Reducing Distress And Improving Glycemic Control In Adults With Type 1 Diabetes.

描述(由申请人提供)：糖尿病困扰(DD)指的是患者在处理糖尿病等严重、苛刻的慢性疾病时所经历的独特的情感负担、担忧和担忧。高DD在糖尿病患者中非常常见并持续一段时间，即使在控制了临床抑郁之后，它也与血糖控制差、自我护理差、糖尿病自我效能低和生活质量差密切相关。DD的绝大多数研究都集中在患有2型糖尿病的成年人身上，2型糖尿病是一种基于遗传易感性、肥胖、久坐的生活方式和胰岛素抵抗的代谢性疾病。很少有研究关注成人1型糖尿病患者DD的截然不同的经历：这是一种自身免疫性疾病，需要比2型糖尿病患者更密集和更具侵入性的治疗。这项拟议的研究解决了成人1型糖尿病患者和DD患者临床护理中的两个主要差距：为1型糖尿病成人患者开发一种实用、可靠和有效的DD测量方法，根据经验确定高DD的临界点；以及测试一种独特、实用、基于理论的计划，以降低高危、控制不佳的1型成年人的DD水平。在一项简短的测量研究为高DD建立可靠的切入点之后，我们提议进行一项双臂临床试验，以测试改编的问题解决疗法的比较有效性，该疗法现在包括对情绪、行为和认知的全面关注，与当前标准的加强护理的糖尿病教育。主要结果是减少了DD和改善了血糖控制。这种创新的干预方式使用了多种方式，其中一些基于电子和社交媒体(例如，基于网络的实时群呼、基于网络的博客、个人电话联系)，以增强参与度和留存，并减轻患者负担。我们还将评估选择性调解和缓和变量的影响，收集成本衡量标准，并将利用RE-AIM将结果与传播和实施联系起来。

DESCRIPTION (provided by applicant): Diabetes distress (DD) refers to the unique emotional burdens, worries and concerns that are part of the spectrum of patient experience when managing a severe, demanding chronic disease like diabetes. High DD is very common and persistent over time among those with diabetes, and it has been significantly associated with poor glycemic control, poor self-care, low diabetes self-efficacy, and poor quality of life, even after controlling for clinical depression. The vast majority of research in DD has focused on adults with type 2 diabetes, a metabolic disease based on genetic predisposition, obesity, sedentary lifestyle and insulin resistance. Far less research has focused on the very different experiences of DD among adults with type 1 diabetes: an autoimmune disease that requires much more intensive and intrusive management than type 2. The proposed research addresses two major gaps in the clinical care of adult patients with type 1 diabetes and DD: to develop a practical, reliable and valid measure of DD for adult patients with type 1 diabetes, with empirically defined cut- points for high DD; and to test a unique, pragmatic, theory based program to reduce high DD among at-risk, poorly controlled type 1 adults. Following a brief measurement study to establish reliable cut-points for high DD, we propose a 2-arm clinical trial to test the comparative effectiveness of an adaptation of Problem Solving Therapy, which now includes a comprehensive focus on emotion, behavior and cognition, with a current standard of care - enhanced diabetes education. Primary outcomes are reduced DD and improved glycemic control. The innovative intervention uses a variety of modalities, some based on electronic and social media (e.g., real time web-based group calls, web-based blogging, personal telephone contact) to enhance participation and retention, and reduce patient burden. We will also assess the impact of selective mediating and moderating variables, collect measures of cost, and will link the findings to dissemination and implementation using RE-AIM.