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)每年给美国造成的损失为3270亿美元，比2012年增长了26% 2017年。非洲裔美国人(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，并且不太可能从事自我管理行为。解决这些问题的干预措施 我们迫切需要差距。在AA中，与T2 DM相关的应激通常与日常生活有关 压力，这进一步限制了糖尿病的自我管理，并与血糖控制不良(A1C)有关 以及抑郁症等并发症。压力对糖尿病自我管理和健康结局的影响 韧性可能会减弱：即使在逆境中也要取得成功的决心。即使有证据支持 复原力资源惠及其他健康结果，缺乏循证的T2 DM复原力 干预措施。在我们有前景的试点工作的基础上，拟议的研究使用了我们的文化定制、理论派生 基于复原力的糖尿病自我管理教育(RB-DSME)干预以帮助参与者管理 这种疾病的心理社会和行为需求。我们建议24个月，2-ARM，集群RCT分配 教堂达到RB-DSME或标准DSME条件。两组都将接受为期10个月的干预：8 每周举行一次教育会议，随后是8次双月支助小组会议，然后是2次支持会议。 为了研究RB-DSME的疗效，我们将比较RB-DSME和DSME对T2 DM体格(A1C、FBG、 血脂、BMI、腰围、血压)和精神(抑郁症状、糖尿病痛苦、一般 压力)健康后果。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(VS DSME)关于弹性资源(适应压力、发现积极意义、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 探讨韧性资源通过自我管理行为对T2 DM健康结局的间接影响 (饮食摄入量、体力活动、血糖自我监测、服药依从性)。新出现的证据--包括 我们的研究将头发皮质醇与A1C联系在一起--表明HPA轴功能的改善，是AAS的生物标志 压力，与良好的T2 DM健康结局相关。因此，我们还将研究 通过HPA轴功能(皮质醇、DHEA)对T2 DM健康结局的复原力资源。具体目标是： 1)比较T2 DM的生理(主要结果：A1C)和精神(主要结果：抑郁症状) RB-DSME与DSME在研究开始后3、6、12和24个月的健康结果；2)间接测试 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负担提供至关重要的指导 通过建立我们的RB-DSME的有效性并确定行为和生物学机制 通过该计划影响T2 DM的健康结果。我们的长远目标是使机场管理局能够有效地管理 在一系列社区环境中，通过RB-DSME干预措施，预防2型糖尿病，从而避免其严重后果。

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.