Delay discounting as a target for self-regulation in prediabetes

 描述（由申请人提供）：预防糖尿病前期肥胖患者的2型糖尿病需要养成更健康的生活方式。对于糖尿病前期患者来说，合理的方法是吃得更健康，更活跃，减肥，并管理他们的合并症。然而，初步研究表明，2型糖尿病患者会低估未来，并从事最大化当前快乐和短期收益的行为;因此，改善未来健康所需的日常选择在这一人群中很少见。延迟折扣（DD）描述了较小的即时奖励与较大的延迟奖励的选择。这种行为过程与各种各样的健康选择有关，从预防性健康到行为和医疗方案依从性，包括用于2型糖尿病的方案。我们相信，DD提供了一种自我调节的目标，可以改善各种各样的健康行为和医疗依从性。 我们实验室的研究表明，情景未来思维（episodic future thinking，EFT）是一种减少对即时满足的偏见的前瞻性思维，它激活了参与计划和前瞻性思维的大脑区域，从而增加了未来奖励的价值，减少了延迟折扣的程度。提示个体在跨期决策过程中思考未来事件，可以降低DD、实验室内外饮食和吸烟行为的发生率。该补助金的总体目标是使用实验医学方法将DD和EFT的基础研究转化为临床干预措施，以防止从糖尿病前期转变为2型糖尿病的诊断。我们正在使用资助机制RFA-RM-14-020，“行为改变的科学：自我调节目标（UH 2/UH 3）的检测开发和验证”，因为这提供了整合观察、实验室和现场研究的机会，以评估DD和疾病自我管理之间的关系，了解这些关系在多个分析水平上的机制，并完善干预措施，为临床试验做准备。 我们提出了一系列的观察，实验室和现场研究，以确定DD作为一个行为目标，以改善行为和医疗依从性和代谢控制的成人糖尿病前期谁是高风险的发展为2型糖尿病。具体目标1将检查DD，执行功能和fMRI测量的大脑激活之间的横截面关系，以预测诊断为糖尿病前期的人的依从性和代谢控制。具体目标2将评估EFT对实验室中糖尿病前期参与者的DD、fMRI测量的大脑激活和能量摄入的影响。具体目标3将评估EFT对DD和fMRI测量的大脑激活的影响，模拟贫困，增加未来的折扣。具体目标4扩展了EFT对DD、执行功能、健康行为变化、合并症的药物依从性和血糖控制的影响的研究，在本申请UH 3组件的一项现场研究中，与对照相比，EFT目标参与6个月后。

 DESCRIPTION (provided by applicant): The prevention of Type 2 diabetes in an obese person with pre-diabetes requires developing a healthier lifestyle. The rational approach for someone with pre-diabetes would be to eat healthier, be more active, lose weight, and manage their comorbidities. However, preliminary research suggests that individuals with Type 2 diabetes discount the future and engage in behaviors that maximize current pleasure and short-term gain; thus, daily choices needed to improve future health are rare in this population. Delay discounting (DD) describes the choice of smaller immediate versus larger delayed rewards. This behavioral process is related to a wide variety of health choices, ranging from preventive health to behavioral and medical regimen adherence, including regimens used for Type 2 diabetes. We believe that DD provides a target for one type of self- regulation that can improve a wide variety of health behaviors and medical adherence. Research from our laboratories has shown that episodic future thinking (EFT), a form of prospection which reduces the bias towards immediate gratification, activates brain regions involved in planning and prospection such that future rewards have increased value and the extent of delay discounting is reduced. Cueing individuals to think about future events during inter-temporal decision-making reduces the rate of DD, eating in and outside of the laboratory, and smoking behavior. The overarching goal of this grant is to use an experimental medicine approach to translate basic research on DD and EFT into clinical interventions to prevent the transition from pre-diabetes to a diagnosis of Type 2 diabetes. We are using the grant mechanism RFA-RM-14-020, "Science of Behavior Change: Assay Development and Validation for Self-Regulation Targets (UH2/UH3)" as this provides for the opportunity to integrate observational, laboratory and field studies to assess relationships between DD and disease self-management, understand mechanisms of these relationships across multiple levels of analysis, and refine interventions in preparation for a clinical trial. e propose a series of observational, laboratory and field studies to identify DD as a behavioral target to improve behavioral and medical adherence and metabolic control in adults with pre-diabetes who are at high risk for development of Type 2 diabetes. Specific Aim 1 will examine the cross sectional relationship between DD, executive function, and fMRI-measured brain activation to predict adherence and metabolic control in persons diagnosed with pre-diabetes. Specific Aim 2 will assess the effects of EFT on DD, fMRI measured brain activation and energy intake in participants with pre-diabetes in the laboratory. Specific Aim 3 will assess the effects f EFT on DD and fMRI measured brain activation under simulations of poverty that increase discounting of the future. Specific Aim 4 extends the study of the effects of EFT on DD, executive function, health behavior change, medication adherence for comorbid conditions and glycemic control after a 6-month target engagement with EFT versus control in a field study for the UH3 component of this application.