Enhancing Informal Caregiving to Support Diabetes Self-Management

描述(由申请人提供)：尽管居家照顾者(ICGS)有助于改善糖尿病(DM)的预后，但他们可能缺乏优化这一点所需的资源，并面临心理社会衰退和“照顾者倦怠”的风险。让事情变得更复杂的是，数百万患有慢性病的美国老年人独自生活，接受“远程护理”，没有任何支持结构或资源来确保其有效性。初步数据表明，糖尿病患者将在持续的时间内持续进行自动化远程监护。由此产生的数据似乎有效地检测到随着时间的推移，健康状况和自我管理方面的变化。我们建议将患者联系到愿意与患者的ICG(如果存在)和临床医生(S)密切协调，支持患者的健康和自我管理的非家庭家庭成员或亲密朋友(“护理伙伴；”CP)。通过自动远程监护，患者将每周提供关于他们的DM健康和自我管理的最新情况。这些摘要将与帮助患者解决报告问题的指导一起通过电子邮件发送给CPS(S)；临床医生将收到有关医学紧急问题的警报。我们发现，在另一个具有挑战性的环境中，类似的干预是可行的，并且可能有效，即充血性心力衰竭自我管理。对于该计划，我们制定了与DM相关的电话脚本和详细的参与者指南。在这份重新提交的报告中，我们现在纳入了试点数据，这些数据不仅表明糖尿病患者非常愿意接受干预，而且还通过建议干预不太可能造成或加剧CP、ICGS和患者之间的人际冲突来解决审查人员的担忧。我们现在提出一个基于社区的有效性RCT。具体目标1是比较CP干预和单独远程监护(对照)对糖尿病患者12个月血糖控制和糖尿病相关痛苦的影响(即初始HbA1c和Gt；8.0%)。具体目标2是检查对糖尿病自我管理、与健康相关的生活质量、收缩压、照顾者负担、关系质量和糖尿病护理成本的次要影响。我们已经招募了临床站点，为大量低收入和保险不足的患者提供服务，这项干预措施专门为他们设计的受益对象。如果这种干预措施在不增加成本或临床医生负担的情况下被证明是有效的，那么它的实施可能会带来重大的公共卫生好处，特别是对脆弱和服务不足的糖尿病患者。更广泛的社会效益可以通过增加帮助行为和加强社会关系来实现。后续工作可以调整干预措施，使其适用于需要自我管理的并存疾病和其他慢性疾病。

DESCRIPTION (provided by applicant): Although in-home caregivers (ICGs) help improve diabetes mellitus (DM) outcomes, they may lack the resources needed to do this optimally, and are at risk for psychosocial decline and "caregiver burnout." Complicating matters, millions of chronically-ill older Americans live alone and receive "long-distance caregiving" without any supporting structure or resources to ensure its effectiveness. Preliminary data indicate that DM patients will engage in automated telemonitoring consistently for sustained periods. The resulting data seems to validly detect changes over time in health status and self-management. We propose to link patients with a non-household family member or close friend (the "CarePartner;" CP) who is willing to support the patient's health and self-management in close coordination with the patient's ICG (if one exists) and clinician(s). Through automated telemonitoring, patients will provide weekly updates on their DM health and self-management. Summaries of this will be emailed to CPs along with guidance on helping the patient address reported problem(s); clinicians will be alerted about medically-urgent problems. We found a similar intervention to be feasible and potentially effective in another challenging setting, i.e., congestive heart failure self-management. For this proposal, we developed DM-related telephone scripts and detailed participant guidelines. In this resubmission, we now include pilot data that not only indicates that DM patients are very receptive to the intervention, but also addresses a Reviewer concerns by suggesting that the intervention is unlikely to create or worsen interpersonal conflicts between CPs, ICGs, and patients. We now propose a community-based effectiveness RCT. Specific Aim 1 is to compare the effects of CP intervention to telemonitoring alone (control) upon 12-month glycemic control and DM-related distress for patients with poorly-controlled DM (i.e., initial HbA1c > 8.0%). Specific Aim 2 is to examine secondary effects on DM self-management, health-related quality of life, systolic blood pressure, caregiver burden, relationship quality, and cost of DM care. We have already recruited clinical sites serving large numbers of low-income and underinsured patients, whom this intervention was especially designed to benefit. If this intervention proves effective without increasing costs or clinician burden, then its implementation could yield major public health benefits, especially for vulnerable and underserved DM patients. Broader societal benefit may occur through increased helping behavior and strengthened social ties. Followup work could adapt the intervention for use with comorbid conditions and other chronic conditions requiring self-management.