Joint Patient and Caregiver Intervention for Older African Americans with Poorly Controlled Type 2 Diabetes (Joint Home-DM-BAT)

针对 2 型糖尿病控制不佳的老年非裔美国人的患者和护理人员联合干预 (Joint Home-DM-BAT)

• 批准号: 10644727
• 负责人: Aprill Dawson
• 金额: $ 59.7万
• 依托单位: MEDICAL COLLEGE OF WISCONSIN
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-11 至 2026-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10644727
• 关键词: Address; Adherence; Adult; African American population; Age; Behavior; Behavioral; Blood Pressure; Caregiver Burden; Caregivers; Caring; Chronic; Clinical; Cognitive Therapy; Complex; Complications of Diabetes Mellitus; Control Groups; Data; Diabetes Mellitus; Elderly; Feedback; Focus Groups; Funding; Glycosylated hemoglobin A; High Prevalence; Home; Hour; Housing; Impaired cognition; Individual; Intervention; Joints; LDL Cholesterol Lipoproteins; Learning Module; Life Style; Literature; Low income; Manuals; Mediator; Medical; Mental Depression; Mental Health; Morbidity - disease rate; Non-Insulin-Dependent Diabetes Mellitus; Nursing Faculty; Outcome; Participant; Patient-Focused Outcomes; Patients; Pilot Projects; Quality of life; Randomized; Recommendation; Resources; Risk Factors; SF-12; Schedule; Self Care; Shapes; Social isolation; Social support; Stress; Stress and Coping; Telephone; Testing; Training; Treatment Protocols; United States National Institutes of Health; care coordination; care costs; caregiver interventions; comparison control; cost effectiveness; diabetes education; diabetes management; diabetes mellitus nursing; diabetes risk; disability; efficacy evaluation; efficacy trial; ethnic minority; experience; follow-up; food insecurity; health determinants; impaired functional status; improved; informal caregiver; informal support; intervention effect; intervention mapping; loved ones; mortality; multiple chronic conditions; perceived stress; physical conditioning; pressure; psychosocial; social; social health determinants; telephone delivery; therapy development; treatment as usual

Older African Americans (AAs) have higher prevalence of type 2 diabetes (T2DM) and increased risk of diabetes related complications and mortality. In addition, older AAs are more likely to require help from caregivers to manage their diabetes and caregivers provide numerous hours of costly care daily providing physical and social support, and care coordination. However, informal/unpaid caregivers frequently have little or no formal training on managing diabetes or addressing the social risk factors associated with patient outcomes. Therefore, there is an urgent need to provide informal caregivers with appropriate training and strategies for diabetes management to reduce caregiver burden and improve their quality of life, so they can continue to care for older AAs with T2DM. Behavioral activation is a cognitive behavior therapy, originally developed to address depression, that has shown promise in individuals with chronic medical conditions, including T2DM. We are currently completing an NIH funded RCT (R01DK118038) to evaluate the efficacy and cost-effectiveness of 8 sessions of in-home, telephone-delivered, behavioral activation treatment for older adults with diabetes (Home DM-BAT). 40% of AAs in the study have informal caregivers. Caregivers have requested formal training on managing diabetes in the form of joint training sessions with participants. We conducted focus groups with participant-caregiver dyads and their feedback has guided the decision to conduct this R21 study and shaped the proposed intervention. The proposed study will test the preliminary efficacy of home-based, joint patient and caregiver intervention (Joint Home-DM-BAT) on patient clinical outcomes (hemoglobin A1c, blood pressure, and LDL-Cholesterol) and quality of life and caregiver quality of life and caregiver burden. This study fills a gap in the literature by combining diabetes education with brief behavioral activation treatment, addressing social determinants of health, and incorporating training and support for informal caregivers. Finally, this study is responsive to patient and caregiver feedback and allows incorporation of the lived experience into intervention development for older AAs with T2DM.

老年非裔美国人（AA）2型糖尿病（T2 DM）的患病率较高， 糖尿病相关并发症和死亡率。此外，年龄较大的AA更有可能需要来自 护理人员管理他们的糖尿病，并且护理人员每天提供许多小时的昂贵护理， 身体和社会支持以及护理协调。然而，非正规/无报酬的照顾者往往没有多少 或没有接受过管理糖尿病或解决与患者相关的社会风险因素的正式培训 结果。因此，迫切需要向非正规护理人员提供适当的培训， 糖尿病管理策略，以减轻照顾者的负担，提高他们的生活质量，使他们能够 继续治疗老年T2 DM患者。行为激活是一种认知行为疗法， 开发用于治疗抑郁症，在患有慢性疾病的个体中显示出希望， 包括T2 DM。我们目前正在完成一项由NIH资助的RCT（R 01 DK 118038），以评估其疗效， 老年人8次家庭电话行为激活治疗的成本效益 成人糖尿病（家庭DM-BAT）。研究中40%的AA有非正式的照顾者。照顾者有 要求以与参与者联合培训班的形式进行关于糖尿病管理的正式培训。我们 进行了焦点小组与参与者照顾者的二人组，他们的反馈指导了决定， 进行这项R21研究，并制定了拟议的干预措施。拟议的研究将测试初步的 以家庭为基础的患者和护理人员联合干预（联合家庭-DM-BAT）对患者临床的功效 结果（血红蛋白A1 c、血压和LDL-胆固醇）和生活质量以及护理者的生活质量 生活和照顾者的负担。本研究通过将糖尿病教育与简短的 行为激活治疗，解决健康的社会决定因素，并将培训和 支持非正式护理人员。最后，本研究对患者和护理人员的反馈做出了回应， 将生活经验纳入老年T2 DM患者AA的干预开发。