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

描述（由申请人提供）：糖尿病痛苦（DD）是指独特的情感负担，担忧和担忧，这些是患者在管理严重，要求苛刻的慢性疾病（如糖尿病）时经历的一部分。高DD在糖尿病患者中非常常见，并且随着时间的推移而持续存在，即使在控制临床抑郁症后，它也与血糖控制不良，自我护理不良，糖尿病自我效能低和生活质量差显著相关。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，这是一种基于遗传易感性、肥胖、久坐不动的生活方式和胰岛素抵抗的代谢疾病。很少有研究关注1型糖尿病成人中非常不同的DD经历：一种自身免疫性疾病，需要比2型更密集和侵入性的管理。拟议的研究解决了1型糖尿病和DD成人患者的临床护理中的两个主要差距：为1型糖尿病成人患者开发实用、可靠和有效的DD测量方法，并根据经验定义高DD的临界点;并测试一种独特的、实用的、基于理论的方案，以降低处于风险中的、控制不良的1型成人中的高DD。在一项简短的测量研究以建立高DD的可靠临界点之后，我们提出了一项双臂临床试验，以测试问题解决疗法的适应性的比较有效性，该疗法现在包括对情绪，行为和认知的全面关注，以及当前的护理标准-加强糖尿病教育。主要结局是DD降低和血糖控制改善。创新的干预措施使用了多种形式，有些是基于电子和社交媒体（例如，真实的实时基于网络的群组呼叫、基于网络的博客、个人电话联系），以增强参与和保持，并减轻患者负担。我们还将评估选择性中介和调节变量的影响，收集成本措施，并将使用RE-AIM将调查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.