Enhancing Informal Caregiving to Support Diabetes Self-Management

描述（由申请人提供）：尽管家庭照护者（ICGs）有助于改善糖尿病（DM）的预后，但他们可能缺乏达到最佳效果所需的资源，并且有心理社会衰退和“照护者倦怠”的风险。更复杂的是，数百万患有慢性疾病的美国老年人独自生活，接受“远距离护理”，没有任何支持结构或资源来确保其有效性。初步数据表明，糖尿病患者将持续进行自动远程监测。由此得出的数据似乎可以有效地检测到健康状况和自我管理随时间的变化。我们建议将患者与非家庭成员或亲密朋友(“护理伙伴”；CP)愿意与患者的ICG（如果存在）和临床医生密切协调，支持患者的健康和自我管理。通过自动远程监测，患者将每周提供有关糖尿病健康和自我管理的最新信息。这些总结将通过电子邮件发送给CPs，并提供帮助患者解决报告问题的指导；临床医生将被告知医疗紧急问题。我们发现类似的干预措施在另一个具有挑战性的环境中是可行的，并且可能有效，即充血性心力衰竭的自我管理。为了这个提案，我们开发了dm相关的电话脚本和详细的参与者指南。在这次再提交中，我们现在纳入了试点数据，这些数据不仅表明糖尿病患者非常接受干预，而且还通过表明干预不太可能产生或加剧cp、icg和患者之间的人际冲突来解决审稿人的担忧。我们现在建议进行基于社区的有效性随机对照试验。具体目的1是比较CP干预与单独远程监测（对照）对控制不良的DM（即初始HbA1c为8.0%）患者12个月血糖控制和DM相关窘迫的影响。具体目标2是检查糖尿病自我管理、健康相关生活质量、收缩压、照顾者负担、关系质量和糖尿病护理成本的继发性影响。我们已经招募了临床站点，为大量低收入和保险不足的患者服务，这种干预措施是专门为他们设计的。如果这种干预措施被证明是有效的，而不会增加成本或增加临床医生的负担，那么它的实施可能会产生重大的公共卫生效益，特别是对弱势和得不到充分服务的糖尿病患者。通过增加帮助行为和加强社会联系，可能会产生更广泛的社会效益。后续工作可以使干预措施适用于合并症和其他需要自我管理的慢性疾病。

DESCRIPTION (provided by applicant): Although in-home caregivers (ICGs) help improve diabetes mellitus (DM) outcomes, they may lack the resources needed to do this optimally, and are at risk for psychosocial decline and "caregiver burnout." Complicating matters, millions of chronically-ill older Americans live alone and receive "long-distance caregiving" without any supporting structure or resources to ensure its effectiveness. Preliminary data indicate that DM patients will engage in automated telemonitoring consistently for sustained periods. The resulting data seems to validly detect changes over time in health status and self-management. We propose to link patients with a non-household family member or close friend (the "CarePartner;" CP) who is willing to support the patient's health and self-management in close coordination with the patient's ICG (if one exists) and clinician(s). Through automated telemonitoring, patients will provide weekly updates on their DM health and self-management. Summaries of this will be emailed to CPs along with guidance on helping the patient address reported problem(s); clinicians will be alerted about medically-urgent problems. We found a similar intervention to be feasible and potentially effective in another challenging setting, i.e., congestive heart failure self-management. For this proposal, we developed DM-related telephone scripts and detailed participant guidelines. In this resubmission, we now include pilot data that not only indicates that DM patients are very receptive to the intervention, but also addresses a Reviewer concerns by suggesting that the intervention is unlikely to create or worsen interpersonal conflicts between CPs, ICGs, and patients. We now propose a community-based effectiveness RCT. Specific Aim 1 is to compare the effects of CP intervention to telemonitoring alone (control) upon 12-month glycemic control and DM-related distress for patients with poorly-controlled DM (i.e., initial HbA1c > 8.0%). Specific Aim 2 is to examine secondary effects on DM self-management, health-related quality of life, systolic blood pressure, caregiver burden, relationship quality, and cost of DM care. We have already recruited clinical sites serving large numbers of low-income and underinsured patients, whom this intervention was especially designed to benefit. If this intervention proves effective without increasing costs or clinician burden, then its implementation could yield major public health benefits, especially for vulnerable and underserved DM patients. Broader societal benefit may occur through increased helping behavior and strengthened social ties. Followup work could adapt the intervention for use with comorbid conditions and other chronic conditions requiring self-management.