和研究经验，成为独立研究者所必需的，其患者- 以研究为导向的研究将有助于改善情绪困扰，自我管理，并在脆弱的结果 2型糖尿病患者糖尿病困扰-生活和管理糖尿病的情感负担 每天一次-影响36%的2型糖尿病患者，与糖尿病依从性差密切相关 自我管理行为，以及次优血糖控制，心血管疾病风险的存在 因素和糖尿病并发症。低收入人群受糖尿病和糖尿病 和糖尿病困扰。目前，缺乏干预措施，以同时帮助2型糖尿病成人， 改善他们的糖尿病自我管理和血糖控制，以及减少糖尿病痛苦。在这 在为期四年的K23项目中，普雷斯利博士计划研究基于正念的糖尿病教育-一种干预措施 特别适用于患有2型糖尿病和糖尿病困扰的成年人，旨在减轻压力 改善糖尿病自我管理行为和结果。在安全网医疗诊所，她 将进行一项试点随机对照试验（RCT），将这种干预措施与标准糖尿病自我治疗进行比较。 管理教育（DSME）在低收入成人控制不佳的2型糖尿病和 中重度糖尿病患者的痛苦，以评估可行性和可接受性。此外，普雷斯利博士将使用混合 评估与干预递送和实施相关的关键背景因素的方法 提供者和患者利益相关者。评估背景对于设计实施至关重要， 持续发展这些结果将为未来安全网干预措施的完全有效性研究提供信息 医疗保健系统。我们假设正念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。目的1：开展正念糖尿病教育试点RCT 与标准DSME比较，以确定在控制欠佳型成人中的可行性和可接受性 2型糖尿病和中重度糖尿病困扰。目标2：描述与下列方面有关的背景因素： 使用PRISM提供和实施基于正念的糖尿病教育。沿着这个指导 研究经验，职业发展计划已创建博士普雷斯利获得技能和经验 1）行为干预和试验，2）基于正念干预的临床应用，3）混合 方法研究和实施科学通过专家指导，高级培训，课程，和 会议，以及持续专业发展的机会。项目完成后， 博士普雷斯利将准备进行一项关于正念糖尿病教育的全面有效性研究 由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.