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

项目摘要 农村社区的多种综合性疾病发病率很高， 疾病负担。这在阿巴拉契亚和密西西比三角洲的南部地区尤为突出 区域，那里有很高比例的得不到充分服务的群体（例如，农村居民），以及潜在的社会（例如， 收入、教育、住房）和环境（例如，食物沙漠、绿色空间/安全空间、获得初级 健康护理服务）的风险因素，这可能会增加患慢性疾病的可能性，如 糖尿病和其他健康问题。 慢性疼痛是一种持续三个月以上的持续性或复发性疼痛， 美国对生活质量和福祉产生负面影响，并造成相当大的经济负担。这 条件有一个复杂的病因，影响身体和情绪功能，并有不同的方法， 治疗和管理。大约3400万美国人患有糖尿病，大约50-70%的人患有糖尿病。 患有糖尿病的美国成年人也患有慢性疼痛。糖尿病，一种代谢紊乱 其特征是高水平的血糖，可能会对心脏，血管，眼睛， 肾脏和神经慢性疼痛和2型糖尿病的共同发生的特点是减少身体 功能，降低生活质量和抑郁症，这可能会增加心脏病，中风的发病率，以及 加重其他风险因素，如高血压或高胆固醇。 充分的证据表明治疗和自我管理策略（例如，血糖监测、饮食、运动） 对于糖尿病是有效的，适当遵守推荐的指南。然而，控制慢性疼痛 糖尿病会破坏一个人参与推荐的糖尿病自我管理活动的能力 因为它经常导致血糖水平升高。技术有可能支持自我管理 只有针对具体和独特的需要， 社区。因此，拟议的项目将审查心理因素、心理社会风险和 与糖尿病和慢性疼痛共病患者的过早发病率和死亡率相关的弹性因素 南方农村，目标是改善2型糖尿病的结果（例如，血糖控制，生活质量， 预防或减少糖尿病并发症）。此外，我们还将研究 利用技术的力量（即，可穿戴活动监测器），以进一步检查障碍和促进因素， 自我管理策略和一般健康促进行为在南方农村居民。

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.