EDUCATION AND GROUP SUPPORT FOR DIABETIC HISPANICS

患者教育和团体支持是具有成本效益的方法 改善糖尿病患者的健康状况；然而，从文化上讲- 为经历非胰岛素依赖的拉美裔人提供相关方法 糖尿病的发病率是非西班牙裔白人的3到5倍 被调查过了。拟议项目的主要目的是 进行前瞻性随机临床研究以确定疗效 与文化相关的、以社区为基础的干预措施符合国家 标准，旨在改善墨西哥糖尿病患者的健康- 美国人和他们的家人。干预以西班牙语提供， 由一位西班牙裔硕士毕业的临床护士专家指导， 由执业护士、营养师和社区业馀工作者协助。 干预的主要内容包括：(1)营养指导， 自我监测血糖、锻炼和其他相关话题 与糖尿病自我管理相关；以及(2)团体支持，以促进 行为上的改变。 居住在德克萨斯州-墨西哥边境农村社区的成年糖尿病患者将 作为可用的目标样本。在四年时间里，总共有 256名糖尿病患者将从以下患者名单中随机挑选 由联合PI进行的以前的糖尿病研究；以及家庭成员或 每名受试者指定一名朋友，作为支持 人。受试者将被随机分配进入干预或 到等待名单的对照组，该对照组将在一次干预后接受干预 年。糖尿病受试者和支持人员将以小组形式会面 在县农技推广办公室进行干预 包括12个每周2小时的教育课程和9个月 两个小时的支持小组会议。主要结果变量将是 代谢控制指标，特别是糖化血红蛋白，如 以及空腹血糖水平和其他生理指标 糖尿病的代谢状况。作为指标衡量的其他变量 糖尿病受试者的干预效果将包括：糖尿病 知识、糖尿病相关的健康信念、健康行为和身体 重量。这些变量中的一些也将在支持小组中进行测量 以确定干预对个人的益处 他们可能还没有患上糖尿病，但患糖尿病的风险很高。 将使用通径分析和增长曲线分析来确定 代谢控制随时间的累积变化程度并解释 发生变化的机制。

Patient education and group support are cost effective approaches to improving health outcomes of persons with diabetes; however, culturally- relevant approaches for Hispanics who experience non-insulin dependent diabetes 3 to 5 times more frequently than non-Hispanic whites have not been investigated. The primary purpose of the proposed project is to conduct a prospective, randomized clinical study to determine the efficacy of a culturally-relevant, community-based intervention that meets national standards and that is aimed at improving the health of diabetic Mexican- Americans and their families. The intervention is provided in Spanish and is directed by a Hispanic master's-prepared clinical nurse specialist, assisted by a nurse practitioner, dietitians, and community lay workers. Key elements of the intervention include: (1) instruction on nutrition, self-monitoring of blood glucose, exercise, and other pertinent topics relevant to diabetes self-management; and (2) group support to promote behavioral changes. Diabetic adults residing in a rural Texas-Mexico border community will serve as the available target sample. Over a four-year period, a total of 256 diabetic subjects will be randomly selected from patient rosters of previous diabetes studies conducted by the co-PI; and family members or friends, one designated by each subject, will participate as support persons. Subjects will be randomly assigned to enter the intervention or to a wait-list control group that will receive the intervention after one year. The diabetic subjects and support persons will meet in small groups in the county agricultural extension offices for the intervention consisting of twelve weekly two-hour educational sessions and nine monthly two-hour support group sessions. The primary outcome variables will be indices of metabolic control, particularly glycosylated hemoglobin, as well as fasting blood sugar levels and other physiological indicators of diabetes metabolic status. Other variables measured as indicators of intervention effectiveness in the diabetic subjects will include: diabetes knowledge, diabetes-related health beliefs, health behaviors, and body weight. Some of these variables also will be measured on the support group persons in order to determine the benefits of the intervention on persons who may not yet have diabetes but who are at high risk for developing it. Path analysis and growth curve analysis will be used to determine the cumulative degree of change in metabolic control over time and to explain the mechanisms by which change occurs.