Collaborative Care for Depression and Diabetic Retinopathy in African Americans

抑郁症发生在20-25%的老年非裔美国人与糖尿病视网膜病变（DR）和加速 通过损害糖尿病自我管理实践和升高血红蛋白A1 C水平导致DR进展 （HbA1C）。治疗抑郁症可以改善糖尿病自我管理，降低HbA 1C， 然而，与白人相比，AA患者接受抑郁症治疗的可能性更小。抑郁 有助于解释为什么AA的血糖控制更差，DR发生率更高（39% vs. 26%）， DR（9.3%比3.2%）和法律的失明（7.3%比5.4%）。这些差异需要新的 治疗抑郁症、改善血糖控制和预防老年AA患者DR进展的干预措施。我们 寻求规划补助金的支持，以完善方法，进行可行性研究，并制定手册， 一项名为“抑郁症的协作治疗”的随机对照临床试验（RCT）的程序 和糖尿病视网膜病变”（CC-DDR）。CC-DDR是一种新型的心理健康/眼科干预， 正在设计治疗轻度至中度DR的老年AA患者的抑郁症和较低的HbA 1C水平， 共病抑郁症社区卫生工作者，谁匹配参与者的种族和文化背景， 将与视网膜诊所的眼科医生合作，教育参与者抑郁症， HbA 1C和DR，并将护理扩展到家庭，他们将使用行为激活来治疗抑郁症 提高糖尿病自我管理能力。在进行CC-DDR的全面RCT之前，我们提出了一个3- 阶段规划补助金在第一阶段，我们将：1）开发CC-DDR治疗方案; 2）开发一种工具， 评估治疗师的坚持和能力; 3）寻求专家小组的意见，以完善这些 材料.在第二阶段，我们会进行公开试验，以评估CC-DDR的可行性。在第三阶段，我们将 为计划的CC-DDR RCT制定程序手册。随着人口老龄化， DR的患病率在老年AA中迅速增加，这是一种治疗抑郁症的文化相关干预措施， 降低HbA 1C，并防止DR的进展是重要的，如果我们要保持视力在这一人群中。

Depression occurs in 20-25% of older African Americans with diabetic retinopathy (DR) and accelerates progression of DR by compromising diabetes self-management practices and raising hemoglobin A1C levels (HbA1C). Treating depression improves diabetes self-management and lowers HbA1C and may thereby prevent progression of DR. AAs, however, are less likely to be treated for depression than whites. Depression contributes to why AAs have worse glycemic control and higher rates of DR (39% vs. 26%), vision-threatening DR (9.3% vs. 3.2%), and legal blindness (7.3 vs. 5.4%) than whites. These disparities necessitate new interventions to treat depression, improve glycemic control, and prevent progression of DR in older AAs. We seek support for a planning grant to refine the methods, conduct a Feasibility Study, and develop a Manual of Procedures for a planned randomized controlled clinical trial (RCT) entitled, "Collaborative Care for Depression and Diabetic Retinopathy" (CC-DDR). CC-DDR is a novel mental health/ophthalmologic intervention that we are designing to treat depression and lower HbA1C levels in older AAs with mild-to-moderate DR and comorbid depression. Community Health Workers, who match participants in race and cultural background, will work with ophthalmologists in the retina clinic to educate participants on the links between depression, HbA1C, and DR, and will extend care into the home where they will use Behavior Activation to treat depression and improve diabetes self-management skills. Before moving to a full-scale RCT of CC-DDR, we propose a 3- stage planning grant. In Stage I we will: 1) develop the CC-DDR treatment protocol; 2) develop a tool to assess therapists' adherence and competency; and 3) seek input from a panel of experts to refine these materials. In Stage II we will conduct an open trial of CC-DDR to evaluate its feasibility. In Stage III we will develop the Manual of Procedures for the planned RCT of CC-DDR. As the population ages and the prevalence of DR rapidly increases in older AAs, a culturally relevant intervention that treats depression, lowers HbA1C, and prevents progression of DR is significant if we are to preserve vision in this population.