A Mixed Methods Investigation of Attitudes and Self-Care in Individuals with Type-1 Diabetes Mellitus with Intact and Impaired Awareness of Hypoglycemia

低血糖意识完整和受损的 1 型糖尿病患者的态度和自我护理的混合方法调查

• 批准号: 10462958
• 负责人: Austin M Matus
• 金额: $ 4.68万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-05-01 至 2023-10-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10462958
• 关键词: Address; Adopted; Adult; Analysis of Covariance; Area; Attitude; Awareness; Behavior; Belief; Beta Cell; Black Populations; Black race; Chronic Disease; Classification; Cluster Analysis; Complication; Dangerousness; Data; Development; Diabetes Mellitus; Enrollment; Equipment and supply inventories; Event; Fellowship; Health system; Hospitals; Hyperglycemia; Hyperinsulinism; Hypoglycemia; Iatrogenesis; Impairment; Incidence; Individual; Insulin; Insulin-Dependent Diabetes Mellitus; Intervention; Interview; Investigation; Knowledge; Lead; Life; Measures; Methodology; Methods; Nurses; Online Systems; Patients; Pattern; Patterns of Care; Pennsylvania; Perception; Persons; Phase; Physiological; Prevalence; Procedures; Psychosocial Factor; Recording of previous events; Recovery; Research; Research Personnel; Risk; Risk Factors; Sampling; Science; Scientist; Self Care; Structure; Subjects Selections; Surveys; Symptoms; Technology; Training; Universities; behavior influence; career; combat; design; diabetes self-management; experience; innovation; lifestyle factors; mortality; novel strategies; peer; programs; racial disparity; racial diversity; recruit; response; side effect; symptom management; symptom science; ward

Project Summary Hypoglycemia is an inevitable consequence of insulin therapy. Individuals with type-1 diabetes mellitus (T1DM) rely on symptom perception as the primary physiologic defense against developing severe hypoglycemia. Up to 60% of individuals with T1DM experience blunting of the sympathoadrenal response to hypoglycemia that results in impaired awareness of hypoglycemia (IAH). Those with IAH have a significantly higher likelihood of experiencing severe, life-threatening hypoglycemia. Racial disparities exist between Black and White individuals regarding incidence of severe hypoglycemia and prevalence of IAH. Further, current approaches to remedying IAH rely on advanced technologies, a form of intervention that Black individuals are significantly less likely to adopt. To reduce risk for severe hypoglycemic events and disparities, novel approaches to understanding IAH are warranted. Hypoglycemia awareness may be restored with significant hypoglycemia avoidance, yet we believe that many individuals are unable to achieve sufficient avoidance to restore awareness due to self-care behaviors that cause frequent iatrogenic hyperinsulinemia, and resultant hypoglycemia. Individuals with IAH have been shown to hold unique attitudes and beliefs that may encourage these behaviors. This fellowship application will determine differentiating attitudes and self-care of individuals with IAH, describe the common attitude and self-care profiles of individuals with IAH, and more deeply explain findings qualitatively to launch a line of inquiry for a career investigating these relationships. The specific aims of the study are to (1) compare the attitudes and self-care behaviors in adults with T1DM with and without IAH, (2) identify clusters of attitudes and self-care behavior patterns that correspond best with IAH classification, and (3) explore the relationship between attitudes and self-care in a racially diverse group of adults with T1DM complicated and uncomplicated by IAH to better explain patterns observed in cluster analysis. Data will be collected from a sample of patients at the Penn Rodebaugh Diabetes Center, the largest diabetes center in the University of Pennsylvania Health System. Data will first be analyzed with ANCOVA to compare attitudes and self-care behaviors of those with and without IAH while holding recognized covariates constant. Then, we will perform a cluster analysis using Ward’s minimum variance method to determine what attitude and self-care patterns correspond most with IAH classification in adults with T1DM. Finally, we will perform qualitative directed content analysis of interviews of individuals with IAH who were clustered into the group determined to correspond best with IAH to explain results. This fellowship application will provide the applicant training and research experiences necessary to become an independent nurse researcher with developing expertise in self-care, attitudes, and IAH in individuals with T1DM. This proposal aligns with NINR Innovative Questions Initiative in symptom science, as it addresses how psychosocial factors influence symptoms in chronic illness. This study is anticipated to help identify targetable points of intervention for future research as I develop my career as an emerging nurse scientist.

项目摘要 低血糖是胰岛素治疗的必然结果。患有1型糖尿病的人（T1DM） 依靠症状感知作为反对患严重低血糖症的主要生理防御。到 60％的T1DM患者经历了对低血糖的交感神经反应的钝化，结果 意识到低血糖（IAH）的意识受损。那些IAH的人的可能性明显更高 患有严重的，威胁生命的低血糖。黑人和白人之间存在种族差异 考虑到严重低血糖症和IAH患病率的发生。此外，当前记住的方法 IAH依靠先进的技术，这是黑人个人明显较小的干预形式 采纳。为了降低严重降血糖事件和差异的风险，了解IAH的新方法 有必要。低血糖的意识可能会通过避免大量低血糖症来恢复，但是我们 认为许多人无法实现足够的回避以恢复由于自我保健而恢复意识 经常引起息肉性高胰岛素血症和导致的低血糖症的行为。患有IAH的人 已被证明是有独特的与会者，并认为可以鼓励这些行为。这个奖学金 申请将确定与IAH个人的不同参与者和自我保健，描述常见 IAH患者的态度和自我保健概况，更深入地解释发现的发现，以推出 调查这些关系的职业询问线。研究的具体目的是（1）比较 有或没有IAH的T1DM成年人的态度和自我保健行为，（2）确定吸引和 与IAH分类最相对应的自我护理行为模式，（3）探索 在大致多样化的T1DM成年人中，IAH对T1DM的态度和自我保健 更好地解释在群集分析中观察到的模式。数据将从宾夕法尼亚州的患者样本中收集 Rodebaugh糖尿病中心，宾夕法尼亚大学卫生系统最大的糖尿病中心。数据 将首先与ANCOVA进行分析，以比较有或没有IAH的人的参与者和自我保健行为 同时保持公认的协变量恒定。然后，我们将使用Ward的最低限度进行集群分析 确定哪种态度和自我保健模式与IAH分类最相对应的方差方法 具有T1DM的成年人。最后，我们将对个人进行定性定向内容分析 被群落到该小组中的IAH确定与IAH相对应以解释结果。这个奖学金 申请将为成为独立的申请培训和研究经验 具有T1DM个人的自我保健，参加者和IAH方面的专业知识的护士研究人员。这 提案与NINR症状科学方面的创新问题倡议保持一致，因为它解决了心理社会的如何 因素会影响慢性病的症状。预计这项研究将有助于确定 当我发展新兴护士科学家的职业生涯时，对未来的研究进行干预。