Cognitive Behavioral Intervention in Diabetes Self-Mgt.

描述(申请人提供)：2型糖尿病目前被认为是对患者行为要求最高的慢性病之一。每天必须口服或注射药物，必须定时用餐，必须区分食物类型并测定卡路里和脂肪含量，运动必须与用餐时间相关联，通常每天需要进行两到三次血液检测，当血糖检测较高时，还必须进行尿酮检测。实现和维持这种行为需要信息和知识，但需要技能、动机和强化，以及高效的行为自我管理。毫不奇怪，在糖尿病教育知识中发现的关于坚持的研究不再是改变行为的灵丹妙药，也不再是在计划完成后保持需要改变生活方式的行为的灵丹妙药(Campbell，Redman，Mofitt，&Sanson-Fischer，1996；Rubin，Peyrow，&Saudek，1991)。格拉斯哥和奥斯汀(1992)建议从知识-态度-信念模式转变为以患者为中心的观点、自我效能、自我管理和赋权。这些生活和应对糖尿病的心理社会问题在治疗研究结果中也被忽视了。由于心理社会变量显著影响疾病的进程，我们需要更好地了解是什么帮助个人自助。由于护理主要由疾病患者提供，他们是需要信息、技能、动力来做出决定和选择的人。然而，家庭在亚太岛民中扮演着重要的角色，他们也必须被视为糖尿病护理的外部影响。解决这些问题的具体目标如下：1)确定认知/行为干预计划在提高患有2型糖尿病的亚太岛民对自我管理策略的遵守方面的有效性；2)确定认知/行为干预计划在改善患有2型糖尿病的亚太岛民的生活质量和血糖控制方面的有效性；以及3)确定对患有2型糖尿病的亚太岛民进行治疗的独特反应。这项研究的拟议设计是一项双臂随机对照临床试验，并进行后续跟踪，检查给予以下干预措施的2型糖尿病患者的行为和健康结果：使用标准建议(ADA指南)的糖尿病自我管理教育计划，与包括标准自我管理计划加上认知/行为干预以提高遵从性的治疗组(增强)。

DESCRIPTION (provided by applicant): Type 2 diabetes mellitus is currently viewed as one of the chronic disease with the most behavioral demands on the patient. Medication must be taken daily either orally or by injection, meals must be timed, types of food must be distinguished and determinations made regarding calories and fat content, exercise must be timed in relationship to meals, blood testing is often required two to three times a day as well as urine testing for ketones when glucose tests are high. Achieving and sustaining such behaviors require information and knowledge but skills, motivation and reinforcement and highly effective behavioral self-management. It is not surprising that studies on adherence found in diabetes education knowledge alone is no longer the panacea for changing behavior nor maintaining behaviors that require changes in life-style after program completion (Campbell, Redman, Mofitt, & Sanson-Fischer, 1996; Rubin, Peyrot, & Saudek, 1991). Glasgow & Osteen (1992) suggest a shift from a knowledge-attitude-belief model to patient-centered perspectives, self-efficacy, self-management, and empowerment. These psychosocial issues of living and coping with diabetes have also been neglected in treatment research outcomes. Because psychosocial variables significantly influence the course of a disease, we need to better understand what assists individuals to help themselves. As care is provided mainly by the persons with the disease, they are the ones who need the information, skills, motivation, to make decisions and choices. However, the family plays a large role in Asian-Pacific Islanders, they must also be looked upon as external influences in diabetes care. The following specific aims to address these issues are to: 1) determine the effectiveness of a cognitive/behavioral intervention program in enhancing adherence to self-management strategies for Asian Pacific Islanders with type 2 diabetes; 2) determine the effectiveness of cognitive/behavioral intervention program in improving health outcomes of quality of life and glycemic control for Asian/Pacific Islander with type 2 diabetes; and 3) identify unique responses to treatment of Asian/Pacific Islander with type 2 diabetes. The proposed design of the study is a two-arm randomized, controlled clinical trial with follow-up that examines behavioral and health outcomes in individuals with type 2 diabetes given the following interventions: a diabetic education program for Self-Management, using standard recommendations (Guidelines from ADA), versus the treatment group which would include the Standard Self-Management program plus Cognitive/Behavioral Interventions to enhance adherence (ENHANCE).