Glycemic Relapse Prevention: Maintenance Dose Assessment

点击翻译按钮获取中文摘要

DESCRIPTION (provided by applicant): The broad, long-term objectives are to generate and test hypotheses leading to theories that guide improved care of patients with diabetes. The specific aims of this project are: 1) to compare the relative effectiveness of 3 precisely defined different follow-up management strategies for preventing glycemic relapse after acceptable glycemic control is achieved; 2) to determine patient characteristics that are predictive of successful/failed relapse prevention in order to better understand the target group most likely to respond to a given maintenance plan. This project addresses a gap in our knowledge as how to maintain glycemic control after good glycemic control has been achieved. In addition, this project quantitatively addresses the maintenance dose required to prevent such relapse. The project has important health-relatedness as it allows us to translate the experimental success to the primary care setting where the majority of diabetes care occurs. The research design is a controlled trial of 150 subjects randomized into one of three varying intensity treatment arms: 1) routine ongoing standard care; 2) routine standard care plus every 3 month phone interaction with a nurse practitioner who targets all four self care behaviors (diet, activity, self monitoring of blood glucose and medication management) ; or 3) identical intervention as #2 except at a 1 month interval. This project, therefore, is unique in selecting subjects at entry who have already achieved adequate, albeit not ideal, glycemic control so as to assess the effectiveness of a "maintenance", not "induction", dose of diabetes care. Second, this line of inquiry does not attempt to answer the question of whether case management or increased resources improve glycemic control. Rather, this line of inquiry seeks to "unpack" the nature and intensity of diabetes care required to maintain glycemic control.