Chronic Disease Management for Adolescents with Type 2 Diabetes

描述（由申请人提供）： 2型糖尿病（T2 DM）被认为是青少年中日益严重的问题，特别是在少数民族人群中。虽然T2 DM以前占儿科新诊断糖尿病的不到5%，但现在占新诊断糖尿病的50%。青少年T2 DM的治疗需要全面的护理，包括行为和药物干预。研究表明，大约50%的患有慢性病的青少年不遵守护理建议。患者、提供者和系统属性可能会加剧这种不依从性。解决患者、提供者和系统的护理障碍对于制定成功的青少年T2 DM综合治疗方案至关重要。 该提案将通过强调识别护理障碍，并将此信息应用于开发和评估改善青少年糖尿病护理的综合干预措施，来提高目前对青少年T2 DM的认识。为了实现这些目标，我将与范德比尔特卫生服务研究中心主任Robert Dittus博士、儿科内分泌科科长William Russell博士和范德比尔特糖尿病研究和培训中心（DRTC）行为核心联合主任大卫Schlundt博士合作，以进一步发展我在（1）青少年糖尿病，（2）识别和测量青少年行为的心理社会决定因素的方法，以及（3）设计和评估干预措施，以改善T2 DM青少年的自我管理行为和治疗依从性。 这项研究的具体目标是：（1）进行调查和焦点小组，以确定患者/父母在护理T2 DM青少年方面的障碍以及解决这些障碍的策略（2）检查提供者和系统在适当管理青少年T2 DM方面的障碍，以及（3）利用这些信息来开发和实施一项针对青少年的新的综合糖尿病管理计划的随机对照试验，2型糖尿病。这项研究的过程和结果将为青少年糖尿病提供有价值的见解，并将加速我未来对青少年T2 D的独立研究。

DESCRIPTION (provided by applicant): Type 2 diabetes (T2DM) is recognized as a growing problem among adolescents, particularly in minority populations. While T2DM previously represented less than 5% of new diabetes diagnoses in pediatrics, it now accounts for as much as 50% of new diagnoses. The treatment of T2DM in adolescents requires comprehensive care that includes behavioral and pharmacologic interventions. Studies show that approximately 50% of adolescents with chronic problems do not comply with care recommendations. This non-adherence can be exacerbated by patient, provider and system attributes. Addressing patient, provider and system barriers to care are crucial in the development of a successful comprehensive program for the treatment of T2DM in adolescents. This proposal will advance current knowledge about T2DM in adolescents through emphasis on identifying barriers to care, and applying this information to the development and evaluation of a comprehensive intervention to improve adolescent diabetes care. To accomplish these goals I will work with Dr. Robert Dittus, Director of the Vanderbilt Center for Health Services Research, Dr. William Russell, Division Chief of Pediatric Endocrinology, and Dr. David Schlundt, Co-director of the Behavioral Core of the Vanderbilt Diabetes Research and Training Center (DRTC) to further my career development in (1) adolescent diabetes, (2) methods for identifying and measuring psychosocial determinants of adolescent behavior, and (3) designing and evaluating interventions to improve self-management behaviors and treatment adherence in adolescents with T2DM. The specific aims of this research will be to: (1) perform surveys and focus groups to identify patient/parent barriers to care for adolescents with T2DM and strategies for addressing these barriers (2) examine provider and system barriers to proper management of adolescent T2DM, and (3) to use this information to develop and implement a randomized controlled trial of a new comprehensive diabetes management program for adolescents with T2DM. The process and results of this research will provide valuable insights into adolescent diabetes, and will accelerate my future independent investigation in adolescent T2D.