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.

项目概要 低血糖是胰岛素治疗不可避免的结果。 1 型糖尿病 (T1DM) 患者 依靠症状感知作为防止发生严重低血糖的主要生理防御。最多 60% 的 T1DM 患者会出现交感肾上腺对低血糖反应减弱的情况 低血糖意识受损（IAH）。患有 IAH 的人罹患 IAH 的可能性明显更高 经历严重的、危及生命的低血糖。黑人和白人之间存在种族差异 关于严重低血糖的发生率和 IAH 的患病率。此外，目前的补救方法 IAH 依赖先进技术，这是黑人不太可能采取的干预形式 采纳。为了降低严重低血糖事件和差异的风险，了解 IAH 的新方法 是有保证的。通过显着避免低血糖可以恢复低血糖意识，但我们 相信许多人由于自我保健而无法实现足够的回避来恢复意识 导致频繁医源性高胰岛素血症以及由此导致的低血糖的行为。患有 IAH 的人 已被证明持有可能鼓励这些行为的独特态度和信念。这个团契 应用程序将确定 IAH 患者的不同态度和自我护理，描述常见的情况 IAH 患者的态度和自我保健概况，并更深入地定性解释研究结果，以启动 调查这些关系的职业调查线。研究的具体目的是（1）比较 患有或不患有 IAH 的 1 型糖尿病成人患者的态度和自我保健行为，(2) 识别态度和自我保健行为 与 IAH 分类最相符的自我护理行为模式，以及 (3) 探索之间的关系 患有 IAH 复杂性和非复杂性 T1DM 的不同种族成人群体的态度和自我护理 更好地解释聚类分析中观察到的模式。数据将从宾夕法尼亚大学的患者样本中收集 Rodebaugh 糖尿病中心是宾夕法尼亚大学医疗系统最大的糖尿病中心。数据 首先使用 ANCOVA 进行分析，以比较患有和不患有 IAH 的人的态度和自我护理行为 同时保持已识别的协变量不变。然后，我们将使用 Ward 最小值进行聚类分析 方差法来确定哪种态度和自我护理模式与 IAH 分类最相符 患有 T1DM 的成人。最后，我们将对个人访谈进行定性定向内容分析 聚集到该组中的 IAH 确定与 IAH 最佳对应以解释结果。这个团契 申请将为申请人提供成为独立人士所需的培训和研究经验 护士研究员，致力于发展 1 型糖尿病患者的自我护理、态度和 IAH 方面的专业知识。这 该提案与症状科学领域的 NINR 创新问题倡议相一致，因为它解决了心理社会如何 影响慢性疾病症状的因素。这项研究预计将有助于确定目标点 当我作为一名新兴护士科学家发展我的职业生涯时，对未来的研究进行干预。