Creating Effective Self-Management for Type 2 Diabetes in Persons with Dementia

描述(申请人提供)：随着美国老年人数量的增加，患有2型糖尿病和痴呆症的老年人人数也在增加。这些老年人面临糖尿病药物自我管理不善、血糖控制不善以及随后出现严重并发症的风险。因此，这一鲜有研究的糖尿病患者亚群构成了一个日益严重的公共卫生问题。在老年人中，糖尿病是少数几个正在增加的死亡原因之一，自1987年以来，2型糖尿病的死亡率增加了45%。随着美国人口肥胖和久坐不动的生活方式的增加，糖尿病将变得更加普遍，特别是在老年人中。这项研究的目的是确定为早期痴呆症患者设计的糖尿病教育材料，加上认知干预(Space Retrival-SR)，是否可以改善患有2型糖尿病和痴呆症的老年人的药物自我管理和血糖监测以及随后的血糖控制。本研究的目标如下：(1)确定可以在多大程度上学习为改善患有2型糖尿病和早期痴呆的老年患者的药物和血糖监测相关的自我管理行为而制定的策略，以及在什么条件下使用上网本进行干预。(2)确定这些策略一旦学会，是否能够成功实施；以及(3)检查策略学习和实施与成功控制血糖相关的心理和生理结果变化之间的关系。48名患有2型糖尿病和早期痴呆症的老年人，只服用口服糖尿病药物，将被随机分配到标准教育组或标准教育+SR组。糖尿病自我管理的标准教育课程将由经过认证的糖尿病教育工作者通过Skype通过上网本提供。这一条件产生的效果将与标准教育+SR条件产生的效果进行比较。这两组人都将参加两个初始教育会议，旨在通过制定两个个性化的自我监测战略来改善服药和血糖监测。然后，两组都将参加8个额外的教育课程，重点是饮食自我管理。SR组将接受这种带有嵌入式SR治疗的教育，旨在增强保留和实施最初的两个个性化自我监控策略。在干预后1、3和6个月，组间比较和测量的主要结果指标包括策略学习和策略实施。其他结果包括情绪状态和管理糖尿病的自我效能感。对使用上网本、HgA1c和血清胆固醇面板的满意度将在最后的后测中进行评估。还将制定成本分析和卫生保健利用措施，以协助今后的翻译工作。 公共卫生相关性：患有2型糖尿病和痴呆症的老年人人数预计将继续快速增长。这一很少被研究的亚群将在未来构成一个重大的公共卫生问题。这些老年人，特别是那些独立生活的早期痴呆症患者，面临糖尿病自我管理不善和随后出现严重并发症的风险。这项研究的目的是开发与这一人群有效合作的糖尿病教育材料，并测试这些材料与称为空间检索的认知干预相结合是否将改善糖尿病的自我管理和临床结果。

DESCRIPTION (provided by applicant): As the number of older adults in the U.S. increases, the population of older adults living with co-existing Type 2 diabetes and dementia is increasing. These older adults are at risk for poor self-management of medications for diabetes, poor glycemic control, and subsequent serious complications. As such, this little- studied subpopulation of those living with diabetes constitutes a growing public health concern. Among older adults, diabetes mellitus is one of the few causes of death that is increasing in frequency, with the death rate for Type 2 diabetes increasing 45% since 1987. With increasing frequency of obesity and sedentary lifestyles in the U.S. population, diabetes will become more prevalent, especially among older adults. The purpose of this study is to determine if diabetes educational materials designed for persons with early dementia, coupled with a cognitive intervention (Space Retrieval - SR), improve self-management of medications and blood glucose monitoring and subsequent glycemic control for older adults living with both Type 2 diabetes and dementia. Objectives of the study are as follows: (1) To determine the extent to which strategies developed to improve self-management behaviors related to medications and blood glucose monitoring for older adults with Type 2 diabetes and early stage dementia can be learned, and under what conditions, using netbooks for intervention. (2) To determine whether such strategies, once learned, can be implemented successfully; and, (3) To examine the relationship between strategy learning and implementation and changes in both psychological and physiological outcomes associated with successful glycemic control. Forty-eight older adults with Type 2 diabetes and early dementia, taking oral diabetic medications only, will be randomly assigned to either a Standard Education or Standard Education + SR group. Standard Education sessions for self-management of diabetes will be delivered via netbooks with Skype by Certified Diabetes Educators. Effects produced by this condition will be compared with those produced by a Standard Education + SR condition. Both groups will participate in two Initial Education sessions designed to improve medication-taking and blood glucose monitoring through the development of two individualized self-monitoring strategies. Both groups will then participate in 8 Additional Education sessions, focused on diet self-management. The SR group will receive this education with embedded SR treatment designed to enhance retention and implementation of the original two individualized self- monitoring strategies. Primary outcome measures, compared between groups, and measured at 1, 3, and 6-months post-intervention include strategy learning and strategy implementation. Additional outcomes include mood state and perceived self-efficacy for managing diabetes. Satisfaction with the use of netbooks, and HgA1c and serum cholesterol panels, will be assessed at final posttest. Cost analyses and health care utilization measures will be developed, as well, to assist in future translation efforts. PUBLIC HEALTH RELEVANCE: The number of older adults living with both Type 2 diabetes and dementia is expected to continue increasing rapidly. This little-studied subpopulation will constitute a significant public health concern for the future. These older adults, especially those living independently with early stage dementia, are at risk for poor self-management of diabetes and subsequent serious complications. The purpose of this study is to develop diabetes educational materials that work effectively with this demographic and to test whether these materials, coupled with a cognitive intervention called Spaced Retrieval, will improve diabetes self- management and clinical outcomes.