Improving Diabetes Outcomes: The Diabetes Support Project

描述（由申请人提供）：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，以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关系有助于患者控制糖尿病。这项研究的目的是测试针对夫妇及其关系的干预是否比只针对个人的干预能更好、更持久地改善血糖控制。这项研究具有很高的创新性，因为它是第一个将夫妇作为干预目标的研究。这项研究也很重要，因为我们建议通过电话进行干预，以增加对更多样化和更多数量的患者的影响。具体目的是衡量夫妻干预与个人干预和常规护理相比的相对效益。在一组中，受试者将参加糖尿病自我管理教育（DSME）的两次接触（与一名认证的糖尿病教育者），然后进行常规护理。在一个积极治疗组中，个体受试者也将接受DSME，随后有10位联系人进行个性化目标设定并处理情绪和糖尿病。在另一个积极治疗组，患者和他们的伴侣将一起参与，也接受DSME，随后有10个联系人进行个性化目标设定，并解决关系和糖尿病问题。夫妻组将通过家庭作业和互动讨论进行协作。我们相信，更好的合作伙伴合作将对医疗、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，从而对糖尿病的预后产生更大的影响。伴侣确实对病人有影响，有时是好的，有时是坏的。现在是努力增强这种效应的积极效益的时候了。如果证明夫妻干预能带来重大而持久的行为改变和医疗成果，将导致对其他干预措施进行调整，使其包括伴侣并促进夫妻合作，以及今后确定这种干预措施对谁最有帮助的工作。

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.