Episodic Future Thinking to Improve Management of Type 2 Diabetes in Rural and Urban Patients: Remote Delivery and Outcomes Assessment to Increase Reach and Dissemination

项目总结 2型糖尿病(T2D)的成功治疗需要坚持饮食、体力活动和 患者和他们的医疗保健提供者之间达成一致的用药计划。生活方式的改变涉及到 在这些协作性护理计划中通常提供很少或没有短期益处并且可能相反是令人厌恶的(例如， 卡路里限制和体力活动)。然而，这些变化在未来提供了关键的健康益处， 允许患有T2D的患者停止或逆转疾病进展并避免与T2D相关的并发症(例如， 肾脏疾病或糖尿病视网膜病变)。因此，2型糖尿病的成功治疗需要一个人的在场 行为要以未来的结果为指导。不幸的是，越来越多的证据表明，患有 2型糖尿病和这种疾病的风险人群表现出延迟折扣率升高(即 延迟后果)，先前的数据表明，这有助于T2D的发展和进展。因此， 显示出增加对未来估值的干预措施可能会改善T2D管理。这样的一个 干预是断断续续的未来思维(EFT)，是参与者生动地想象事件的一种预测形式 这可能会在他们的未来发生。来自调查小组的初步数据表明，EFT有助于减肥 降低和改善T2D患者的血糖控制。在拟议的工作中，我们将调整这些方法以 检查远程交付EFT和远程结果评估的可行性(例如，体重减轻， 在地理分布的城市和农村参与者中的血糖控制和延迟折扣)。因为 远程交付和评估将参与者和实验者的负担降至最低，这些方法可以 增加干预的覆盖范围、传播范围和影响。特定目标1将检查8-和24- 远程EFT在T2D患者体重减轻、血糖远程测量中的周疗效 控制，并延迟折扣。次要措施将包括饮食召回、体力活动和药物治疗 坚持不懈。参与者将生成生动的插曲活动，并通过引导的智能手机应用程序进行提示 24周来进行EFT或在日常生活中控制状况。所有参与者(EFT和控制) 将根据患者的协作护理计划获得个性化的饮食和体力活动支持。次级目标1a 将比较城市和农村人口的结果衡量标准，以评估EFT的疗效 坚决反对城乡差距。具体目标2将检查远程EFT的可接受性。对于一个 干预要在临床环境中有效，它应该易于使用，其帮助应该是显而易见的 病人。因此，参与者将根据可接受性的两个维度对EFT或控制条件进行评级： 感受到的帮助和易用性。参与者还将完成简短的半结构化面试， 干预后汇报阶段，尽可能提供有关感知优势的反馈 干预的障碍和限制。

PROJECT SUMMARY Successful management of type 2 diabetes (T2D) requires adherence to a dietary, physical activity, and medication plan agreed upon between a patient and their healthcare providers. The lifestyle changes involved in these collaborative care plans often provide little to no short-term benefit and may instead be aversive (e.g., caloric restriction and physical activity). However, these changes provide critical health benefits in the future, allowing patients with T2D to halt or reverse disease progression and avoid T2D-related complications (e.g., renal disease or diabetic retinopathy). Thus, successful management of type 2 diabetes requires one's present behavior to be guided by future outcomes. Unfortunately, accumulating evidence indicates that individuals with type 2 diabetes and those at risk for this disorder show elevated rates of delay discounting (i.e., devaluation of delayed consequences), which prior data suggest contribute to development and progression of T2D. Thus, interventions shown to increase valuation of the future are likely to improve T2D management. One such intervention is episodic future thinking (EFT), a form of prospection in which participants vividly imagine events that might occur in their future. Preliminary data from the investigative team suggests that EFT facilitates weight loss and improves glycemic control in patients with T2D. In the proposed work, we will adapt these methods to examine the feasibility of both remote delivery of EFT and remote outcomes assessment (e.g., weight loss, glycemic control, and delay discounting) in geographically distributed urban and rural participants. Because remote delivery and assessment minimize both participant and experimenter burden, these methods may increase the reach, dissemination, and impact of the intervention. Specific Aim 1 will examine the 8- and 24- week efficacy of remotely delivered EFT in patients with T2D on remote measures of weight loss, glycemic control, and delay discounting. Secondary measures will include dietary recalls, physical activity, and medication adherence. Participants will generate vivid, episodic events and be prompted via a guided smartphone app for 24 weeks to engage in EFT or a control condition in their daily lives. All participants (EFT and control control) will receive diet and physical activity support, individualized for patients' collaborative care plans. Sub-aim 1a will compare outcome measures between urban and rural populations to evaluate whether EFT's efficacy is robust against rural-urban disparities. Specific Aim 2 will examine the acceptability of remote EFT. For an intervention to be effective in clinical settings, it should be easy to use and its helpfulness should be apparent to patients. Thus, participants will rate the EFT or control conditions along two dimensions of acceptability: perceived helpfulness and ease of use. Participants will also complete brief, semi-structured interviews during a post-intervention debriefing phase to provide feedback regarding perceived strengths, as well as possible barriers and limitations, of the intervention.