Diabetes Self-Management Lifestyle Intervention for Urban Minority Young Adults

城市少数民族青少年糖尿病自我管理生活方式干预

• 批准号: 8891415
• 负责人: Elizabeth F Pyatak
• 金额: $ 15.21万
• 依托单位: UNIVERSITY OF SOUTHERN CALIFORNIA
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-07-15 至 2017-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8891415
• 关键词: 19 year old; Accounting; Address; Adolescent; Adult; African American; Attention; Award; Behavior; Behavior Therapy; Behavioral; Blinded; Childhood; Chronic; Client satisfaction; Clinical; Clinical Management; Clinical Trials; Communities; Complex; Complications of Diabetes Mellitus; Control Groups; Data; Development Plans; Diabetes Mellitus; Diagnosis; Disease; Dose; Encounter Groups; Environment; Epidemic; Evaluation; Event; Feedback; Focus Groups; Funding Mechanisms; Goals; Habits; Health; Health Care Costs; Health behavior; Healthcare; High Prevalence; Hispanics; Hospitalization; Incidence; Insulin-Dependent Diabetes Mellitus; Intervention; K-Series Research Career Programs; Knowledge; Latino; Life; Mediating; Mediator of activation protein; Medical; Mental Depression; Mental Health; Mental disorders; Mentored Research Scientist Development Award; Mentors; Methods; Minority; Needs Assessment; Non-Insulin-Dependent Diabetes Mellitus; Not Hispanic or Latino; Occupational Therapy; Outcome; Participant; Pilot Projects; Population; Population Heterogeneity; Positioning Attribute; Prevalence; Problem Solving; Procedures; Process; Protocols documentation; Psychosocial Influences; Quality of life; Randomized; Research; Research Personnel; Research Project Grants; Risk; Risk-Taking; Self Care; Self Efficacy; Self Management; Stress; Substance abuse problem; Testing; Time; Training; Treatment Efficacy; Underrepresented Minority; Underserved Population; United States; Youth; base; burnout; cardiovascular risk factor; career development; cost; diabetes control; diabetic; empowered; ethnic minority population; evidence base; experience; follow-up; glycemic control; group intervention; health disparity; high risk; improved; innovation; lifestyle intervention; mHealth; medically underserved; meetings; mortality; multi-component intervention; peer; physical conditioning; primary outcome; programs; psychologic; psychosocial; racial and ethnic; randomized trial; research and development; response; satisfaction; secondary outcome; skills; success; therapy design; treatment adherence; type I and type II diabetes; young adult

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.

描述（由申请人提供）：1 型糖尿病（T1D）是美国第二大常见的严重儿童疾病，而青少年中 2 型糖尿病（T2D）的发病率显着增加，少数种族/族裔人群的风险尤其高。当这些青少年进入成年早期时，保持对糖尿病的控制尤其困难。患有 T1D 的年轻人的死亡率比未患糖尿病的人高 3-6 倍，并且出现精神健康障碍、药物滥用和糖尿病并发症的风险也较高。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，患有 T2D 的年轻人的健康结果知之甚少，但其病程呈侵袭性，并发症发生更快，糖尿病相关压力和负面生活事件更大。年轻糖尿病患者健康状况不佳的原因复杂且相互关联，包括心理社会问题、糖尿病“倦怠”、冒险行为、优先事项竞争以及从儿科医疗保健环境过渡到成人医疗保健环境的挑战。总体而言，评估改善年轻人糖尿病自我护理干预措施的研究表明，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却没有成功。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——这一群体健康状况不佳的风险特别高。鉴于现有干预措施的效果有限，该群体在自我保健方面遇到了重大障碍，以及 鉴于他们承担高额医疗费用的可能性，我们认为可能需要采取密集、多方面的干预措施来改善这一人群的健康。 Elizabeth Pyatak 博士获得的为期三年的职业发展指导奖旨在通过试点测试创新的糖尿病自我管理干预措施“弹性、赋权、积极的糖尿病生活”(REAL) 来解决这些问题。 REAL 干预措施是采用基于活动的干预措施“生活方式重新设计”的原则开发的，已被证明可以经济有效地改善长期身心健康结果，并且对于不同人群的一系列慢性病实施是可行且易于实施的。拟议的职业发展计划将 Pyatak 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，他们在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措施的随机试验方面拥有集体专业知识。职业发展计划包括临床试验管理、统计分析、流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 Pyatak 博士具备进行复杂干预措施的大规模随机对照试验所需的技能，以满足服务不足人群的健康和心理社会需求。