Mobile Phone Support for Adults and Support Persons to Live Well with Diabetes

项目摘要 我们建议修订当前的项目R 01 DK 119282，标题为“成人和儿童的移动的电话支持”。 支持糖尿病患者好好生活。”目前的项目包括随机对照试验（RCT） 在N=334人中测试FAMS 2.0（家庭/朋友激活以激励自我护理）干预的有效性 患有2型糖尿病的成年人和作为支持者登记的朋友或家庭成员。的RCT 包括为被分配的人提供9个月的干预期， 15-月研究。最近，我们的团队确定了一种糖尿病特异性家庭功能的类型， 干预的重要意义。我们确定了四个概念上不同的家庭功能概况， 关于糖尿病（“类型”），使用聚类分析和检查调整后的横截面关联 类型和糖尿病结果之间的关系。我们发现，在分析方法中，类型学是稳定的， 与糖尿病结局独立相关，包括血糖控制（FAMS中的主要结局 2.0 RCT）、糖尿病痛苦（FAMS 2.0 RCT的次要结局）、糖尿病自我效能和药物治疗 依从性（FAMS 2.0干预的目标机制）。这种类型学是有史以来第一次 糖尿病自我管理的家庭功能的多个维度，适用于整个现代社会。 家庭结构，并有可能导致突破性的家庭干预措施，为成年糖尿病患者。 基线时糖尿病特异性家庭功能类型可能是家庭功能的关键和被忽视的调节因素 干预措施-包括FAMS 2.0干预措施-在糖尿病成人中， 类型可以最大化效果。然而，我们之前的类型学研究是在75%为白色的样本中进行的 并使用横截面数据。因此，我们建议扩大目前R 01的目标， 二次数据分析，并为分配到干预的参与者增加离职面谈。的目标 当前项目将保持不变，FAMS 2.0将不会针对本RCT中的类型进行定制。对于目标1，我们使用 在RCT期间收集的数据，以确定类型学是否在更多样化的样本中复制，检查类型 稳定性随时间的变化，并检查类型随时间的糖尿病结果的预测有效性。目标2： 使用混合方法来了解FAMS 2.0干预的参与和有效性如何因类型而异， 糖尿病特有的家庭功能。在完成这些目标后，我们将知道如何识别具有 糖尿病最有可能受益于FAMS 2.0，以告知可扩展性和实施工作，我们将有 一项试验的初步数据，该试验测试了针对参与者的糖尿病特异性类型进行定制干预的益处。 家庭功能。这项研究和未来的应用类型学，将导致这项研究将 通过支持新的糖尿病自我管理的家庭干预措施， 研究问题，如：对谁来说，家庭干预比个人干预更有效？ 我们如何预测患者和干预内容之间的匹配度？

Project Summary We are proposing a revision to a current project, R01DK119282 entitled, “Mobile Phone Support for Adults and Support Persons to Live Well with Diabetes.” The current project includes an randomized controlled trial (RCT) to test the efficacy of the FAMS 2.0 (Family/friend Activation to Motivate Self-Care) intervention among N=334 adults with type 2 diabetes mellitus and a friend or family member who enrolls as a support person. The RCT includes a 9-month intervention period for those so assigned and 6-months of post-intervention follow up for a 15-month study. Recently, our team identified a typology of diabetes-specific family functioning which has important implications for intervention. We identified four conceptually distinct profiles of family functioning with respect to diabetes ("types") using cluster analysis and examined adjusted cross-sectional associations between type and diabetes outcomes. We found the typology was stable across analytic method and type was independently associated with diabetes outcomes, including glycemic control (primary outcome in the FAMS 2.0 RCT), diabetes distress (secondary outcome in the FAMS 2.0 RCT), diabetes self-efficacy and medication adherence (targeted mechanisms of the FAMS 2.0 intervention). The typology is the first ever to capture multiple dimensions of family functioning specific to diabetes self-management, is applicable across modern family structures, and has the potential to lead to breakthroughs in family interventions for adults with diabetes. Diabetes-specific family functioning type at baseline may be a critical and overlooked moderator of family interventions – including the FAMS 2.0 intervention – among adults with diabetes, and tailoring interventions to type may maximize effects. However, our prior typology study was conducted in a sample that was 75% White and used cross-sectional data. Therefore, we propose to expand the aims of the current R01 by conducting secondary data analysis and adding an exit interview for participants assigned to intervention. The aims of the current project will be unchanged and FAMS 2.0 will not be tailored to type in this RCT. For Aim 1 we will use data collected during the RCT to determine if the typology is replicated in a more diverse sample, examine type stability over time, and examine predictive validity of type for diabetes outcomes over time. For Aim 2, we will use mixed-methods to learn how engagement with and efficacy of the FAMS 2.0 intervention varies by type of diabetes-specific family functioning. Upon completion of these aims we will know how to identify persons with diabetes most likely to benefit from FAMS 2.0 to inform scalability and implementation efforts, and we will have preliminary data for a trial testing the benefit of tailoring interventions to participants' type of diabetes-specific family functioning. This research and future applications of the typology that will result from this research will rapidly advance the science on family interventions for diabetes self-management by supporting novel research questions such as: For whom are family interventions more effective than individual interventions? and How can we predict fit between the patient and intervention content?