Intervention to Reduce Fear of Hypoglycemia and Optimize Type 1 Diabetes Outcomes

减少对低血糖的恐惧并优化 1 型糖尿病结局的干预措施

• 批准号: 9284451
• 负责人: Kimberly Driscoll
• 金额: $ 7.78万
• 依托单位: UNIVERSITY OF COLORADO DENVER
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-08-01 至 2020-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9284451
• 关键词: Acute; Adaptive Behaviors; Address; Adherence; Adolescent; Adopted; Adverse effects; Anxiety; Artificial Pancreas; Awareness; Behavior; Blindness; Blood Glucose; Brain; Carbohydrates; Caring; Child; Clinical; Coma; Complications of Diabetes Mellitus; Data; Devices; Diabetes Mellitus; Disease Management; Evidence based intervention; Fright; Future; Glucose; Goals; Grant; Health; Heart; Heart Diseases; Hyperglycemia; Hypoglycemia; Impaired cognition; Injection of therapeutic agent; Insulin; Insulin Infusion Systems; Insulin-Dependent Diabetes Mellitus; Intervention; Intervention Trial; Kidney Failure; Lead; Life; Longitudinal Studies; Measures; Mentored Patient-Oriented Research Career Development Award; National Institute of Diabetes and Digestive and Kidney Diseases; Outcome; Palpitations; Parents; Patients; Physicians; Provider; Public Health; Questionnaires; Randomized; Randomized Clinical Trials; Risk; Seizures; Surveys; Sweat; Sweating; Techniques; Technology; Testing; Training; Treatment Protocols; Unconscious State; Youth; avoidance behavior; boys; clinical care; diabetes control; effective therapy; experience; follow-up; glucose monitor; glycemic control; improved; innovation; insulin secretion; meetings; pediatric patients; personalized intervention; physical symptom; prevent; programs; psychologic; tool; uptake

Project Summary/Abstract NIDDK describes hypoglycemia as “an Achilles heel in therapy to prevent diabetes complications.” Hypoglycemia causes “difficulties with meeting blood glucose targets because [patients' and parents'] immediate fear of hypoglycemia overshadows their fear of long-term complications.” Hypoglycemia is the most common acute side effect (e.g., unpleasant physical symptoms such as sweating and heart palpitations) of intensive insulin therapy and it significantly interferes with achieving optimal glycemic control in patients with type 1 diabetes (T1D). Severe hypoglycemia is life-threatening and occurs when a shortage of glucose in the brain results in cognitive impairment, unconsciousness, or seizure. The experience of hypoglycemic episodes as a patient or a parent of a child with T1D can be psychologically traumatizing. Many studies have documented that fear of hypoglycemia increases anxiety about the T1D treatment regimen leading to engagement in “hypoglycemia avoidance behaviors,” including over-vigilant blood glucose monitoring, treating low blood glucose levels with excessive amounts of carbohydrates, and maintaining high blood glucose by intentionally withholding insulin. Ultimately, inappropriate behaviors to counteract hypoglycemia can lead to poor glycemic control and long-term complications. Thus, it is critically important to assist patients with T1D and their parents to adopt adaptive behaviors to counteract hypo- and hyperglycemia. The overall objective and Primary Aim of this project is to address the critical need of identifying and providing intervention for fear of hypoglycemia, which will be accomplished by conducting a pilot, randomized clinical trial to evaluate the efficacy of Blood Glucose Awareness Training, which has been adapted for, but never evaluated in adolescents with T1D who use insulin pumps and their parents. In addition, we will establish cutoff scores that may increase the clinical utility of the Child and Parent Versions of the Hypoglycemia Fear Survey, the only existing questionnaires to assess fear of hypoglycemia. If the aims of this project are achieved clinical care of pediatric patients with T1D and their parents will be substantially improved by 1) establishing an evidence-based intervention to treat fear of hypoglycemia; and 2) improving the clinical utility of the Hypoglycemia Fear Survey. This project is innovative and significant because it will test an intervention specifically developed for those with high fear of hypoglycemia, a potential cause of insulin pump nonadherence and a significant impediment to full utilization of the technological advances insulin pumps offer. This intervention has the potential to become more widely disseminated into a manualized treatment and training materials so that a variety of diabetes care providers will be able to implement the intervention techniques with patients with T1D and their parents.

项目总结/摘要 NIDDK将低血糖描述为“预防糖尿病并发症治疗中的致命弱点”。 低血糖导致“难以达到血糖目标，因为[患者和父母] 对低血糖的直接恐惧掩盖了他们对长期并发症的恐惧。” hypoxia是最 常见的急性副作用（例如，不愉快的身体症状，如出汗和心悸） 强化胰岛素治疗，并显著干扰患者达到最佳血糖控制， 1型糖尿病（T1 D）。严重的低血糖是危及生命的，发生时，葡萄糖不足， 大脑导致认知障碍、意识丧失或癫痫发作。 作为T1 D患儿的患者或家长，低血糖发作的经历可能 心理创伤许多研究证明，对低血糖的恐惧会增加焦虑 关于T1 D治疗方案导致参与“低血糖避免行为”，包括 过度警惕的血糖监测，用过量的 碳水化合物，并通过故意抑制胰岛素来维持高血糖。最后， 对抗低血糖的不适当行为可导致血糖控制不良， 并发症因此，帮助T1 D患者及其父母采取适应性治疗是至关重要的。 行为来抵消低血糖和高血糖。 本项目的总体目标和主要目的是满足确定和 为低血糖恐惧提供干预，这将通过进行试点、随机 临床试验，以评估血糖意识培训的有效性，这已经适应，但 从未在使用胰岛素泵的T1 D青少年及其父母中进行评价。此外，我们将建立 可能增加儿童和父母版本的低恐惧症的临床效用的截止分数 调查，唯一现有的问卷，以评估低血糖的恐惧。如果这个项目的目标实现了 T1 D儿科患者及其父母的临床护理将通过以下方式得到实质性改善：1）建立 循证干预治疗低血糖恐惧症; 2）改善 抑郁症恐惧调查。这个项目是创新和重要的，因为它将测试一种干预措施， 专为那些高度害怕低血糖的人开发，低血糖是胰岛素泵的潜在原因 不依从性和充分利用胰岛素泵提供的技术进步的重大障碍。 这种干预有可能成为一种更广泛传播的手动治疗， 培训材料，以便各种糖尿病护理提供者能够实施干预措施 T1 D患者和他们的父母。