Chronic Disease Management for Adolescents with Type 2 Diabetes

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DESCRIPTION (provided by applicant): Type 2 diabetes (T2DM) is recognized as a growing problem among adolescents, particularly in minority populations. While T2DM previously represented less than 5% of new diabetes diagnoses in pediatrics, it now accounts for as much as 50% of new diagnoses. The treatment of T2DM in adolescents requires comprehensive care that includes behavioral and pharmacologic interventions. Studies show that approximately 50% of adolescents with chronic problems do not comply with care recommendations. This non-adherence can be exacerbated by patient, provider and system attributes. Addressing patient, provider and system barriers to care are crucial in the development of a successful comprehensive program for the treatment of T2DM in adolescents. This proposal will advance current knowledge about T2DM in adolescents through emphasis on identifying barriers to care, and applying this information to the development and evaluation of a comprehensive intervention to improve adolescent diabetes care. To accomplish these goals I will work with Dr. Robert Dittus, Director of the Vanderbilt Center for Health Services Research, Dr. William Russell, Division Chief of Pediatric Endocrinology, and Dr. David Schlundt, Co-director of the Behavioral Core of the Vanderbilt Diabetes Research and Training Center (DRTC) to further my career development in (1) adolescent diabetes, (2) methods for identifying and measuring psychosocial determinants of adolescent behavior, and (3) designing and evaluating interventions to improve self-management behaviors and treatment adherence in adolescents with T2DM. The specific aims of this research will be to: (1) perform surveys and focus groups to identify patient/parent barriers to care for adolescents with T2DM and strategies for addressing these barriers (2) examine provider and system barriers to proper management of adolescent T2DM, and (3) to use this information to develop and implement a randomized controlled trial of a new comprehensive diabetes management program for adolescents with T2DM. The process and results of this research will provide valuable insights into adolescent diabetes, and will accelerate my future independent investigation in adolescent T2D.