Collaborative Care for Depression and Diabetic Retinopathy in African Americans

患有糖尿病视网膜病变(DR)的老年非裔美国人中有20%-25%会出现抑郁症，并会加速 糖尿病自我管理实践和提高糖化血红蛋白水平对糖尿病视网膜病变进展的影响 (HbA1c)。治疗抑郁症可改善糖尿病的自我管理，降低糖化血红蛋白，从而可能 然而，与白人相比，AAA博士更不可能接受抑郁症的治疗。抑郁症 这就是为什么AA的血糖控制较差，DR的发病率较高(39%对26%)，威胁视力的原因 DR(9.3%比3.2%)，合法失明(7.3%比5.4%)。这些差异需要新的 干预措施，以治疗抑郁症，改善血糖控制，并防止老年AA患者DR的进展。我们 寻求规划拨款的支持，以改进方法，进行可行性研究，并制定一份 一项计划中的随机对照临床试验(RCT)的程序，题为“抑郁症的协作护理” 和糖尿病视网膜病变“(CC-DDR)。CC-DDR是一种新的心理健康/眼科干预措施，我们 正在设计用来治疗患有轻中度糖尿病视网膜病变和糖尿病的老年AA患者的抑郁和降低HbA1C水平 共病抑郁。社区卫生工作者，他们在种族和文化背景上匹配参与者， 将与视网膜诊所的眼科医生合作，教育参与者抑郁症、 HbA1c和DR，并将把护理扩展到家庭，在那里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。在进入CC-DDR的全面RCT之前，我们提出了一个3- 舞台规划补助金。在第一阶段，我们将：1)开发CC-DDR治疗方案；2)开发工具以 评估治疗师的忠诚度和能力；以及3)寻求专家小组的意见以完善这些 材料。在第二阶段，我们将进行CC-DDR的公开试验，以评估其可行性。在第三阶段，我们将 为CC-DDR计划的RCT制定程序手册。随着人口老龄化和 DR在老年AA中的患病率迅速上升，这是一种治疗抑郁症的文化相关干预措施， 降低HbA1C，防止DR的进展对于我们保护这一人群的视力具有重要意义。

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.