Community-Based Diabetes Care for Korean American Immigrants

描述（由申请方提供）：本转化研究的主要目的是对患有2型糖尿病（DM）的韩裔美国移民（KAI）进行基于社区的血糖控制干预计划的有效性试验。韩裔美国人自助干预计划（SHIP-DM）侧重于DM控制的自助方面，通过增强DM和饮食知识、利用现有技术培养患者自我监测血糖控制状态的能力、促进与医疗保健提供者的更好沟通以及提高其健康素养和一般问题解决技能，增强患者的能力。 SHIP-DM是通过NIDDK（R34）的“规划赠款”机制开发和试点测试的。在我们的初步研究中使用随机实验设计（N=80），我们能够证明SHIP-DM与KAI在干预后长达6个月的有效性和可行性。最终分析表明，SHIP-DM在显著降低HbA 1c和空腹血糖以及改善样本中的心理社会变量方面均有效： 干预组受试者的HbA 1c水平降低（18周时为1.19%，30周时为1.31%）不仅具有统计学意义，而且具有临床意义，干预组中分别有10%和15%的受试者达到了HbA 1c <7%的建议目标。与对照组相比，干预组在糖尿病知识、自我护理活动、糖尿病相关自我效能、对糖尿病的态度、抑郁和生活质量方面均有显著改善。此外，我们意识到迫切需要传播有效的干预措施，这些干预措施在语言和文化上都适合KAI。随着我们研究的消息通过朝鲜族社区的媒体传播，我们被KAI家庭和社区组织（包括美国糖尿病协会）的要求淹没，这些要求是针对KAI受众的2型糖尿病教育材料和文化相关干预措施。由于试点项目的资源限制，我们被迫拒绝了大量的KAI与2型DM谁想要参加我们的研究。 为了满足KAI社区的这一迫切需求，我们现在建议在我们的试点工作的基础上，通过进行两阶段临床试验，在更大的KAI样本和更长的随访（12个月）中测试SHIP-DM的有效性，同时建立重要的基础设施，以传播一系列旨在解决这一弱势群体的健康知识和资源需求的干预材料。 公共卫生相关性：本申请提出了一项基于社区的行为干预的随机对照试验，在语言隔离的韩国移民2型糖尿病患者中进行，终点关注（1）血糖控制和血压控制，（2）自我效能和自助技能，包括健康素养技能，以及（3）健康相关生活质量的改善。

DESCRIPTION (provided by applicant): The primary objective of this translational study is to conduct an effectiveness trial of a community-based glucose control intervention program for Korean American immigrants (KAI) with type-2 diabetes mellitus (DM). The self-help intervention program for Korean Americans ( SHIP-DM) focuses on the self-help aspect of DM control by empowering patients through enhanced knowledge of DM and diet, utilizing available technology to develop their ability for self -monitoring their glucose control status, facilitating better communication with their health care providers, and enhancing their health literacy and general problem-solving skills. The SHIP-DM has been developed and pilot tested through a "planning grant" mechanism via NIDDK (R34). Using a randomized experimental design (N=80) in our pilot study, we were able to demonstrate the efficacy and feasibility of the SHIP-DM with KAIs up to 6 months post-intervention. The final analysis suggested that the SHIP-DM was effective in both significantly lowering HbA1c and fasting glucose as well as in improving psychosocial variables in the sample: The reduction of HbA1c levels among intervention group participants (1.19% at 18 weeks and 1.31% at 30 weeks) were not only statistically significant but clinically meaningful, with 10%and 15% of the intervention group achieving the suggested goal of HbA1c < 7%. In comparison to the control group, the intervention group showed significant improvement in DM knowledge, self-care activities, DM-related self-efficacy, and their attitudes toward diabetes, depression, and quality of life. In addition, we became aware of the urgent need for disseminating effective interventions which are both linguistically and culturally tailored to KAI. As news of our study spread through media sources in the Korean ethnic community, we became inundated by requests from KAI families and community organizations (including the American Diabetes Association) for type-2 DM educational materials and culturally relevant interventions targeted toward KAI audiences. Because of the resource limitations of the pilot project, we were forced to turn away substantial numbers of KAI with type 2 DM who wanted to participate in our study. To address this critical need within the KAI community, we now propose to build upon our pilot work by conducting a two-phase clinical trial to test the effectiveness of the SHIP-DM in a larger sample of KAI and a longer follow-up (12months) while building important infrastructures for disseminating an array of intervention materials designed to address the health literacy and resources necessities for this vulnerable population. PUBLIC HEALTH RELEVANCE: This application proposes a randomized controlled trial of a community-based behavioral intervention in linguistically isolated Korean immigrants with type-2 DM with endpoint focus on the improvement of (1) glycemic control and BP control, (2) self-efficacy and self-help skills including health literacy skills, and (3) health related quality of life.