Mindfulness-Based Stress Reduction in Adolescents with Type 1 Diabetes

项目摘要 1型糖尿病（T1 D）是美国青少年中最普遍的慢性疾病之一， 大约每400名18岁的青少年中就有1人受到影响。患有T1 D的青少年有急性 和长期并发症，包括糖尿病酮症酸中毒，严重低血糖，以及心血管，肾脏， 和神经性疾病。维持适当的血糖控制可降低这些并发症的风险。 焦虑症状在T1 D青少年中普遍存在，发生率约为T1 D青少年的2至3倍。 一般青少年人口。焦虑症状与血糖控制超出范围、不良 生活质量（QOL）和自我管理差。减少焦虑症状的有针对性的干预措施将 有助于改善QOL和改善T1 D的自我管理，从而改善疾病结局。 尽管焦虑症状的患病率很高，而且与糖尿病相关并发症有很强的关联， 很少有循证干预措施适用于这一高风险人群。该提案使用一个 系统和迭代的方法，以适应基于证据的干预焦虑症状，正念- 基于压力减轻（MBSR），特别是为了满足这一人群的发展和生活方式的需要。 我寻求导师研究职业发展奖的目标是获得知识，技能， 成为一名独立的临床研究者所需的研究经验， 实施和测试行为干预措施，改善青少年型糖尿病患者的疾病结局 1例糖尿病（T1 D）。本建议构建并测试了一个适应性正念减压疗法的可行性和可接受性 移动健康应用程序为青少年与T1 D。这一混合方法提案的具体目标是：1. 分析与20名T1 D青少年的定性访谈，并与10名关键利益相关者进行访谈 （儿科内分泌学家、儿科内分泌（PE）执业护士、PE护士、PE心理学家和PE 社会工作者），以确定与焦虑管理，正念相关的挑战，需求和看法- 基于干预措施和mHealth应用程序功能。2.生成mHealth应用程序原型， 整合从目标1中获得的数据，以使MBSR专门适用于患有T1 D的青少年; 3a.评价 MBSR mHealth应用程序原型在40名青少年中的参与，可行性和可接受性 T1 D;和3B。探索改编的MBSR mHealth应用原型对焦虑的初步疗效 40例T1 D青少年的症状、QOL、自我管理和血糖控制。 建议的职业和学习目标是：1。发展全面的移动健康干预知识 发展和实施。2.接受正念减压疗法的强化培训。;和3.传播 通过国家和国际演讲以及同行评审的出版物得出的调查结果。 长期职业目标：建立一个强大的外部资助研究计划，以开发和传播 在临床实践中可持续和积极利用的干预措施。

PROJECT SUMMARY Type 1 diabetes (T1D) is one of the most prevalent chronic conditions in adolescents in the United States, affecting approximately 1 in 400 adolescents by 18 years of age. Adolescents with T1D are at risk for acute and long-term complications, including diabetic ketoacidosis, severe hypoglycemia, and cardiovascular, renal, and neuropathic disease. Maintaining adequate glycemic control reduces the risk of these complications. Anxiety symptoms are prevalent in adolescents with T1D, occurring at approximately 2 to 3 times the rate of the general adolescent population. Anxiety symptoms are associated with out-of-range glycemic control, poor quality of life (QOL), and poor self-management. Targeted interventions to reduce anxiety symptoms will contribute to improved QOL and improved self-management of T1D and thus improved disease outcomes. Despite the high prevalence of anxiety symptoms and strong associations with diabetes-related complications, few evidence-based interventions have been adapted for this high-risk population. This proposal uses a systematic and iterative approach to adapt an evidence-based intervention for anxiety symptoms, mindfulness- based stress reduction (MBSR), specifically to meet the developmental and lifestyle needs of this population. My goal in seeking a Mentored Research Career Development Award is to acquire the knowledge, skills, and research experience necessary to become an independent clinical investigator focused on developing, implementing, and testing behavioral interventions and improving disease outcomes in adolescents with Type 1 diabetes (T1D). This proposal constructs and tests the feasibility and acceptability of an adapted MBSR mHealth application for adolescents with T1D. The specific aims of this mixed methods proposal are to: 1. Analyze qualitative interviews with 20 adolescents with T1D and conduct interviews with 10 key stakeholders (pediatric endocrinologist, pediatric endocrinology (PE) nurse practitioner, PE nurse, PE psychologist, and PE social worker) to ascertain challenges, needs, and perceptions related to anxiety management, mindfulness- based interventions, and mHealth application features.; 2. Generate an mHealth application prototype that integrates data obtained from Aim 1 to adapt MBSR specifically for adolescents with T1D; 3a. Evaluate the MBSR mHealth application prototype for engagement, feasibility, and acceptability among 40 adolescents with T1D; and 3b. Explore preliminary efficacy of the adapted MBSR mHealth application prototype on anxiety symptoms, QOL, self-management, and glycemic control in 40 adolescents with T1D. Proposed career and learning objectives are to: 1. Develop comprehensive knowledge of mHealth intervention development and implementation.; 2. Acquire intensive training in the delivery of MBSR.; and 3. Disseminate findings through national and international presentations, and peer-reviewed publications. Long-term career goal: Build a robust program of externally-funded research to develop and disseminate interventions that are sustainable and actively utilized in clinical practice.