Lifestyle and Medication Management to Lower Diabetes Risk in Severe Mental Illness

 描述（由申请人提供）：抑郁症和2型糖尿病是相关的紧迫的公共卫生问题。抑郁症、抗抑郁药物以及与之相关的健康风险行为都是2型糖尿病的危险因素。本研究的总体目标是测试两种已证实的健康干预措施-生活方式改变和药物治疗管理-对抑郁症和功能障碍患者糖尿病风险的叠加效应。治疗将通过我们为精神疾病（MI）患者设计的模型提供，这些患者的护理受到距离，残疾，语言和文化的挑战。柬埔寨裔美国人非常适合这个研究问题，因为与一般人群和其他亚裔美国人相比，他们有：1）糖尿病和残疾的高发病率; 2）MI的高发病率; 3）多种药物和药物治疗问题的高发病率;以及，4）健康的社会决定因素更差。我们将从我们在东北部的社区组织网络中招募210名患有重度抑郁症和相关功能障碍的成年柬埔寨裔美国人，他们是糖尿病的高危人群。70名参与者每人将被分配到三个组中的一个。在生活方式方面，社区卫生工作者（CHW）将在18个月内每周至每三周一次的逐渐减少的小组会议和5次个人家访期间提供生活方式干预。在联合治疗组中，除了生活方式外，药剂师还将在18个月的5次家庭访视期间通过远程医疗加入患者和CHW，以提供药物治疗管理。在强化标准护理组中，受试者将接受通过支持性服务强化的常规医疗保健。将在基线、1年和2年时对受试者进行评估。我们假设：1）与加强标准治疗相比，生活方式干预将在抑郁症状、药物依从性、客观体力活动、客观睡眠质量和营养方面产生更大的改善; 2）与单独干预相比，联合治疗将改善胰岛素敏感性、HbA 1c、C反应蛋白、人体测量学、血压、血脂和抑郁症状。如果成功，这些方法可能适用于其他社区的障碍，以照顾和生产糖尿病预防干预措施的MI患者。

 DESCRIPTION (provided by applicant): Depression and type 2 diabetes are related pressing public health problems. Depression, antidepressant medications, and the health risk behaviors they are associated with, are all risk factors for type 2 diabetes. The overarching goal of this study is to test the additive effects of two proven health interventions - lifestyle modification ad medication therapy management - on risk for diabetes in persons with depression and functional impairment. Treatments will be delivered through our model designed for patients with mental illness (MI) whose care is challenged by distance, disability, language, and culture. Cambodian Americans are ideally suited for this research question because, compared to the general population and other Asian Americans they have: 1) high rates of diabetes and disability; 2) high rates of MI; 3) high rates of polypharmacy and medication problems; and, 4) a worse profile of the social determinants of health. We will recruit 210 adult Cambodian Americans with major depressive disorder and associated impaired functioning, and who are at high risk for diabetes, from our network of community based organizations in the northeast. Seventy participants each will be assigned to one of three arms. In the lifestyle arm, Community Health Workers (CHWs) will deliver the lifestyle intervention during weekly-to-triweekly tapered group sessions and 5 individual home visits over 18 months. In the combination arm, in addition to lifestyle, a pharmacist will join the patient and CHW during home visits via telemedicine to deliver medication therapy management, during 5 home visits over 18 months. In the enhanced standard care arm, participants will receive their usual healthcare enhanced by supportive services. Participants will be assessed at baseline, 1 year, and 2 years. We hypothesize that 1) compared to enhanced standard care, the lifestyle intervention will produce greater improvements in depressive symptoms, medication adherence, objective physical activity, objective sleep quality, and nutrition; and 2) compared to either intervention alone, the combined treatment will improve insulin sensitivity, HbA1c, c-reactive protein, anthropmetrics, blood pressure, lipids and depressive symptoms. If successful, these approaches may apply to other communities with barriers to care and produce diabetes prevention interventions for patients with MI.