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

描述（由申请人提供）：随着美国老年人数量的增加，同时患有2型糖尿病和痴呆的老年人数量正在增加。这些老年人面临糖尿病药物自我管理不良、血糖控制不良以及随后严重并发症的风险。因此，这个很少被研究的糖尿病患者亚群构成了一个日益增长的公共健康问题。在老年人中，糖尿病是为数不多的死亡率增加的原因之一，自1987年以来，2型糖尿病的死亡率增加了45%。随着美国人口中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，尤其是在老年人中。本研究的目的是确定为早期痴呆患者设计的糖尿病教育材料，加上认知干预（空间检索- SR），是否能改善老年2型糖尿病和痴呆患者对药物和血糖监测的自我管理以及随后的血糖控制。本研究的目的如下：(1)确定在何种程度上可以学习改善老年2型糖尿病和早期痴呆患者与药物和血糖监测相关的自我管理行为的策略，以及在何种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；(3)研究策略学习和实施与成功控制血糖相关的心理和生理结果的变化之间的关系。48名患有2型糖尿病和早期痴呆的老年人，仅服用口服糖尿病药物，将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认证糖尿病教育者通过带有Skype的上网本提供。此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。两组都将参加两个初始教育课程，旨在通过开发两种个性化的自我监测策略来改善药物服用和血糖监测。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组将接受这种教育，并采用嵌入式SR治疗，旨在增强原始两种个性化自我监测策略的保留和实施。在干预后1、3和6个月，组间比较的主要结果测量包括策略学习和策略实施。其他结果包括情绪状态和对糖尿病管理的自我效能感。上网本的使用满意度、HgA1c和血清胆固醇水平将在最终的测试后进行评估。还将制定成本分析和保健利用措施，以协助今后的翻译工作。

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.