Improving Self-Regulation and Social Support for Type 1 Diabetes During Emerging Adulthood

项目总结 1型糖尿病(T1D)是一个重大的公共卫生问题，约有300万美国人患有 生病了。尽管广泛的研究已经检查了促进或阻碍T1D管理的因素 童年和青春期，人们对成年高危时期的了解要少得多。少于 三分之一的初出茅庐的成年人进行自我管理，这与血糖的建议一致。 检查和饮食，只有17%的人符合血糖控制的建议，使初出茅庐的成年人 有可能出现严重的长期并发症。我们推论这些风险的发生是因为新兴的成年人仍然 培养独立管理T1D的自我调节技能，并缺乏必要的社会资源来 随着父母参与度的下降以及工作和大学中新关系的出现，管理他们的疾病。 迫切需要干预，然而，几乎没有高质量的干预措施来满足独特的需求 患有T1D的新兴成人。科学的前提是以自我调节为目标的干预(设置 目标、计划)和社会监管(向他人披露，以便他们能够提供社会支持)将是有益的 在成年初期应对管理T1D的挑战。这项研究在测试方面具有创新性 以理论为基础的干预针对自我调节和利用日常社会关系的有效性 不同族裔/种族的新兴成年人样本的生活。FAMS-T1D是一种新适应的干预措施 基于为以下目的开发的高效干预措施(FAMS-家人/朋友激活以激励自我护理) 成人2型糖尿病(T2D)，包括三个组成部分：1)基于电话的指导，以改善 患者在追求目标和管理社会关系方面的技能，2)向患者发送短信以促进自我 监管和社会监管，以及3)向支持人员(SP)发送短信，以改善与和 对病人的支持。这项研究将干预与对照(如往常一样加强治疗)进行了比较。 调查小组的大量初步数据支持对新兴成年人进行干预的必要性 T1D和干预对成人T2D的疗效。在目标1中，我们评估了6- 在基线后6个月、9个月和12个月对糖化血红蛋白、自我管理和糖尿病痛苦进行月度干预 在两个站点招募了280名新兴成年人和SP的多样化样本。在目标2中，我们考察了 对预后的影响通过改善患者的自我调节报告(计划、自我调节和自我调节)来实现 效率、自我调节失败)和社会调节(向他人披露；有益的和有害的参与 家人和朋友)。在目标3中，我们评估干预如何改善SP对其参与情况的报告 而不会增加SP负担。在目标4中，我们在范围内探索了干预对时间的影响的时间过程 使用来自参与者子样本的连续血糖监测数据。这种干预有可能 影响力大，覆盖面广，因为它帮助患有T1D的新兴成年人培养可在 多个社交环境、新的关系，以及生活的其他领域。

PROJECT SUMMARY Type 1 diabetes (T1D) is a significant public health problem, with some three million Americans living with the illness. Although extensive research has examined factors that facilitate or impede T1D management during childhood and adolescence, much less is known about the high-risk time of emerging adulthood. Less than one-third of emerging adults engage in self-management consistent with recommendations for blood glucose checking and diet, and only 17% meet recommendations for blood glucose control, placing emerging adults at risk for serious long-term complications. We theorize these risks occur because emerging adults are still developing the self-regulation skills to manage T1D independently and lack the necessary social resources to manage their illness as parental involvement declines and new relationships at work and in college occur. There is a critical need to intervene, however, few high-quality interventions exist to address the unique needs of emerging adults with T1D. The scientific premise is that an intervention targeting self-regulation (setting goals, planning) and social-regulation (disclosing to others so they can provide social support) will be beneficial for meeting the challenges of managing T1D during emerging adulthood. The research is innovative in testing the efficacy of a theory-based intervention to target self-regulation and leverage social relationships in the daily lives of a sample of ethnically/racially diverse emerging adults. FAMS-T1D is a newly adapted intervention based on a highly effective intervention (FAMS-Family/friend Activation to Motivate Self-Care) developed for adults with type 2 diabetes (T2D) that involves three components: 1) phone-based coaching to improve patients’ skills in goal pursuit and managing social relationships, 2) text messaging to patients to facilitate self- regulation and social-regulation, and 3) text messaging to a support person (SP) to improve dialogue with and support for the patient. The study compares the intervention to control (enhanced treatment as usual). Extensive preliminary data of the investigative team support the need for the intervention in emerging adults with T1D and the efficacy of the intervention for adults with T2D. In Aim 1, we evaluate the effects of the 6- month intervention on A1c, self-management, and diabetes distress at 6-, 9-, and 12-months post baseline with a diverse sample of 280 emerging adults and SPs recruited across two sites. In Aim 2, we examine whether the effects on outcomes occur through improvements in patients’ reports of self-regulation (planning, self- efficacy, self-regulation failures) and social-regulation (disclosure to others; helpful and harmful involvement of family and friends). In Aim 3, we evaluate how the intervention improves SP reports of their involvement without increasing SP burden. In Aim 4, we explore the time course of intervention effects on time in range using continuous glucose monitoring data from a subsample of participants. The intervention has the potential for high impact and broad reach as it helps emerging adults with T1D develop skills that can be leveraged in multiple social settings, new relationships, and across other domains of life.