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Reducing Stress in Adolescents and Young Adults with T1D to Improve Diabetes Care

减轻患有 T1D 的青少年和年轻人的压力以改善糖尿病护理

基本信息

批准号：
8436956
负责人：
DEBORAH A. ELLIS
金额：
$ 234.31万
依托单位：
WAYNE STATE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2012
资助国家：
美国
起止时间：
2012-09-21 至 2017-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8436956
关键词：
Adolescence Adolescent Adult Affect Attention Awareness Behavior Behavior Therapy Blood Glucose Caring Catecholamines Clinical Trials Cognitive Therapy Complex Complications of Diabetes Mellitus Consensus Data Development Diabetes Mellitus Distress Event Exposure to Generations Goals Health Health Status Healthcare Hormones Hydrocortisone Insulin Insulin-Dependent Diabetes Mellitus Intervention Life Longitudinal Studies Measures Mental Depression Metabolic Metabolic Control Metabolism Outcome Participant Patient Self-Report Persons Phase Physiological Problem Solving Protocols documentation Quality of life Randomized Randomized Clinical Trials Research Personnel Risk Role Sampling Self Care Signal Transduction Stress Stressful Event Symptoms Testing Thinking Time Series Analysis Training Vulnerable Populations Youth aged base design diabetes management efficacy testing experience glycemic control high risk improved innovative technologies mindfulness mindfulness-based stress reduction novel physical conditioning psychologic response satisfaction stress management stressor therapy development treatment strategy treatment trial trial comparing young adult

项目摘要

DESCRIPTION (provided by applicant): Suboptimal diabetes management (DM) is an important factor in the development of poor metabolic control. Adolescence and young adulthood are developmental periods marked by increased risk for poor DM. Therefore, interventions to improve illness management difficulties in older adolescents and young adults (OAYA) with T1D have the potential to significantly improve health outcomes and quality of life. Exposure to stress significantly increases vulnerability to poor health outcomes. A significant body of both cross-sectional and longitudinal studies demonstrates that stress affects both DM and metabolic control in persons with T1D. Despite the large number of studies showing the importance of reducing stress, to date, stress management interventions have been ineffective in improving health outcomes for adolescents and adults with T1D. There are two significant problems with stress management treatments as currently applied to T1D. First, CBT-based interventions have largely relied on participant self-report to determine which life events are causing stress and, thus, impairing DM. However, self-reports of illness management behaviors are notoriously biased/inaccurate. Therefore, stress management interventions for OAYA may have unsuccessful not due to the ineffectiveness of cognitive behavioral treatment approaches per se, but rather due to inadequate targeting of those stressors that are most responsible for derailing DM. Second, a new generation of behavioral therapies called mindfulness approaches focus on changing the meaning of psychological events that people experience, rather than on changing or modifying the events themselves. Therefore, effective stress management interventions for OAYA with T1D may also need to utilize new treatment strategies such as mindfulness. The goal of the proposed study is to develop a potent diabetes management intervention for OAYA aged 16-20 with T1D using a phased approach to intervention development. In Phase 1, we will use an innovative technology (Electronically Activated Recorder; EAR) to more accurately identify stressors that affect DM in OAYA with T1D. In Phase 2, we will use this data to adapt existing CBT interventions previously used with OAYA to increase their efficacy. We will also adapt a mindfulness approach (Mindfulness Based Stress Reduction; MBSR) for use with OAYA with T1D. Next, we will test for signals of efficacy for each of the two approaches to reduce stress and improve DM, as well as evaluating implementation feasibility and satisfaction rates. In Phase 3, we will conduct a pilot randomized clinical trial (RCT) among OAYA with poorly controlled T1D comparing the most successful Phase 2 stress management approach to an attention control condition. PUBLIC HEALTH RELEVANCE: Older adolescents and young adults with poor diabetes management are at high risk for short and long-term diabetes complications and are also heavy users of health care dollars. The primary purpose of the proposed study is to develop and test the efficacy of a novel stress management intervention to improve diabetes management using a phased approach to intervention development. If successful, the stress management intervention would have the potential to improve health outcomes and quality of life in a vulnerable population.

描述（由申请人提供）：次优糖尿病管理（DM）是代谢控制不良的重要因素。青春期和青年期是以不良DM风险增加为标志的发育期。因此，改善患有T1 D的大龄青少年和年轻人（OAYA）疾病管理困难的干预措施有可能显着改善健康结果和生活质量。暴露在压力之下会大大增加健康状况不佳的可能性。一个重要的机构的横向和纵向研究表明，压力影响糖尿病和代谢控制的人与T1 D。尽管大量研究表明减轻压力的重要性，但迄今为止，压力管理干预措施在改善T1 D青少年和成人的健康结果方面无效。目前应用于T1 D的压力管理治疗存在两个显著问题。首先，基于CBT的干预措施在很大程度上依赖于参与者的自我报告，以确定哪些生活事件引起的压力，从而损害DM。然而，疾病管理行为的自我报告是出了名的有偏见/不准确。因此，OAYA的压力管理干预可能不成功，不是由于认知行为治疗方法本身无效，而是由于对那些最负责使DM脱轨的压力源的靶向不足。其次，新一代的行为疗法称为正念疗法，专注于改变人们经历的心理事件的意义，而不是改变或修改事件本身。因此，对患有T1 D的OAYA进行有效的压力管理干预可能还需要利用新的治疗策略，如正念。拟议研究的目标是使用分阶段干预开发方法为16-20岁的T1 D OAYA开发有效的糖尿病管理干预。在第一阶段，我们将使用一种创新技术（电子激活记录仪; ESTA）来更准确地识别影响OAYA T1 D患者DM的压力源。在第二阶段，我们将使用这些数据来调整先前与OAYA一起使用的现有CBT干预措施，以提高其疗效。我们还将采用正念方法（基于正念的减压; MBSR）用于患有T1 D的OAYA。接下来，我们将测试两种方法中每一种方法的有效性信号，以减轻压力和改善DM，并评估实施的可行性和满意度。在第3阶段，我们将在控制不佳的T1 D OAYA中进行一项试点随机临床试验（RCT），比较最成功的第2阶段压力管理方法与注意力控制条件。公共卫生相关性：糖尿病管理不善的老年青少年和年轻人患短期和长期糖尿病并发症的风险很高，也是医疗保健费用的主要使用者。拟议研究的主要目的是开发和测试一种新的压力管理干预措施的有效性，以改善糖尿病管理，采用分阶段的干预措施开发方法。如果成功，压力管理干预措施将有可能改善弱势群体的健康状况和生活质量。