Biobehavioral Bases & Management of Type 2 Diabetes and Depression

2型糖尿病是冠心病(CHD)的主要危险因素。肥胖，血糖控制不佳， 抑郁、社会经济地位低和是种族/少数族裔群体的一员 增加这种风险。该项目的主要目标是确定与标准护理(SC)相比， 改善糖尿病生活方式的社区方法(CAMAL-D)计划，包括饮食、锻炼和 应对技能训练，可降低抑郁、体重和糖化血红蛋白，提高低血压患者服药依从性 收入，主要是黑人和拉丁裔/西班牙裔，抑郁，超重，2型糖尿病患者在 大型、综合性、社区卫生中心。Calm-D和SC都将被指定为选择性 他们的主治医生使用5-羟色胺再摄取抑制剂(SSRI)治疗重度抑郁症。该项目 将比较100名CAMPE-D(75名预期完成者)和100名SC(75名预期完成者)参与者。 在对SC和CAMPE-D参与者进行3次磨合治疗后，SC患者将在 根据ADA临床实践指南(2005)，并由项目工作人员在基线上进行评估，6 月和一年。收集的所有生物医学数据将被汇总并转发到每个患者的 医生。Calm-D参与者将接受2个单独的压力管理和生活方式会议 然后是每周两次的小组会议。然后是每周4次，然后是每月9次，每次 共17次会议。Calm-D参与者将被鼓励携带配偶或居住在 到医疗室治疗。这是为了在情感上和有形上支持 参与者。该项目的次要目标是确定与SC相比，CAME-D是否可以改进 糖耐量挑战，胰岛素抵抗，氧化应激，炎症，促凝血，血脂， 内皮功能静息血压，心脏和血管功能，心脏形态，心理社会 功能和健康的生活质量。由于许多参与者已经服用了阿司匹林， 他汀类药物、口服降糖药和其他药物，该项目的一个重要目标将是评估 改善服药依从性的程度--Calm-D计划的一个目标--可以解释 改善了干预效果。

Type 2 diabetes is a major risk factor for coronary heart disease (CHD). Obesity, poor glycemic control, depression, low socioeconomic status (SES) and being a member of a racial/ethnic minority group all increase this risk. The major objective of this project is to determine if compared to Standard Care (SC), a Community Approach to Lifestyle Modification for Diabetes (CALM-D) program including diet, exercise and coping skills training, can decrease depression, weight and HbA1c and improve medication adherence in low income, primarily Black and Latino/Hispanic, depressed, overweight, Type 2 diabetic patients seen in a large, comprehensive, community health center. Both CALM-D and SC will be prescribed a selective serotonin reuptake inhibitor (SSRI) by their primary physician for treatment of major depression. The project will compare 100 CALM-D (75 expected completers) and 100 SC (75 expected completers) participants. Following 3 run-in sessions given to both SC and CALM-D participants, SC patients will be treated in accordance with ADA Clinical Practice Guidelines (2005) and also assessed by project staff at baseline, 6 months and 1 year. All biomedical data collected will be summarized and forwarded to each patient's physician. The CALM-D participants will receive 2 individual stress management and lifestyle sessions followed by 2 weekly group sessions. Then 4 bi-weekly sessions will be followed by 9 monthly sessions for a total of 17 sessions. CALM-D participants will be encouraged to bring a spouse or someone living in the house to treatment sessions. This is intended to provide both emotional and tangible support for participants. Secondary objectives of the project are to determine if compared to SC, CALM-D can improve glucose tolerance to challenge, insulin resistance, oxidative stress, inflammation, procoagulation, lipid profile, endothelial function resting blood pressure, cardiac and vascular function, cardiac morphology, psychosocial functioning and health quality of life. As many of the participants will already have been prescribed aspirin, statins, oral hypoglycemics and other medications, an important objective of the project will be to assess the extent to which improved adherence to medications - a goal of the CALM-D program - can account for improved intervention effects.