Community-Based Intervention to Improve Diabetes Outcomes in Older African American Women with Multi-Caregiving Burden

项目摘要/摘要 患有2型糖尿病(T2 DM)的非裔美国人(AA)的糖尿病患病率更高，更贫穷 代谢控制，与白人相比，并发症和死亡的风险更大。AA女性(AAW)有一个 糖尿病患病率高，视力损害患病率高，终末期肾病发生率高，以及 与白人女性相比，年龄调整的死亡率更高。而糖尿病发病率较高的原因与 AAW的发病率和死亡率尚未明确阐明，多重护理责任，或 向父母/祖父母提供照顾(情感上、身体上/有形上、经济上、精神上)， 子女/孙辈、重要的其他人和他们更大的社区，是有效工作的重要障碍 糖尿病的护理，并促成更高的疾病负担和增加死亡率的AAW与T2 DM。这是 三明治一代的AAW尤其如此(40多岁和50多岁的成年人，他们夹在 年迈的父母和成年子女/孙辈)和俱乐部三明治一代(50多岁和 60岁，夹在年迈的父母/祖父母、成年子女和孙辈之间)，其中多人 照顾责任导致压力增加，血糖控制较差，自我护理能力欠佳。 行为。此外，关于解决多重照料负担的有效干预措施的证据有限。 在市中心患有T2 DM的AAW。我们小组的初步数据显示，一名社区护士- 促进的、基于小组的、同行支持的干预，包括讲故事、解决问题和 目标设定、应对策略、糖尿病教育和技能培训在这方面可能是有效的 人口。因此，我们建议进行一项先导性随机研究，以测试 新颖的、社区知情的、多组分的干预措施，用于缓解与多人相关的压力源 与糖尿病相比，改善糖尿病结局的护理责任加强了常规护理。这个 该项目的长期目标是确定有效的战略，以改善代谢控制和减少 AAW合并T2 DM患者的糖尿病并发症和死亡率。

PROJECT SUMMARY/ABSTRACT African Americans (AA) with type 2 diabetes (T2DM) have a higher prevalence of diabetes, poorer metabolic control, and greater risk for complications and death compared to Whites. AA Women (AAW) have a higher rate of diabetes, higher prevalence of visual impairment, higher rate of end-stage renal disease, and higher age-adjusted mortality rate compared to White women. While the reasons for higher diabetes-related morbidity and mortality in AAW have not been clearly elucidated, multi-caregiving responsibilities, or the provision of care (emotional, physical/tangible, financial, spiritual) to parents/grandparents, children/grandchildren, significant others, and their larger community, is a significant barrier to effective diabetes care and contributes to the higher disease burden and increased mortality in AAW with T2DM. This is particularly true for AAW in the Sandwich Generation (adults in their 40s and 50s who are wedged between elderly parents and adult children/grandchildren), and the Club Sandwich Generation (adults in their 50s and 60s, who are wedged between aging parents/grandparents, adult children, and grandchildren), where multi- caregiving responsibilities have resulted in increased stress, poorer glycemic control, and suboptimal self-care behaviors. In addition, there is limited evidence on effective interventions that address multi-caregiving burden in inner city AAW with T2DM. Preliminary data from our group suggests that a community-based, nurse- facilitated, group-based, peer-support intervention that incorporates storytelling, problem solving and goal setting, coping strategies, and diabetes education and skills training may be effective in this population. Therefore, we propose a pilot randomized study to test the feasibility and preliminary efficacy of a novel, community-informed, multicomponent intervention on mitigating stressors associated with multi- caregiving responsibilities to improve diabetes outcomes compared to diabetes enhanced usual care. The long-term goal of the project is to identify effective strategies for improving metabolic control and reducing diabetes complications and mortality rates in AAW with T2DM.