A Mindfulness-based Intervention to Reduce Diabetes Risk in Prediabetic Afr-Ameri

描述（由申请人提供）：糖尿病前期，其特征是血糖水平高于正常，但低于糖尿病的诊断标准，是一种越来越常见的疾病，影响了大约5400万美国成年人。非裔美国人受到糖尿病前期的影响不成比例，糖尿病相关的发病率和死亡率很高，包括循环系统、肾脏和神经系统的损害。糖尿病前期患者增加体育锻炼和改善饮食可以降低患糖尿病的风险。心理困扰通过增加有害健康行为对病程产生负面影响；防止计划和维护积极的行为改变；刺激HPA轴的激活和失调，这可能对胰岛素抵抗和葡萄糖代谢有直接影响。由于非洲裔美国人独特的历史、社会文化经历和在美国的社会地位，他们可能更容易受到压力的影响，更容易受到与压力相关的不良健康结果的影响，比如糖尿病。帮助个人减轻压力，增加健康的应对策略，可能会加强传统的糖尿病预防工作，尤其是在非洲裔美国人中。正念减压（MBSR）是一种对健康有广泛益处的身心练习，在随机对照研究中显示，它在统计上显著减少了心理压力和焦虑。与其他小团体或个人项目相比，正念训练是经济有效的，并且可以由训练有素的教师安全有效地教授。很少有研究，也没有随机对照试验将正念减压疗法作为糖尿病前期患者的治疗方法。对于非裔美国人糖尿病前期亚群的MBSR项目的可接受性，或者对于非裔美国人一般人群的MBSR项目的可接受性，也很少有研究。这项探索性试点研究的总体目标是研究糖尿病预防教育计划的潜在功效，该计划包括对糖尿病前期非洲裔美国人进行以正念为基础的减压训练。具体目的：1)确定开展一项临床试验的可行性，以比较基于正念的糖尿病预防计划（治疗组）与传统的糖尿病预防计划（对照组）在改善糖尿病前期非洲裔美国成年人葡萄糖代谢方面的有效性；2)确定非裔美国人糖尿病前期的生理和心理次要结局与正念为基础的教育自我保健计划相关；3)通过干预后定性研究评估糖尿病前期非裔美国人MBSR的可接受性和文化相关性，包括对参与者、辍学生和教师的访谈；4)确定并找到解决方案，开展一项强有力的临床试验，以评估以正念为基础的糖尿病预防项目在改善糖尿病前期非洲裔美国人葡萄糖代谢方面的功效。

DESCRIPTION (provided by applicant): Pre-diabetes, characterized by glucose levels that are above normal but below the diagnostic criteria for diabetes, is an increasingly common condition affecting approximately 54 million U.S. adults. African Americans are disproportionately affected by pre-diabetes and experience high rates of diabetes-associated morbidity and mortality including damage to the circulatory system, kidneys, and nervous system. Patients with pre-diabetes who increase their physical activity and improve their diets have reduced risk of developing diabetes. Psychological distress negatively influences the course of the disease by increasing deleterious health behaviors; preventing scheduling and maintenance of positive behavior change; and stimulating HPA- axis activation and dysregulation, which may have a direct impact on insulin resistance and glucose metabolism. African Americans may have increased exposure to stress and increased vulnerability to adverse stress-related health outcomes like diabetes, because of their unique history, socio-cultural experiences, and societal position in the U.S. Helping individuals to reduce stress and to increase healthy coping strategies may enhance conventional diabetes prevention efforts, especially among African Americans. Mindfulness-based stress reduction (MBSR), a mind-body practice with a wide range of health benefits, has been shown to result in statistically significant reductions in psychological stress and anxiety in randomized, controlled studies. Mindfulness training is cost-effective in comparison with other small-group or individualized programs, and can be taught safely and effectively by well-trained instructors. There is little research, and no randomized, controlled trials of MBSR as a treatment for individuals with pre-diabetes. There is also little research on the acceptability of MBSR program to a pre-diabetic subgroup of African Americans, or on the acceptability of an MBSR program for a general population of African Americans. Overall goals of this exploratory pilot study are to study the potential efficacy of a diabetes prevention education program that includes training in mindfulness-based stress reduction for pre-diabetic African Americans. Specific Aims are 1) to determine the feasibility of developing a clinical trial to compare the effectiveness of a mindfulness-based diabetes prevention program (treatment group) with a conventional diabetes prevention program (control group) in improving glucose metabolism in pre-diabetic African American adults; 2) to identify relevant physiological and psychological secondary outcomes associated with a mindfulness-based, educational self-care program in African Americans with pre-diabetes; 3) to assess the acceptability and cultural relevance of MBSR for pre-diabetic African Americans via a post-intervention qualitative study, to include interviews of participants, dropouts, and instructors; and 4) to identify, and find solutions for, problems in conducting a well-powered clinical trial to assess the efficacy of a mindfulness-based diabetes prevention program in improving glucose metabolism in pre-diabetic African-Americans.