Improving Diabetes Self Management in Minorities

描述（由申请人提供）：糖尿病已被确定为美国的一种流行病，并且患病率持续增长，特别是2型糖尿病。此外，糖尿病的负担，包括患病率和并发症的风险，在低收入个人和少数群体中更大，特别是拉丁美洲人和非洲裔美国人。《2010年健康人报告》指出，可以通过二级和三级预防以及促进最佳自我管理来减轻糖尿病负担。很少有对照研究关注于加强少数民族或其他服务不足人群糖尿病自我管理的策略。增加我们覆盖面和影响力的一种方法是培训非专业人员或辅助专业人员与多学科糖尿病护理团队合作，以最小的额外费用支持最佳的糖尿病自我管理。本研究的目的是开发、实施和评估一种创新干预的影响，该干预将糖尿病自我管理教育、培训和支持与医疗助理教练（mac）提供的病例管理方面相结合，以支持低收入少数民族2型糖尿病患者的最佳糖尿病自我管理（以及二级和三级预防）。这项疗效试验比较了医疗助理自我管理教练（MAC）干预和“常规治疗”（TAU）。目标人群将构成914名非洲裔美国人和拉丁裔美国人的总样本，他们在芝加哥的五个联邦合格医疗中心接受治疗，这些中心为低收入人群提供服务。拟议的研究将采用前瞻性随机两组分离图重复测量设计。具体而言，它将是一个两个（治疗组：TAU， MAC）由四个（时间：基线，6个月，12个月，18个月）重复测量设计。MAC干预将根据跨理论模型和文化量身定制，包括必要时的西班牙语翻译。MAC干预将在一年的时间内每月进行一次，包括常规初级保健访问期间的面对面接触和定期电话指导接触。主要结局变量将是由HbA1C值测量的血糖控制。次要结局包括：心理社会介质、行为结局、短期和长期生物医学结局。如果在改善血糖控制和/或其他糖尿病自我管理措施方面有效，这种干预措施有可能在其他为少数民族人群服务的初级保健诊所中容易实施。此外，这种干预有可能帮助控制成本，同时最大限度地扩大我们的覆盖范围，促进可持续性。

DESCRIPTION (provided by applicant): Diabetes has been identified as an epidemic in the U. S. and is continuing to grow in prevalence, especially type 2 diabetes. In addition, the burden of diabetes, including prevalence and risk of complications, is greater for low-income individuals and minority groups, especially Latinos and African Americans. The Healthy People 2010 report notes that the burden of diabetes can be reduced through secondary and tertiary prevention and facilitating optimal self-management. Few controlled studies have focused on strategies to enhance diabetes self-management in minority or other underserved populations. One approach to increasing our reach and impact is to train nonprofessionals or paraprofessionals to work with multidisciplinary diabetes care teams to support optimal diabetes self-management with minimal added expense. The purpose of this study is to develop, implement, and evaluate the impact of an innovative intervention that combines diabetes self-management education, training, and support with aspects of case management delivered by Medical Assistant Coaches (MACs), to support optimal diabetes self-management (and secondary and tertiary prevention) in low-income minority populations with type 2 diabetes. This efficacy trial compares the Medical Assistant self-management coach (MAC) Intervention with "treatment as usual" (TAU). The target populations will form a total sample of 914 African Americans and Latinos receiving care at five Federally Qualified Health Centers serving low-income individuals in Chicago. The proposed study will use a prospective randomized two-group split-plot repeated measures design. Specifically, it will be a two (treatment groups: TAU, MAC) by four (time: baseline, 6-month, 12-month, 18- month) repeated measures design. The MAC Intervention will be individually tailored based on the Transtheoretical Model and culturally tailored, including Spanish translation where needed. The MAC intervention will be delivered monthly over a one-year period, including both face-to-face contacts during routine primary care visits and regular telephone coaching contacts. The primary outcome variable will be glycemic control measured by HbA1C values. Secondary outcomes include: psychosocial mediators, behavioral outcomes, and short- and longer term biomedical outcomes. If effective in improving glycemic control and/or other measures of diabetes self-management, this intervention has the potential to be easily implemented in other primary care clinics serving minority populations. Furthermore, this intervention has the potential to help contain costs while maximizing our reach and facilitating sustainability.