HOME DM-BAT: Home-based Diabetes-Modified Behavioral Activation Treatment for Low Income Seniors with T2DM

HOME DM-BAT：针对患有 T2DM 的低收入老年人的家庭糖尿病改良行为激活治疗

• 批准号: 10088440
• 负责人: Leonard E. Egede
• 金额: $ 78.61万
• 依托单位: MEDICAL COLLEGE OF WISCONSIN
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-04-01 至 2024-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10088440
• 关键词: Address; African American; Area; Behavior; Behavior Therapy; Behavioral; Blood Glucose Self-Monitoring; Blood Pressure; Chronic; Chronic Disease; Clinical; Code; Cognitive Therapy; Complex; Complications of Diabetes Mellitus; Control Groups; Data; Diabetes Mellitus; Elderly; Ethnic Origin; Glycosylated hemoglobin A; Goals; Health; Healthcare; Home; Housing; Impaired cognition; Individual; Intervention; LDL Cholesterol Lipoproteins; Language; Latina; Life Style; Low income; Maintenance; Measures; Mediator of activation protein; Medical; Mental Depression; Mental Health; Meta-Analysis; Metabolic Control; Minority; Minority Groups; Morbidity - disease rate; Non-Insulin-Dependent Diabetes Mellitus; Nursing Faculty; Outcome; Patients; Personal Satisfaction; Pilot Projects; Population; Psychosocial Factor; Psychosocial Influences; Quality of life; Race; Randomized; Recommendation; Resources; Role; SF-12; Schedule; Self Care; Social Environment; Social isolation; Socioeconomic Status; Stress and Coping; Supportive care; Testing; Training; Treatment Efficacy; Treatment Protocols; Underserved Population; United States; United States Agency for Healthcare Research and Quality; Walkers; base; behavioral adherence; behavioral health; behavioral outcome; cost effective; cost effectiveness; design; diabetes education; diabetes management; diabetes mellitus nursing; dietary adherence; disability; effectiveness evaluation; efficacy evaluation; efficacy testing; efficacy trial; ethnic minority population; exercise adherence; experience; follow-up; food insecurity; glycemic control; health care disparity; health disparity; impaired functional status; improved; improved outcome; medication compliance; mortality; multiple chronic conditions; older patient; physical conditioning; premature; program costs; psychosocial; racial and ethnic; racial and ethnic disparities; social; social health determinants; social stigma; treatment comparison

Persistent disparities based on race/ethnicity and socioeconomic status in healthcare are well documented in the United States. Social determinants of health are key drivers of health disparities, especially in the elderly. Type 2 diabetes (T2DM) is a chronic disease that is highly prevalent in the elderly, associated with significant racial/ethnic disparities, and impacted by social determinants of health. Elderly individuals with diabetes have high multimorbidity, complex treatment regimens, impaired functional status and are often impacted by psychosocial determinants of health such as food insecurity, housing insecurity, competing needs, stress/coping, cognitive dysfunction, limited social and financial resources, and social isolation. Behavioral activation is a cognitive behavior therapy, originally developed to address depression, that has shown promise in individuals with chronic medical conditions, including T2DM. Therefore, especially among racial/ethnic minority elderly patients with diabetes, interventions that directly addresses psychosocial issues and social context factors that can influence lifestyle behaviors in the treatment and management of diabetes are likely to improve clinical outcomes and general well-being. Preliminary data from our group has demonstrated that 8 sessions of culturally-modified, manualized, diabetes-modified, behavioral activation treatment that incorporates: 1) diabetes education, 2) addresses social determinants of health (e.g. food insecurity, housing insecurity, competing needs, stress/coping etc.), and 3) brief behavioral activation treatment achieved maintenance of glycemic control in older adults with T2DM. This project will evaluate the efficacy and cost- effectiveness of 8 sessions of in-home, group-based, manualized diabetes-modified behavioral activation treatment (Home DM-BAT) delivered by trained diabetes nurse educators to low income, minority elders living in independent senior housing. The proposed study will test new strategies for improving clinical outcomes for T2DM in minority elders by addressing both diabetes-specific factors and social determinants of health.

基于种族/民族和社会经济地位的医疗保健方面的持续差异在以下文献中有充分记载： 美国的健康的社会决定因素是健康差距的主要驱动因素，特别是在老年人中。 2型糖尿病（T2 DM）是一种慢性疾病，在老年人中高度流行，与显著的糖尿病并发症相关。 种族/民族差异，并受到健康的社会决定因素的影响。老年糖尿病患者 高多药血症、复杂的治疗方案、受损的功能状态，并且经常受到 健康的社会心理决定因素，如粮食无保障、住房无保障、相互竞争的需求， 压力/应对、认知功能障碍、有限的社会和财政资源以及社会孤立。行为 激活是一种认知行为疗法，最初是为了解决抑郁症而开发的， 患有慢性疾病（包括T2 DM）的个体。特别是在种族/民族之间， 少数老年糖尿病患者，直接解决心理社会问题和社会问题的干预措施， 在糖尿病的治疗和管理中，可能影响生活方式行为的背景因素可能会 改善临床结果和总体健康状况。我们小组的初步数据表明， 经过文化改造的，手动的，糖尿病改造的，行为激活治疗的疗程， 包括：1）糖尿病教育，2）解决健康的社会决定因素（如粮食不安全，住房 不安全感、竞争性需求、压力/应对等），和3）获得短暂的行为激活治疗 在老年T2 DM患者中维持血糖控制。该项目将评估效率和成本- 8次家庭、基于小组的手动糖尿病改良行为激活的有效性 由受过培训的糖尿病护士教育工作者向低收入的少数民族老年人提供家庭糖尿病治疗（家庭糖尿病最佳治疗）， 在独立的老年人住房。拟议的研究将测试改善临床结果的新策略， 2型糖尿病在少数民族老年人通过解决糖尿病的具体因素和健康的社会决定因素。