A Mixed Methods Investigation of Attitudes and Self-Care in Individuals with Type-1 Diabetes Mellitus with Intact and Impaired Awareness of Hypoglycemia

项目摘要 低血糖是胰岛素治疗的必然结果。1型糖尿病(T1 DM)患者 依靠症状感知作为对抗严重低血糖的主要生理防御措施。至.为止 60%的T1 DM患者对由此导致的低血糖反应迟钝 低血糖(IAH)意识受损。那些患有IAH的人患上 出现严重的、危及生命的低血糖。黑人和白人之间存在种族差异 关于严重低血糖的发生率和IAH的流行率。此外，目前的补救方法 IAH依赖于先进的技术，这是一种黑人个人明显不太可能进行的干预 领养。为了减少严重低血糖事件和差异的风险，了解IAH的新方法 都是有根据的。通过显著避免低血糖，低血糖意识可能会恢复，但我们 相信许多人由于自我照顾而无法获得足够的回避来恢复意识 导致医源性高胰岛素血症和由此产生的低血糖的行为。患有IAH的个体 已经被证明持有独特的态度和信念，这可能会鼓励这些行为。这一团契 应用程序将决定IAH患者的区分态度和自我护理，描述常见的 IAH患者的态度和自我护理概况，并更深入地定性解释调查结果，以启动 调查这些关系的职业。这项研究的具体目的是(1)比较 有无IAH的成人T1 DM患者的态度和自我护理行为，(2)确定态度和自理行为的集群 与IAH分类最符合的自理行为模式，以及(3)探索 不同种族的成年T1 DM合并和不合并IAH To的态度和自我护理 更好地解释在聚类分析中观察到的模式。数据将从宾夕法尼亚大学的患者样本中收集 罗德堡糖尿病中心，宾夕法尼亚大学健康系统中最大的糖尿病中心。数据 首先用方差分析比较患有和不患有IAH的人的态度和自我护理行为 同时保持公认的协变量不变。然后，我们将使用Ward的最小值执行聚类分析 确定哪些态度和自我护理模式最符合IAH分类的方差方法 成年T1 DM患者。最后，我们将对以下个人的访谈进行定性定向内容分析 IAH被归入被确定为与IAH最一致的组来解释结果。这一团契 申请者将提供成为独立申请者所需的培训和研究经验 护理研究员，在T1 DM患者的自我护理、态度和IAH方面具有发展专长。这 该提案与NINR症状科学创新问题倡议相一致，因为它解决了心理社会如何 影响慢性病症状的因素。这项研究预计将有助于确定 在我作为一名新兴的护士科学家发展我的职业生涯时，对未来研究的干预。

Project Summary Hypoglycemia is an inevitable consequence of insulin therapy. Individuals with type-1 diabetes mellitus (T1DM) rely on symptom perception as the primary physiologic defense against developing severe hypoglycemia. Up to 60% of individuals with T1DM experience blunting of the sympathoadrenal response to hypoglycemia that results in impaired awareness of hypoglycemia (IAH). Those with IAH have a significantly higher likelihood of experiencing severe, life-threatening hypoglycemia. Racial disparities exist between Black and White individuals regarding incidence of severe hypoglycemia and prevalence of IAH. Further, current approaches to remedying IAH rely on advanced technologies, a form of intervention that Black individuals are significantly less likely to adopt. To reduce risk for severe hypoglycemic events and disparities, novel approaches to understanding IAH are warranted. Hypoglycemia awareness may be restored with significant hypoglycemia avoidance, yet we believe that many individuals are unable to achieve sufficient avoidance to restore awareness due to self-care behaviors that cause frequent iatrogenic hyperinsulinemia, and resultant hypoglycemia. Individuals with IAH have been shown to hold unique attitudes and beliefs that may encourage these behaviors. This fellowship application will determine differentiating attitudes and self-care of individuals with IAH, describe the common attitude and self-care profiles of individuals with IAH, and more deeply explain findings qualitatively to launch a line of inquiry for a career investigating these relationships. The specific aims of the study are to (1) compare the attitudes and self-care behaviors in adults with T1DM with and without IAH, (2) identify clusters of attitudes and self-care behavior patterns that correspond best with IAH classification, and (3) explore the relationship between attitudes and self-care in a racially diverse group of adults with T1DM complicated and uncomplicated by IAH to better explain patterns observed in cluster analysis. Data will be collected from a sample of patients at the Penn Rodebaugh Diabetes Center, the largest diabetes center in the University of Pennsylvania Health System. Data will first be analyzed with ANCOVA to compare attitudes and self-care behaviors of those with and without IAH while holding recognized covariates constant. Then, we will perform a cluster analysis using Ward’s minimum variance method to determine what attitude and self-care patterns correspond most with IAH classification in adults with T1DM. Finally, we will perform qualitative directed content analysis of interviews of individuals with IAH who were clustered into the group determined to correspond best with IAH to explain results. This fellowship application will provide the applicant training and research experiences necessary to become an independent nurse researcher with developing expertise in self-care, attitudes, and IAH in individuals with T1DM. This proposal aligns with NINR Innovative Questions Initiative in symptom science, as it addresses how psychosocial factors influence symptoms in chronic illness. This study is anticipated to help identify targetable points of intervention for future research as I develop my career as an emerging nurse scientist.