HOME DM-BAT: Home-based Diabetes-Modified Behavioral Activation Treatment for Low Income Seniors with T2DM

医疗保健中基于种族/民族和社会经济地位的持续差异在 美国。健康的社会决定因素是健康差距的关键驱动因素，特别是在老年人中。 2型糖尿病(T2 DM)是一种慢性疾病，在老年人中高度流行，与 种族/族裔差异，并受到健康的社会决定因素的影响。老年糖尿病患者有 多发病高，治疗方案复杂，功能状态受损，经常受到 健康的心理社会决定因素，如粮食不安全、住房不安全、相互竞争的需求、 压力/应对、认知功能障碍、有限的社会和财政资源以及社会孤立。行为 激活是一种认知行为疗法，最初是为治疗抑郁症而开发的，现已显示出希望 在患有慢性疾病的个人中，包括T2 DM。因此，特别是在种族/民族之间 少数民族老年糖尿病患者，直接解决心理社会问题和社会问题的干预措施 在糖尿病的治疗和管理中，可以影响生活方式行为的背景因素可能会 改善临床结果和总体福祉。我们小组的初步数据表明，8 文化改良的、手工的、糖尿病改良的、行为激活治疗的疗程 包括：1)糖尿病教育，2)解决健康的社会决定因素(例如，粮食不安全、住房 不安全感、相互竞争的需求、压力/应对等)，以及3)实现了短暂的行为激活治疗 老年2型糖尿病患者血糖控制的维持。该项目将评估效果和成本- 8次家庭、团体、人工糖尿病改良行为激活的效果 由训练有素的糖尿病护士教育人员向低收入、生活在少数族裔的老年人提供治疗(Home DM-BAT) 在独立的老年住房里。拟议的研究将测试改善临床结果的新策略 通过解决糖尿病特有因素和健康的社会决定因素，在少数族裔老年人中开展T2 DM。

Persistent disparities based on race/ethnicity and socioeconomic status in healthcare are well documented in the United States. Social determinants of health are key drivers of health disparities, especially in the elderly. Type 2 diabetes (T2DM) is a chronic disease that is highly prevalent in the elderly, associated with significant racial/ethnic disparities, and impacted by social determinants of health. Elderly individuals with diabetes have high multimorbidity, complex treatment regimens, impaired functional status and are often impacted by psychosocial determinants of health such as food insecurity, housing insecurity, competing needs, stress/coping, cognitive dysfunction, limited social and financial resources, and social isolation. Behavioral activation is a cognitive behavior therapy, originally developed to address depression, that has shown promise in individuals with chronic medical conditions, including T2DM. Therefore, especially among racial/ethnic minority elderly patients with diabetes, interventions that directly addresses psychosocial issues and social context factors that can influence lifestyle behaviors in the treatment and management of diabetes are likely to improve clinical outcomes and general well-being. Preliminary data from our group has demonstrated that 8 sessions of culturally-modified, manualized, diabetes-modified, behavioral activation treatment that incorporates: 1) diabetes education, 2) addresses social determinants of health (e.g. food insecurity, housing insecurity, competing needs, stress/coping etc.), and 3) brief behavioral activation treatment achieved maintenance of glycemic control in older adults with T2DM. This project will evaluate the efficacy and cost- effectiveness of 8 sessions of in-home, group-based, manualized diabetes-modified behavioral activation treatment (Home DM-BAT) delivered by trained diabetes nurse educators to low income, minority elders living in independent senior housing. The proposed study will test new strategies for improving clinical outcomes for T2DM in minority elders by addressing both diabetes-specific factors and social determinants of health.