Episodic Future Thinking to Improve Management of Type 2 Diabetes in Rural and Urban Patients: Remote Delivery and Outcomes Assessment to Increase Reach and Dissemination

项目摘要 2型糖尿病（T2D）的成功管理需要坚持饮食，体力活动， 患者与其医疗保健提供者之间达成的药物治疗计划。生活方式的改变 在这些协作护理计划中通常提供很少或没有短期益处并且可能相反是令人厌恶的（例如， 热量限制和体力活动）。然而，这些变化在未来提供了关键的健康益处， 允许T2D患者停止或逆转疾病进展并避免T2D相关并发症（例如， 肾病或糖尿病视网膜病变）。因此，成功的管理2型糖尿病需要一个人的存在 行为由未来的结果来指导。不幸的是，越来越多的证据表明， 2型糖尿病和有患这种疾病风险的人显示出延迟折扣率升高（即，贬值 延迟的后果），先前的数据表明这有助于T2D的发展和进展。因此，在本发明中， 干预措施显示，提高未来的价值可能会改善T2D管理。一个这样 干预是情景未来思维（EFT），一种参与者生动想象事件的展望形式 在未来可能发生的事情。调查小组的初步数据表明，EFT有助于体重增加 降低并改善T2D患者的血糖控制。在拟议的工作中，我们将调整这些方法， 检查远程交付EFT和远程结果评估的可行性（例如，体重减轻， 血糖控制和延迟折扣）。因为 远程传递和评估使参与者和实验者的负担最小化，这些方法可以 扩大干预的范围、传播和影响。具体目标1将检查8-和24- T2D患者中远程输送EFT对远程测量体重减轻、血糖 控制和延迟贴现。次要措施将包括饮食回忆，身体活动和药物治疗 坚持。参与者将生成生动的情景事件，并通过引导智能手机应用程序进行提示， 24周内在日常生活中进行EFT或控制条件。所有参与者（EFT和对照组） 将获得饮食和体力活动支持，为患者的合作护理计划个性化。次级目标1a 将比较城市和农村人群的结果指标，以评估EFT的疗效是否 强有力地消除城乡差距。具体目标2将检查远程EFT的可接受性。用于 干预措施要在临床环境中有效，它应该易于使用，其帮助应该是显而易见的， 患者因此，参与者将沿着沿着两个可接受性维度对EFT或对照条件进行评级： 有用性和易用性。参与者还将在一个简短的，半结构化的面试中完成， 干预后汇报阶段，提供关于感知优势的反馈，以及可能的 干预的障碍和限制。

PROJECT SUMMARY Successful management of type 2 diabetes (T2D) requires adherence to a dietary, physical activity, and medication plan agreed upon between a patient and their healthcare providers. The lifestyle changes involved in these collaborative care plans often provide little to no short-term benefit and may instead be aversive (e.g., caloric restriction and physical activity). However, these changes provide critical health benefits in the future, allowing patients with T2D to halt or reverse disease progression and avoid T2D-related complications (e.g., renal disease or diabetic retinopathy). Thus, successful management of type 2 diabetes requires one's present behavior to be guided by future outcomes. Unfortunately, accumulating evidence indicates that individuals with type 2 diabetes and those at risk for this disorder show elevated rates of delay discounting (i.e., devaluation of delayed consequences), which prior data suggest contribute to development and progression of T2D. Thus, interventions shown to increase valuation of the future are likely to improve T2D management. One such intervention is episodic future thinking (EFT), a form of prospection in which participants vividly imagine events that might occur in their future. Preliminary data from the investigative team suggests that EFT facilitates weight loss and improves glycemic control in patients with T2D. In the proposed work, we will adapt these methods to examine the feasibility of both remote delivery of EFT and remote outcomes assessment (e.g., weight loss, glycemic control, and delay discounting) in geographically distributed urban and rural participants. Because remote delivery and assessment minimize both participant and experimenter burden, these methods may increase the reach, dissemination, and impact of the intervention. Specific Aim 1 will examine the 8- and 24- week efficacy of remotely delivered EFT in patients with T2D on remote measures of weight loss, glycemic control, and delay discounting. Secondary measures will include dietary recalls, physical activity, and medication adherence. Participants will generate vivid, episodic events and be prompted via a guided smartphone app for 24 weeks to engage in EFT or a control condition in their daily lives. All participants (EFT and control control) will receive diet and physical activity support, individualized for patients' collaborative care plans. Sub-aim 1a will compare outcome measures between urban and rural populations to evaluate whether EFT's efficacy is robust against rural-urban disparities. Specific Aim 2 will examine the acceptability of remote EFT. For an intervention to be effective in clinical settings, it should be easy to use and its helpfulness should be apparent to patients. Thus, participants will rate the EFT or control conditions along two dimensions of acceptability: perceived helpfulness and ease of use. Participants will also complete brief, semi-structured interviews during a post-intervention debriefing phase to provide feedback regarding perceived strengths, as well as possible barriers and limitations, of the intervention.