ASSIST - Address Self-Management Strategies to Improve and Sustain T2D outcomes for adults with comorbid chronic pain and type 2 diabetes in the South

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PROJECT SUMMARY Rural communities are laden with high rates of multiple syndemic health conditions, contributing to an excess burden of disease. This is particularly salient in the Southern regions of the Appalachia and Mississippi Delta regions, where there is a high proportion of underserved groups (e.g., rural dwellers), and underlying social (e.g., income, education, housing), and environmental (e.g., food deserts, green space/safe spaces, access to primary health care services) risk factors, which may increase the likelihood of developing chronic diseases, such as diabetes and other health conditions. Chronic pain, a persistent or recurring pain that lasts more than three months, is a common condition among U.S. adults that negatively impacts quality of life, wellbeing, and causes considerable economic burdens. This condition has a complex etiology, impacts physical and emotional function, and has a varied approach to treatment and management. Approximately 34 million Americans have diabetes, and approximately 50-70% of the U.S. adult population with diabetes also suffer from chronic pain. Diabetes, a metabolic disorder characterized by high levels of blood glucose, may cause serious damage to the heart, blood vessels, eyes, kidneys, and nerves. The co-occurrence of chronic pain and type 2 diabetes is marked by decreased physical function, lower quality of life, and depression, which may increase the onset of heart disease, stroke, as well as exacerbate other risk factors such as high blood pressure or high cholesterol. Ample evidence suggests treatment and self-management strategies (e.g., glucose monitoring, diet, exercise) for diabetes are effective with proper adherence to recommended guidelines. However, managing chronic pain and diabetes can undermine a person's ability to engage in recommended diabetes self-management activities as it often leads to elevated blood glucose levels. Technology has the potential to support self-management strategies and reduce health disparities for rural dwellers, but only if designed for the specific and unique needs of the community. Therefore, the proposed project will examine the psychological factors, psychosocial risk, and resilience factors associated with premature morbidity and mortality of comorbid diabetes and chronic pain in the rural South, with the goal of improving type 2 diabetes outcomes (e.g., glycemic control, quality of life, and preventing or reducing diabetes complications). Additionally, we will examine the utility and the potential leveraging power of technology (i.e., wearable activity monitors) to further examine barriers and facilitators to self-management strategies and general health promoting behaviors among rural dwellers in the South.