Improving Health Outcomes in African Americans with Type 2 Diabetes: A Culturally Tailored, Resilience-Based Diabetes Self-Management Education (RB-DSME) Intervention

2型糖尿病（T2 DM）每年花费美国3270亿美元，从2012年到2015年增长了26%。 2017.非裔美国人（AA）患T2 DM的可能性是非西班牙裔白人的两倍，健康状况更差 结果，并且不太可能参与自我管理行为。针对这些问题的干预措施 迫切需要消除差距。在AA中，T2 DM相关的压力通常与一般生活有关， 压力，进一步限制糖尿病自我管理，并与血糖控制不良（A1 C）相关 以及抑郁症等并发症。压力对糖尿病自我管理和健康结果的影响 可能会被韧性减弱：尽管逆境也要成功的决心。即使有证据表明 弹性资源有利于其他健康结果，缺乏基于证据的T2 DM弹性 干预措施。在我们有前途的试点工作的基础上，拟议的研究使用了我们的文化定制，理论推导， 基于弹性的糖尿病自我管理教育（RB-DSME）干预，以帮助参与者管理 这种疾病的社会心理和行为需求。我们提出了一项为期24个月的2组整群随机对照试验， 教会的RB-DSME或标准DSME条件。两组都将接受10个月的干预：8 每周一次的教育会议，随后是8次双月一次的支持小组会议，随后是2次助推会议。 为了研究RB-DSME的疗效，我们将比较RB-DSME与DSME对T2 DM物理（A1 C，FBG， 血脂、BMI、腰围、血压）和精神（抑郁症状、糖尿病困扰、一般 压力）健康结果。为了提供更有针对性的未来干预措施，我们将研究RB的间接影响- DSME（与DSME）关于复原力资源（适应压力，寻找积极意义，适应性应对， 应对歧视，精神应对，自我效能，社会支持，情绪调节）。我们还将 通过自我管理行为检查弹性资源对T2 DM健康结果的间接影响 （饮食摄入、体力活动、葡萄糖自我监测、药物依从性）。新出现的证据包括 我们的研究将头发皮质醇与AAs中的A1 C联系起来，这表明改善HPA轴功能， 压力，与良好的T2 DM健康结果相关。因此，我们还将研究 通过HPA轴功能（皮质醇，DHEA）对T2 DM健康结果的弹性资源。具体目标是： 1)比较T2 DM身体（主要结局：A1 C）和精神（主要结局：抑郁症状） 研究入组后3、6、12和24个月时RB-DSME与DSME的健康结局; 2）检测间接 RB-DSME（vs DSME）通过弹性资源、自我管理对T2 DM健康结局的影响 行为和HPA轴功能。我们的项目将为解决T2 DM负担提供重要指导 通过建立我们的RB-DSME的功效并确定行为和生物机制， 该计划对T2 DM健康结果的影响。我们的长远目标是让认可机构有效管理 T2 DM，从而避免其严重后果，通过RB-DSME干预措施，在一系列社区设置。

Type 2 diabetes mellitus (T2DM) costs the U.S. $327 billion annually, representing a 26% increase from 2012 to 2017. African Americans (AAs) are twice as likely to have T2DM as non-Hispanic Whites, have worse health outcomes, and are less likely to engage in self-management behaviors. Interventions addressing these disparities are urgently needed. Among AAs, T2DM-associated stress is often compounded by general life stress, which further constrains diabetes self-management and is associated with poor glucose control (A1C) and complications such as depression. The impact of stress on diabetes self-management and health outcomes may be attenuated by resilience: a resolve to succeed despite adversities. Even with evidence supporting resilience resources benefiting other health outcomes, there is a dearth of evidence-based T2DM resilience interventions. Building on our promising pilot work, the proposed study uses our culturally tailored, theory-derived Resilience-Based Diabetes Self-Management Education (RB-DSME) intervention to help participants manage the psychosocial and behavioral demands of the disease. We propose a 24-month, 2-arm, cluster RCT assigning churches to the RB-DSME or standard DSME condition. Both groups will receive a 10-month intervention: 8 weekly educational sessions, followed by 8 bimonthly support group sessions, followed by 2 booster sessions. To investigate the efficacy of RB-DSME, we will compare RB-DSME to DSME on T2DM physical (A1C, FBG, lipids, BMI, waist circumference, blood pressure) and mental (depressive symptoms, diabetes distress, general stress) health outcomes. To inform more targeted future interventions, we will examine indirect effects of RB- DSME (vs DSME) on resilience resources (adaptation to stress, finding positive meaning, adaptive coping, coping with discrimination, spiritual coping, self-efficacy, social support, emotional regulation). We will also examine indirect effects of resilience resources on T2DM health outcomes through self-management behaviors (dietary intake, physical activity, glucose self-monitoring, medication adherence). Emerging evidence—including our work linking hair cortisol with A1C in AAs—suggests that improved HPA axis function, a biological marker of stress, is associated with favorable T2DM health outcomes. Thus, we will also examine indirect effects of resilience resources on T2DM health outcomes via HPA axis function (cortisol, DHEA). The Specific Aims are: 1) To compare T2DM physical (primary outcome: A1C) and mental (primary outcome: depressive symptoms) health outcomes in RB-DSME vs DSME at 3, 6, 12, and 24 months post-study entry; and 2) To test indirect effects of RB-DSME (vs DSME) on T2DM health outcomes via resilience resources, self-management behaviors, and HPA axis function. Our project will provide crucial guidance for addressing the T2DM burden among AAs by establishing the efficacy of our RB-DSME and identifying behavioral and biological mechanisms by which the program affects T2DM health outcomes. Our long-term goal is to enable AAs to effectively manage T2DM and thus avoid its serious consequences, via RB-DSME interventions in a range of community settings.