Diabetes Self-Management Lifestyle Intervention for Urban Minority Young Adults

描述(申请人提供)：1型糖尿病(T1D)是美国第二种最常见的严重儿童疾病，而2型糖尿病(T2D)在青少年中的发病率显著增加，其中种族/少数民族人群风险特别高。当这些青少年进入青春期时，维持对糖尿病的控制尤其困难。患有T1D的年轻人的死亡率是没有糖尿病的人的3-6倍，并且精神健康障碍、药物滥用和糖尿病并发症的风险更高。对患有T2D的年轻人的健康结局知之甚少，尽管初步研究表明，与患有T1D的同龄人或患有T2D的老年人相比，T2D患者的疾病进程更具侵略性，并发症发作更快，糖尿病相关压力和负性生活事件更多。青年糖尿病患者健康状况不佳的原因是复杂和相互关联的，包括心理社会问题、糖尿病“倦怠”、冒险行为、相互竞争的优先事项以及从儿科向成人医疗机构过渡的挑战。总体而言，评估干预措施以改善年轻人糖尿病自我护理的研究表明，在减少医疗随访损失方面取得了成功，但在改善血糖控制或心理社会结果方面并未取得成功。拟议的研究和职业发展计划针对的是糖尿病控制不佳的城市少数民族年轻人的需求--这是一个健康结果不佳的风险特别高的群体。鉴于现有干预措施的适度效果，这一群体在自我护理方面遇到的重大障碍，以及 考虑到他们产生高额医疗费用的可能性，我们假设有必要进行密集的、多方面的干预，以改善这一人群的健康状况。这项为期三年的伊丽莎白·皮亚塔克博士指导职业发展奖旨在通过试点测试一种创新的糖尿病自我管理干预措施来解决这些问题，该干预措施具有弹性、赋权和积极的糖尿病生活(REAL)。真正的干预措施是利用以活动为基础的干预措施--重新设计生活方式--的原则制定的，已被证明具有成本效益地改善长期的身心健康结果，并且对于不同人口中的一系列慢性病是可行和可获得的。拟议的职业发展计划将皮亚塔克博士置于一个由来自不同学科背景的成功导师组成的网络中，这些导师在以下方面拥有集体专长：不同种族年轻人的糖尿病临床管理，少数族裔青年的健康行为和心理干预，以及糖尿病自我管理干预的随机试验。职业发展计划包括临床试验管理、统计分析、过程和评估方面的培训。 复杂的行为干预。高度支持的指导团队和机构环境旨在使皮亚塔克博士具备必要的技能，以开展大规模复杂干预措施的随机对照试验，以满足服务不足人群的健康和心理社会需求。

DESCRIPTION (provided by applicant): Type 1 diabetes mellitus (T1D) is the second-most common serious childhood disease in the United States, while the incidence of type 2 diabetes mellitus (T2D) has increased markedly among adolescents, with racial/ethnic minority populations at particularly high risk. Maintaining control of diabetes is particularly difficult whn these adolescents enter young adulthood. Young adults with T1D have mortality rates 3-6 times higher than those without diabetes, and are at elevated risk for mental health disorders, substance abuse, and diabetic complications. Less is known about health outcomes for young adults with T2D, although preliminary studies suggest an aggressive disease course, with more rapid onset of complications, and greater diabetes- related stress and negative life events, than their peers with T1D or older people with T2D. The reasons for poor health among young adults with diabetes are complex and interrelated, including psychosocial issues, diabetes "burnout," risk-taking behavior, competing priorities, and the challenge of transitioning from pediatric to adult healthcare settings. Studies evaluating interventions to improve diabetes self-care in young adults have, overall, shown success in reducing loss to medical follow-up, but not in improving glycemic control or psychosocial outcomes. The proposed program of research and career development targets the needs of urban minority young adults with poorly controlled diabetes - a group at particularly high risk for poor health outcomes. Given existing interventions' modest effects, the significant barriers to self-care encountered by this group, and the likelihood of their incurring high healthcare costs, we posit that an intensive, multifaceted intervention may be warranted to improve health in this population. This three-year mentored career development award for Dr. Elizabeth Pyatak aims to address these issues by pilot-testing an innovative diabetes self-management intervention, Resilient, Empowered, Active Living with Diabetes (REAL). The REAL intervention was developed using the principles of an activity-based intervention, Lifestyle Redesign, which has been shown to cost-effectively improve long-term physical and mental health outcomes, and to be feasible and accessible to implement for a range of chronic conditions in diverse populations. The proposed career development program positions Dr. Pyatak within a network of successful mentors from diverse disciplinary backgrounds who have collective expertise in the clinical management of diabetes in ethnically diverse young adults, health behavior and psychological interventions for minority youth, and randomized trials of diabetes self-management interventions. The career development plan includes training in clinical trial management, statistical analysis, and process and evaluation of complex behavioral interventions. The highly supportive mentoring team and institutional environment aim to equip Dr. Pyatak with the skills necessary to conduct large-scale RCTs of complex interventions addressing the health and psychosocial needs of underserved populations.