Using Mobile Devices to Study Daily Diabetes Management in Marital Context

描述(申请人提供)：随着发病率的迅速上升，糖尿病对医疗保健构成了巨大的挑战，影响到2560万成年人，每年有200万新诊断病例。2012年，它耗费了美国经济2450亿美元，与2007年的1740亿美元相比有所上升。在所有病例中，约90%为2型糖尿病(T2 DM)。2型糖尿病及其治疗的影响发生在人际和日常环境中。医疗方案要求高，压力大，不仅影响患者，也影响他们的家人，特别是配偶。成功的T2 DM管理是一项日常工作，需要亲密伴侣的适应和调整。然而，患者及其配偶的日常压力经历和健康行为如何影响患者的日常血糖管理，目前还知之甚少。此外，考虑到最近关于健康和谐和夫妻间情绪传递的研究，这是一个有趣的假设，即配偶的压力和健康行为可能会传递给患者，并导致健康后果。此外，现有研究中有几个方法论问题削弱了他们的推论，包括依赖于容易受到系统性回忆偏差和记忆障碍影响的回溯性自我报告，没有直接从配偶那里收集数据，使用“人与人之间”的设计来测试“人内”假设，以及缺乏对血糖控制日常过程的关注。为了解决这些问题，并利用最近的技术和方法进步，我们建议(1)评估使用几种电子移动设备并实施每日日记和经验抽样方法的可行性，以从患者及其配偶那里收集超过14天的实时或日常数据，并将数据存储在安全的云计算平台上；(2)使用收集的数据来探索几个夫妇内部的二元假设，并为未来的研究建立适当的数据分析策略。具体来说，我们将调查(1)配偶的日常压力和健康状况 除了患者的行为(饮食和体力活动)外，还会影响患者的日常血糖管理，以及(2)是否存在从配偶到患者的情绪和行为“传递”，从而使配偶在某一天的压力和健康行为在患者的压力和健康行为中产生类似的模式，从而影响患者在同一天或第二天的血糖管理。这些发现将有助于建立创新的二元数据收集和存储策略，以促进未来在实时计算方面的研究，以及时提供患者反馈和干预，并将提高我们团队开发的用于检测临床问题的糖尿病监测系统的原型的性能。研究结果还将有助于我们制定创新的监测和干预战略，以解决关键的人际障碍，在日常婚姻环境中实现成功的T2 DM管理。

DESCRIPTION (provided by applicant): With rapidly rising prevalence, diabetes mellitus presents an enormous challenge to healthcare, affecting 25.6 million adults, with 2 million new cases diagnosed annually. It costs a staggering $245 billion of US economy in 2012, which has risen from $174 billion in 2007. Of all cases, approximately 90% are in the form of type 2 diabetes mellitus (T2DM). The impact of T2DM and its treatment occur in an interpersonal and daily context. The medical regimen is demanding and stressful, affecting not only the patients but also their families, especially spouses. Successful T2DM management is a daily endeavor, requiring accommodations and adjustments from intimate partners. However, little is known how the daily stress experience and health behavior of both the patients and their spouses may influence patients' daily glycemic management. Furthermore, considering the recent research on health concordance and emotional transmission within couples, it is an intriguing hypothesis that the spouse's stress and health behavior may transmit to the patient and result in health consequences. In addition, there are several methodological issues in existing studies that weaken their inferences, including reliance on retrospective self-reports susceptible to systematic recall biases and memory failure, no data collected from spouses directly, use of "between-person" design to test "within-person" hypotheses, and lack of attention to the daily process of glycemic management. To address these problems and take advantage of the recent technological and methodological advancements, we propose to (1) evaluate the feasibility of using several electronic mobile devices and implementing daily diary and experience sampling method to collect real-time or daily data over 14 days from both patients and their spouses and store the data on a secure cloud computing platform, and (2) use the collected data to explore several within-couple dyadic hypotheses and establish appropriate data analytic strategy for future research. Specifically, we will investigate (1) whether the spouse's daily stress and health behavior (diet and physical activity), in addition to the patent's, influence the patient's daily glycemic management, and (2) whether there is emotional and behavioral "transmissions" from the spouse to patient such that the spouse's stress and health behavior on one day contribute to a similar pattern in the patient's stress and health behavior which then affect the patient's glycemic management on the same day or the following day. The findings will contribute to the establishment of innovative dyadic data collection and storage strategy to facilitate future research in real-time computing for timely patient feedback and intervention, and they will enhance the performance a prototype of diabetes monitoring system developed by our team to detect clinical problems. The results will also contribute to our long-term goal of developing innovative monitoring and intervention strategies that address critical interpersonal barriers to achieve successful T2DM management in daily marital context.