Improving Self Management in Minority Youths with Type 1 Diabetes

描述（由申请人提供）：本研究旨在开发和测试一种干预措施的有效性，该干预措施旨在改善少数民族1型糖尿病高危人群的自我管理行为、血糖控制和生活质量。由于长期血糖控制不良，这些患者被认为是最终出现健康并发症和生活质量差的高危人群。控制不良的糖尿病的发病率和相关的医疗费用是相当可观的，并且有充分的记录。具有里程碑意义的糖尿病控制和并发症试验的结果确凿地表明，通过强化胰岛素治疗获得良好的血糖控制可以降低健康并发症的风险，即使在青少年中也是如此。因此，加大努力改善血糖控制不良的年轻患者的血糖控制是合理的。我们建议发展一个以家庭为基础的项目，通过增加动机、糖尿病自我护理行为和家庭支持来改善自我管理，并改善一组12-15岁少数民族青年的血糖控制和生活质量。由于血糖控制不佳、少数民族和低社会经济地位以及单亲家庭比例高，该患者群体被认为是高危人群。将进行焦点小组以完善文化适当性干预措施，然后在其他焦点小组中对干预措施进行预测试。干预的一个创新部分将是动机性访谈的使用。然后将进行一项试点研究，其中60名儿童将被随机分配接受或不接受6个月的干预，同时所有儿童继续接受标准的医疗护理。主要结果是干预开始后6个月和12个月的自我管理行为和血糖控制测量。次要结果包括生活质量、糖尿病家庭支持和冲突以及自我效能。对干预反应的潜在中介和调节者也将被审查。本研究的结果将提供有关一种新的干预措施的有效性信息，以改善1型糖尿病儿童高危群体的自我管理。少数民族青年1型糖尿病患者由于长期血糖控制不良，最终出现健康并发症和生活质量下降的风险很高。这项研究将开发一种新的干预措施来改善这些患者的健康状况。

DESCRIPTION (provided by applicant): This research aims to develop and test the efficacy of an intervention designed to improve self-management behaviors, glycemic control, and quality of life in a high risk group of minority youths with type 1 diabetes. This patient population is considered to be at high risk for eventual health complications and poor quality of life due to their chronic poor glycemic control. The morbidity and associated health care costs of poorly controlled diabetes are considerable and well documented. The findings from the landmark Diabetes Control and Complications Trial showed conclusively that attaining good glycemic control through intensified insulin regimens led to reduced risk of health complications, even among adolescents. Increased efforts to improve the glycemic control of young patients in poor control are therefore justified. We propose to develop a family-based program to improve self-management by increasing motivation, diabetes self-care behaviors, and family support, and improving glycemic control and quality of life in a group of 12-15 year-old minority youths. This patient group is considered at high risk due to their poor glycemic control, their minority and low socioeconomic status, and the high rate of single-parent families. Focus groups will be conducted to refine the intervention for cultural appropriateness and then the intervention will be pre-tested in additional focus groups. An innovative component of the intervention will be the use of motivational interviewing. A pilot study will then be conducted in which 60 children will be randomized to either receive or not receive the 6- month intervention, while all continue with standard medical care. Primary outcomes are measures of self-management behaviors and glycemic control obtained six and 12 months after the start of intervention. Secondary outcomes include measures of quality of life, diabetes family support and conflict, and self-efficacy. Potential mediators and moderators of response to intervention will also be examined. The results of this study will provide information concerning the efficacy of a new intervention to improve self-management in a high risk group of children with type 1 diabetes. Minority youth with type 1 diabetes are at high risk for eventual health complications and reduced quality of life due to their chronic poor glycemic control. This research will develop a new intervention to improve health outcomes for these patients.