Improving Diabetes Outcomes: The Diabetes Support Project

描述(申请人提供)：研究表明，强化血糖控制可以减少或预防严重的糖尿病相关并发症。然而，需要开发创新的干预措施，帮助患者实现良好和持久的控制。我们知道，牢固的家庭和婚姻纽带有助于患者控制糖尿病。这项研究的目的是测试针对夫妇和他们的关系的干预是否比只关注个人的干预在血糖控制方面带来更好、更持久的改善。这项研究具有很高的创新性，因为它是第一次将这对夫妇作为干预的目标。这项研究也很有意义，因为我们建议通过电话进行干预，以扩大到更多样化和更多数量的患者。具体目的是衡量夫妇干预与个人干预和常规护理相比的相对好处。在一组中，受试者将参加两次糖尿病自我管理教育(DSME)的接触(与经认证的糖尿病教育者)，然后进行常规护理。在一个积极的治疗组中，个别受试者也将接受DSME，随后是10个联系人，以个性化目标设定并解决情绪和糖尿病问题。在另一个积极治疗组，患者和他们的伴侣将一起参与，并接受DSME，随后是10个联系人，以个性化目标设定和解决关系和糖尿病。情侣小组将通过家庭作业和互动讨论进行合作。我们相信，更好的合作伙伴协作将对医疗、依从性和情感结果产生积极影响，所取得的成果将更加持久，从而对糖尿病结果产生更大影响。伴侣确实会对病人产生影响，有时是好的，有时是坏的。现在是时候努力加强这一效果的积极好处了。证明夫妻干预会导致显著和持久的行为改变和医疗收益，这将导致对其他干预措施的调整，以包括伴侣和促进夫妻合作，以及未来确定这种干预对谁最有帮助的工作。 公共卫生相关性：2型糖尿病会导致严重的健康问题，如果患者保持良好的血糖控制，这些问题可能会减少或推迟。这项研究测试了与伴侣一起教育患者是否比单独教育患者更好，并使用电话来做到这一点。这项研究意义重大，因为专注于夫妇的电话干预可以帮助更多的糖尿病患者更长时间地控制血糖。这将导致改善公共卫生，并解决人们对糖尿病相关健康问题令人震惊的上升的重大关切。

DESCRIPTION (provided by applicant): Studies have shown that intensive blood sugar control can reduce or forestall serious diabetes-related complications. However, innovative interventions need to be developed that can help patients achieve good, and lasting, control. We know that strong family and marital bonds help patients manage diabetes. The purpose of this study is to test whether an intervention that targets the couple and their relationship leads to better, and more lasting, improvements in blood sugar control than one that focuses only on the individual. This study is highly innovative as it is the first to address the couple as the target of the intervention. This study is also significant because we propose to deliver the intervention by telephone to increase reach to more diverse and larger numbers of patients. The specific aims are to measure the relative benefits of a couples intervention compared to an individual intervention and usual care. In one group, subjects will participate in two contacts (with a certified diabetes educator) of diabetes self- management education (DSME) followed by usual care. In one active treatment group, individual subjects will also receive DSME, followed by 10 contacts to individualize goal- setting and address emotions and diabetes. In the other active treatment group, patients and their partners will participate together and also receive DSME, followed by 10 contacts to individualize goal-setting and address relationships and diabetes. The Couples group will work collaboratively via homework and interactive discussions. We believe that better partner collaboration will have a positive impact on medical, adherence, and emotional outcomes, and that the gains achieved will be more lasting, and thus have a greater impact on diabetes outcomes. Partners do have an effect on patients, sometimes good, sometimes bad. It is time to try to enhance the positive benefits of that effect. A demonstration that a couples intervention results in significant and lasting behavior change and medical gains will lead to a tailoring of other interventions to include partners and to promote couples collaboration, as well as future work to identify for whom this intervention is most helpful. PUBLIC HEALTH RELEVANCE: Type 2 diabetes causes serious health problems that can be decreased or delayed if patients maintain good blood sugar control. This study tests whether it is better to educate patients with their partners rather than the patient alone, and does so using the telephone. The study is significant because a couples focused, telephone-administered intervention can help more diabetes patients with their blood sugar control for a longer time. This will lead to improved public health and address the significant concerns about the alarming rise in diabetes-related health problems.