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，其特征在于葡萄糖水平高于正常但低于糖尿病诊断标准，是一种越来越常见的疾病，影响约5400万美国成年人。非裔美国人不成比例地受到前驱糖尿病的影响，并且经历高的糖尿病相关发病率和死亡率，包括对循环系统、肾脏和神经系统的损害。糖尿病前期患者增加身体活动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的健康行为、阻止积极行为改变的安排和维持、刺激HPA轴激活和失调（这可能对胰岛素抵抗和葡萄糖代谢具有直接影响）来负面地影响疾病的进程。非裔美国人可能会增加对压力的暴露，并增加对糖尿病等与压力相关的不良健康结果的脆弱性，因为他们独特的历史，社会文化经历和美国的社会地位帮助个人减轻压力并增加健康的应对策略可能会增强传统的糖尿病预防工作，特别是在非裔美国人中。基于正念的减压（MBSR）是一种身心实践，具有广泛的健康益处，在随机对照研究中，已被证明可显著减少心理压力和焦虑。正念训练与其他小组或个性化课程相比具有成本效益，并且可以由训练有素的教师安全有效地教授。关于正念减压疗法治疗糖尿病前期的研究很少，也没有随机对照试验。关于正念减压疗法对糖尿病前期非裔美国人亚组的可接受性，或者正念减压疗法对非裔美国人一般人群的可接受性，也几乎没有研究。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，其中包括糖尿病前期非洲裔美国人基于正念的减压培训。具体目的是：1）确定开发临床试验的可行性，以比较基于正念的糖尿病预防计划的有效性（治疗组）与传统的糖尿病预防计划（对照组）改善糖尿病前期非洲裔美国成年人的葡萄糖代谢; 2）识别与正念相关的相关生理和心理次要结果，糖尿病前期非裔美国人的教育自我保健计划; 3）通过干预后定性研究评估MBSR对糖尿病前期非裔美国人的可接受性和文化相关性，包括对参与者，辍学者和教师的采访;以及4）确定并找到解决方案，进行一项有效的临床试验，以评估基于正念的糖尿病预防计划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.