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。青春期和年轻成年是发育时期，其特征是DM差的风险增加。因此，在具有T1D的年长青少年和年轻人（OAYA）中，改善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。承受压力的暴露会大大增加对健康状况不佳的脆弱性。大量的横截面和纵向研究都表明，压力会影响T1D患者的DM和代谢控制。尽管大量的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T1D的青少年和成年人的健康状况方面却无效。目前适用于T1D的压力管理治疗有两个重大问题。首先，基于CBT的干预措施在很大程度上取决于参与者的自我报告，以确定哪些生命事件会导致压力，从而损害DM。但是，众所周知，疾病管理行为的自我报告是有偏见/不准确的。因此，OAYA的压力管理干预措施可能没有成功，不是由于认知行为治疗方法本身的无效性，而是由于对那些最负责DM造成DM的压力源的靶向不足。其次，新一代的行为疗法称为正念方法，重点是改变人们经历的心理事件的含义，而不是改变或修改事件本身。因此，使用T1D对OAYA的有效压力管理干预措施也可能需要利用正念等新的治疗策略。拟议的研究的目的是使用分阶段的干预方法为OAYA 16-20岁的Oaya开发有效的糖尿病管理干预措施。在第1阶段，我们将使用创新技术（电子激活的记录仪； EAR）来更准确地识别用T1D影响OAYA DM的压力源。在第2阶段，我们将使用此数据来调整以前与OAYA一起使用的现有CBT干预措施以提高其功效。我们还将适应一种正念方法（基于正念的压力降低； MBSR），以与T1D一起使用。接下来，我们将测试两种方法中每种方法的功效信号，以减轻压力和改善DM，并评估实施可行性和满意度。在第3阶段，我们将在OAYA之间进行一项试验随机临床试验（RCT），其控制不良的T1D将最成功的2期应力管理方法与注意力控制条件进行了比较。公共卫生相关性：糖尿病管理不良的年长青少年和年轻人患有短期和长期糖尿病并发症的风险很高，并且是医疗保健收入的大量使用者。拟议的研究的主要目的是开发和测试新型压力管理干预措施的功效，以使用分阶段的干预方法来改善糖尿病管理。如果成功，压力管理干预将有可能改善脆弱人群的健康成果和生活质量。