The Role of Apathy in Glycemic Control

冷漠在血糖控制中的作用

• 批准号: 7687317
• 负责人: Cyrus V Desouza
• 金额: --
• 依托单位: OMAHA VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-04-01 至 2012-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7687317
• 关键词: Adherence; Aging; Behavior; Blood Vessels; Clinic; Comorbidity; Complex; Complications of Diabetes Mellitus; Diabetes Mellitus; Diabetic Angiopathies; Dose; Double-Blind Method; Effectiveness; Equipment and supply inventories; Evaluation; General Population; Glycosylated hemoglobin A; Goals; Health system; Healthcare; Incidence; Insulin Resistance; Intake; Intervention; Lead; Life Style; Measures; Medical; Methods; Methylphenidate; Morbidity - disease rate; Motivation; Obesity; Outcome; Outcome Measure; Patients; Pharmaceutical Preparations; Pharmacological Treatment; Placebos; Population; Prevalence; Primary Health Care; Problem behavior; Public Health; Randomized; Recommendation; Regimen; Relative (related person); Research; Research Design; Risk; Role; Self Care; Staging; System; Testing; Treatment Protocols; Veterans; Weight; cardiovascular risk factor; clinically significant; compliance behavior; design; diabetes control; diabetes management; diet and exercise; functional status; glycemic control; health administration; improved; macrovascular disease; mortality; placebo controlled study; primary outcome; prospective; public health relevance; secondary outcome; tool

DESCRIPTION (provided by applicant): The prevalence of diabetes among veterans in the VA health system is more than 20% and is double that of the general population. Patients with diabetes are at increased risk for macro and micro vascular complications which are dependant on glycemic control. Control of diabetes depends to a large extent on patient self care behaviors. Apathy is a common behavioral problem characterized by loss of initiative, poor motivation and persistence. Presence of apathy impairs self-care behavior in diabetes patients. Lack of novelty might impair a patient's ability to seek new interactions, life styles and new treatment options for diabetes. Lack of motivation might decrease a patient's ability to initiate exercise, diet and other lifestyle changes, whereas lack of persistence impairs the compliance with these regimens. Thus, apathy influences all stages of self-care. Apathy could also influence patient compliance to diabetes medications. Together this could result in poor control of diabetes and increased complications. Treating apathy might therefore improve adherence to medical regimens and self care behaviors resulting in better diabetes outcomes Hypothesis:Our hypothesis is that pharmacological treatment of apathy will improve glycemic control for patients with poorly controlled diabetes. Specific Aim 1: Evaluate if methylphenidate treatment of apathy improves glycemic control in patients with poorly controlled diabetes. Specific Aim 2: Determine if methylphenidate improves patient motivation and adherence to diabetes self-care behavior. Project Design and Methods: Study Design: This is a prospective randomized double blind placebo-controlled study. Study duration will be 6 months. Patients with poorly controlled diabetes (A1c>8) and clinically significant apathy (AES >30) will be randomized to either treatment with methylphenidate or placebo. Details of dosing strength and duration are given in the proposal. The primary outcome measure will be change in HbA1c. Secondary outcome measures include those in specific Aim 2 and are PAM, sub-domains of AES and SCI. Potential Impact on Veterans health care: About 20% of veterans have diabetes. Complications of diabetes increase mortality and morbidity greatly. Apathy is very prevalent in the veteran population. Apathy may lead to decreased compliance to medication and impair self care behaviors. Treating apathy may therefore improve motivation and persistence thereby improving compliance and self care behavior. This would lead to better outcomes in diabetes patients in the VA. PUBLIC HEALTH RELEVANCE: Narrative-Significance of the proposed research; Over 20% of veteran patients have diabetes. The incidence of diabetes is expected to increase at an alarming rate over the next decade, in tandem with the increase in the incidence of obesity and the relative aging of the population. Patients with diabetes have a 2-4 fold risk of cardiovascular complications when compared to patients without diabetes. In spite of considerable advances in diabetes management, less than 10% of patients are at goal. Factors that effect adequate implementation of diabetes management regimens need to be studied. Apathy may be one of these factors since apathy leads to a loss of motivation and persistence. Treating apathy may lead to increased adherence to management regimens thus leading to better outcomes in diabetes.

描述（由申请人提供）： 退伍军人卫生系统中退伍军人的糖尿病患病率超过20%，是普通人群的两倍。糖尿病患者发生大血管和微血管并发症的风险增加，这些并发症取决于血糖控制。糖尿病的控制在很大程度上取决于患者的自我护理行为。冷漠是一种常见的行为问题，其特征是失去主动性，缺乏动力和坚持性。冷漠的存在损害糖尿病患者的自我护理行为。缺乏新奇可能会损害患者寻求新的互动，生活方式和糖尿病新治疗方案的能力。缺乏动力可能会降低患者开始运动、饮食和其他生活方式改变的能力，而缺乏持久性会损害对这些方案的依从性。因此，冷漠会影响自我照顾的各个阶段。冷漠也可能影响患者对糖尿病药物的依从性。这可能导致糖尿病控制不良和并发症增加。因此，治疗冷漠可能会改善对药物治疗方案的依从性和自我护理行为，从而改善糖尿病结局假设：我们的假设是，药物治疗冷漠将改善血糖控制不佳的糖尿病患者的血糖控制。具体目标1：评价哌醋甲酯治疗情感淡漠是否能改善血糖控制不佳的糖尿病患者的血糖控制。具体目标2：确定哌醋甲酯是否能提高患者对糖尿病自我护理行为的积极性和依从性。 项目设计和方法：研究设计：这是一项前瞻性随机双盲安慰剂对照研究。研究持续时间为6个月。患有控制不佳的糖尿病（A1 c>8）和临床上显著的冷漠（AES >30）的患者将被随机分配到哌醋甲酯或安慰剂治疗组。给药规格和持续时间的详细信息见提案。主要结局指标为HbA 1c的变化。次要结局指标包括特定目标2中的指标，以及PAM、AES和SCI的子域。 对退伍军人医疗保健的潜在影响：大约20%的退伍军人患有糖尿病。糖尿病的并发症大大增加了死亡率和发病率。冷漠在退伍军人中很普遍。冷漠可能会导致药物依从性下降并损害自我护理行为。因此，治疗冷漠可能会提高动机和持久性，从而提高依从性和自我护理行为。这将导致VA中糖尿病患者的更好结果。 公共卫生关系： 叙述性意义的拟议研究;超过20%的退伍军人患者患有糖尿病。随着肥胖症发病率的增加和人口的相对老龄化，预计未来十年糖尿病的发病率将以惊人的速度增加。糖尿病患者发生心血管并发症的风险是非糖尿病患者的2-4倍。尽管糖尿病管理取得了相当大的进展，但只有不到10%的患者达到了目标。需要研究影响糖尿病管理方案充分实施的因素。冷漠可能是这些因素之一，因为冷漠导致失去动力和毅力。治疗情感淡漠可能会导致对管理方案的依从性增加，从而导致糖尿病的更好结局。