Improving Self Management in Minority Youths with Type 1 Diabetes

描述(申请人提供)：这项研究旨在开发和测试一种旨在改善患有1型糖尿病的少数民族青年高危群体的自我管理行为、血糖控制和生活质量的干预措施的有效性。这些患者群体被认为是最终健康并发症和生活质量低下的高危人群，因为他们长期血糖控制不佳。控制不佳的糖尿病的发病率和相关的医疗保健费用是相当可观的，而且有很好的记录。具有里程碑意义的糖尿病控制和并发症试验的结果最终表明，通过强化胰岛素疗法实现良好的血糖控制可以降低健康并发症的风险，即使是在青少年中也是如此。因此，加大努力改善控制不良的年轻患者的血糖控制是合理的。我们建议开发一个以家庭为基础的计划，通过增加动力、糖尿病自我护理行为和家庭支持，以及改善12-15岁少数民族青年的血糖控制和生活质量来改善自我管理。由于血糖控制不佳、少数族裔和较低的社会经济地位以及单亲家庭的高比率，这一患者群体被认为是高危人群。将进行重点小组，以完善干预的文化适当性，然后将在更多的重点小组中对干预进行预先测试。干预的一个创新部分将是使用激励性访谈。然后将进行一项试点研究，其中60名儿童将随机接受或不接受为期6个月的干预，同时所有儿童都继续接受标准的医疗护理。主要结果是在干预开始6个月和12个月后对自我管理行为和血糖控制的测量。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的测量。还将审查对干预作出反应的潜在调解人和调解人。这项研究的结果将提供关于一种新的干预措施的有效性的信息，该干预措施可以改善1型糖尿病高危儿童的自我管理。患有1型糖尿病的少数族裔青年由于长期血糖控制不佳，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，以改善这些患者的健康结果。

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.