Self-Management, Insomnia, and Glucose Control in Adults with Diabetes

摘要 研究目的：探讨失眠治疗对糖尿病患者自我管理行为的影响。 成人2型糖尿病的症状管理(即嗜睡和疲劳)和血糖控制。数据 这项研究将有助于为一项随机临床试验提供信息，该试验将测试行为睡眠干预 人口。这项研究计划的长期目标是确定睡眠障碍作为一种 健康和福祉受损风险人群自我管理和生活质量的障碍 制定行为干预措施以改善症状和自我管理。职业发展目标： 有两个职业发展目标：1)增加申请者在行为方面的知识和专长 睡眠医学和2)提供足够的时间和提高作为博士生有效导师的技能， 博士后研究员和初级教员。研究项目：最近的证据支持失眠是一种 2型糖尿病患者中普遍存在的问题，可能与白天增加有关 嗜睡和疲劳，增加糖尿病相关的痛苦，减少自我管理行为，甚至更糟 血糖控制。当前应用程序的主要假设是，基于网络的认知 对T2 DM患者进行失眠的行为治疗不仅能改善他们的夜间活动 睡眠，还可以提高他们将糖尿病教育融入日常行为的能力，以及 与基于网络的信息控制组相比，他们对血糖控制有积极的影响。的目标是 这项研究的目的是：1)获得初步数据，以便于进一步发展假说，并加强 进行随机临床试验的可行性，以检查失眠治疗是否会导致受试者 能够更好地将糖尿病教育融入到他们的自我管理行为中，并取得改善 血糖控制，2)探索失眠严重程度、疲倦、日间嗜睡、 睡眠质量、A1C和DSM行为，3)探讨干预前到干预后的平均变化 失眠严重程度、白天症状(疲倦、嗜睡、情绪)和DSM行为(饮食和身体 活动度)与IC+DSM组比较，以及4)探索 睡眠片断--联系血糖控制受损(A1C)和睡眠的潜在生理机制 在基线和3个月时有失眠和T2 DM的患者。建议的应用程序与NINR的 使命：1)支持初学者和职业中期科学家的发展，2)改进症状科学，以 减少睡眠紊乱的影响，预防疾病症状；3)提高自我保健的科学性。 通过制定创新的管理方法来减少自我管理的障碍 慢性病。

ABSTRACT Research Goals: To examine the role of treatment of insomnia on diabetes self-management behavior, symptom management (i. e. sleepiness and fatigue), and glucose control in adults with type 2 diabetes. Data from this study will help inform a randomized clinical trial that will test a behavioral sleep intervention in this population. The long-term goal of this program of research is determine the effect of sleep disorders as a barrier to self-management and quality of life in populations with at risk for impaired health and well being and to develop behavioral interventions to improve symptoms and self-management. Career Development Goals: There are two career development goals: 1) to increase the applicant's knowledge and expertise in behavioral sleep medicine and 2) to provide sufficient time and increase skills as an effective mentor of doctoral students, postdoctoral fellows, and junior faculty. Research Project: Recent evidence supports that insomnia is a prevalent problem among persons with type 2 diabetes that may be associated with increased daytime sleepiness and fatigue, increased diabetes-related distress, decreased self-management behavior, and worse glycemic control. The main hypothesis of the current application is that a web-based cognitive behavioral treatment of insomnia (SHUTi) in persons with T2DM will not only improve their nighttime sleep, but also improve their ability to integrate diabetes education into their daily behavior and positively affect their glucose control compared to a web-based Information Control group. The aims of this study are to 1) obtain preliminary data to facilitate further hypothesis development and enhance the feasibility of conducting a randomized clinical trial to examine if treatment of insomnia results in participant's being better able to integrate diabetes education into their self-management behavior and result in improved glucose control, 2) explore the associations among changes in insomnia severity, fatigue, daytime sleepiness, sleep quality, A1C and DSM behaviors, 3) explore average pre-intervention to post-intervention changes in insomnia severity, daytime symptoms (fatigue, sleepiness, mood) and DSM behaviors (diet and physical activity) in subjects treated with SHUTi + DSM compared to IC + DSM subjects at 3 months, and 4) explore sleep fragmentation as a potential physiological mechanism linking impaired glucose control (A1C) and sleep in subjects with insomnia and T2DM at baseline and 3 months. The proposed application is relevant to NINR's mission to: 1) support development of beginning and midcareer scientists, 2) to improve symptom science to reduce the effect of disordered sleep and prevent symptoms of illness and 3) improved the science of self- management by the development of innovative approaches to reduce barriers to the self-management of chronic disease.