权益分类	功能权益	普通用户	{{item.name}}会员
{{category.name}}	{{benefitItem.name}}

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

生活方式和药物管理可降低严重精神疾病患者的糖尿病风险

基本信息

批准号：
9263940
负责人：
JULIE A WAGNER
金额：
$ 59.91万
依托单位：
UNIVERSITY OF CONNECTICUT SCH OF MED/DNT
依托单位国家：
美国
项目类别：
财政年份：
2015
资助国家：
美国
起止时间：
2015-08-01 至 2020-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9263940
关键词：
Adult Affordable Care Act American Antidepressive Agents Asian Americans Behavior Therapy Biological Blood Pressure Body Composition Body Weight decreased C-reactive protein Cambodian American Caring Combined Modality Therapy Communities Community Health Aides Community Networks Complex Connecticut Cultural Diversity Diabetes Mellitus Diabetes prevention Disease Dose Eating Expenditure Face General Population Glycosylated hemoglobin A Goals Guidelines Habits Health Health Insurance Health Professional Health behavior Healthcare Healthcare Systems Home visitation Human Resources Impairment Individual Intervention Language Life Style Lipids Major Depressive Disorder Massachusetts Mediator of activation protein Medication Management Mental Depression Mental disorders Minority Groups Modeling Non-Insulin-Dependent Diabetes Mellitus Participant Patient Self-Report Patients Persons Pharmaceutical Preparations Pharmaceutical Services Pharmacists Pharmacotherapy Phonation Physical activity Physicians Polypharmacy Population Post-Traumatic Stress Disorders Poverty Preventive Intervention Provider Public Health Recruitment Activity Refugees Research Research Infrastructure Rhode Island Risk Risk Behaviors Risk Factors Risk Marker Services Sleep Social isolation Source Symptoms Telemedicine Telephone Testing Time Translations Trauma Walking arm base blood lipid blood pressure regulation chronic depression community partnership cost depressive symptoms design diabetes prevention program diabetes risk disability experience experimental study functional disability health record high risk illiteracy improved innovation insulin sensitivity lifestyle intervention medication compliance model design nutrition public health relevance randomized trial severe mental illness social health determinants standard care therapy design treatment as usual waist circumference

项目摘要

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.

描述(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，抗抑郁药物，以及与之相关的健康危险行为，都是2型糖尿病的危险因素。这项研究的首要目标是测试两种经过验证的健康干预措施--生活方式改变和药物治疗管理--对患有抑郁症和功能障碍的人患糖尿病风险的相加效果。治疗将通过我们为精神病患者设计的模式提供，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回答这一研究问题，因为与普通人群和其他亚裔美国人相比，他们有：1)糖尿病和残疾的高比率；2)MI的高比率；3)多用药和用药问题的高比率；以及4)影响健康的社会决定因素的状况较差。我们将从我们东北部的社区组织网络中招募210名患有严重抑郁障碍和相关功能受损的成年柬埔寨裔美国人，他们是糖尿病的高危人群。70名参赛者每人将被分配到三个手臂中的一个。在生活方式方面，社区卫生工作者(CHWS)将在每周至每三周逐渐减少的小组会议期间提供生活方式干预，并在18个月内进行5次个人家访。在组合ARM中，除了生活方式，在18个月的5次家访期间，一名药剂师将通过远程医疗与患者和CHW一起进行家访，提供药物治疗管理。在增强型标准护理部门，参与者将获得由支持性服务增强的日常医疗保健。参与者将在基线、1年和2年进行评估。我们假设：1)与加强标准护理相比，生活方式干预将在抑郁症状、服药依从性、客观体力活动、客观睡眠质量和营养方面产生更大改善；2)与单独干预相比，联合治疗将改善胰岛素敏感性、糖化血红蛋白、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有护理障碍的社区，并为心肌梗塞患者提供糖尿病预防干预措施。