A Mindfulness-based Intervention to Reduce Diabetes Risk in Prediabetic Afr-Ameri

描述(申请人提供)：糖尿病前期，其特征是血糖水平高于正常但低于糖尿病的诊断标准，是一种越来越常见的疾病，影响着大约5400万美国成年人。非裔美国人受糖尿病前期的影响不成比例，糖尿病相关的发病率和死亡率很高，包括循环系统、肾脏和神经系统的损害。糖尿病前期患者增加体力活动和改善饮食可以降低患糖尿病的风险。心理困扰通过增加有害的健康行为，阻止积极行为的安排和维持，以及刺激HPA轴的激活和调节失调，对疾病的进程产生负面影响，这可能对胰岛素抵抗和葡萄糖代谢产生直接影响。由于非洲裔美国人在美国独特的历史、社会文化经历和社会地位，他们面临的压力可能更大，对糖尿病等与压力相关的不利健康后果的易感性也更高。帮助个人减轻压力并增加健康的应对策略可能会加强传统的糖尿病预防努力，特别是在非裔美国人中。在随机对照研究中，基于正念的压力减轻(MBSR)是一种具有广泛健康益处的身心练习，已被证明在统计上显著减少心理压力和焦虑。与其他小组或个别化项目相比，正念训练具有成本效益，而且可以由训练有素的讲师安全有效地教授。几乎没有研究，也没有随机对照试验将MBSR作为治疗糖尿病前期患者的方法。关于MBSR计划对糖尿病前期非裔美国人亚群的可接受性，或关于MBSR计划对非裔美国人普通人群的可接受性的研究也很少。这项探索性先导研究的总体目标是研究糖尿病预防教育计划的潜在效果，该计划包括为糖尿病前期的非裔美国人提供基于正念的压力减轻培训。具体目标是1)确定开展临床试验的可行性，以比较正念糖尿病预防计划(治疗组)和传统糖尿病预防计划(对照组)在改善糖尿病前期非裔美国人的糖代谢方面的有效性；2)确定与糖尿病前期非裔美国人基于正念的教育自我护理计划相关的生理和心理次要结果；3)通过干预后的定性研究，评估MBSR对糖尿病前期非裔美国人的可接受性和文化相关性，包括对参与者、辍学生和导师的访谈；以及4)在进行一项强大的临床试验以评估以正念为基础的糖尿病预防计划在改善糖尿病前期非裔美国人的葡萄糖代谢方面的有效性时，确定并找到解决方案。

DESCRIPTION (provided by applicant): Pre-diabetes, characterized by glucose levels that are above normal but below the diagnostic criteria for diabetes, is an increasingly common condition affecting approximately 54 million U.S. adults. African Americans are disproportionately affected by pre-diabetes and experience high rates of diabetes-associated morbidity and mortality including damage to the circulatory system, kidneys, and nervous system. Patients with pre-diabetes who increase their physical activity and improve their diets have reduced risk of developing diabetes. Psychological distress negatively influences the course of the disease by increasing deleterious health behaviors; preventing scheduling and maintenance of positive behavior change; and stimulating HPA- axis activation and dysregulation, which may have a direct impact on insulin resistance and glucose metabolism. African Americans may have increased exposure to stress and increased vulnerability to adverse stress-related health outcomes like diabetes, because of their unique history, socio-cultural experiences, and societal position in the U.S. Helping individuals to reduce stress and to increase healthy coping strategies may enhance conventional diabetes prevention efforts, especially among African Americans. Mindfulness-based stress reduction (MBSR), a mind-body practice with a wide range of health benefits, has been shown to result in statistically significant reductions in psychological stress and anxiety in randomized, controlled studies. Mindfulness training is cost-effective in comparison with other small-group or individualized programs, and can be taught safely and effectively by well-trained instructors. There is little research, and no randomized, controlled trials of MBSR as a treatment for individuals with pre-diabetes. There is also little research on the acceptability of MBSR program to a pre-diabetic subgroup of African Americans, or on the acceptability of an MBSR program for a general population of African Americans. Overall goals of this exploratory pilot study are to study the potential efficacy of a diabetes prevention education program that includes training in mindfulness-based stress reduction for pre-diabetic African Americans. Specific Aims are 1) to determine the feasibility of developing a clinical trial to compare the effectiveness of a mindfulness-based diabetes prevention program (treatment group) with a conventional diabetes prevention program (control group) in improving glucose metabolism in pre-diabetic African American adults; 2) to identify relevant physiological and psychological secondary outcomes associated with a mindfulness-based, educational self-care program in African Americans with pre-diabetes; 3) to assess the acceptability and cultural relevance of MBSR for pre-diabetic African Americans via a post-intervention qualitative study, to include interviews of participants, dropouts, and instructors; and 4) to identify, and find solutions for, problems in conducting a well-powered clinical trial to assess the efficacy of a mindfulness-based diabetes prevention program in improving glucose metabolism in pre-diabetic African-Americans.