Reducing Stress in Adolescents and Young Adults with T1D to Improve Diabetes Care

描述(由申请人提供)：次优糖尿病管理(DM)是导致代谢控制不良的一个重要因素。青春期和青春期是贫穷的糖尿病风险增加的发育期。因此，改善患有T1D的老年青少年和年轻人(OAYA)的疾病管理困难的干预措施有可能显著改善健康结果和生活质量。暴露在压力之下会大大增加人们对不良健康结果的脆弱性。大量的横断面和纵向研究表明，应激对T1D患者的DM和代谢控制都有影响。尽管大量研究表明了减轻压力的重要性，但到目前为止，压力管理干预措施在改善患有T1D的青少年和成年人的健康结果方面效果不佳。目前应用于T1D的压力管理治疗有两个明显的问题。首先，基于CBT的干预在很大程度上依赖于参与者的自我报告来确定哪些生活事件造成了压力，从而损害了DM。然而，疾病管理行为的自我报告是出了名的有偏见/不准确。因此，对OAYA的压力管理干预不成功可能不是因为认知行为治疗方法本身无效，而是因为对那些对糖尿病脱轨负有最大责任的压力源没有足够的针对性。其次，被称为正念疗法的新一代行为疗法专注于改变人们经历的心理事件的意义，而不是改变或修改事件本身。因此，对患有T1D的OAYA进行有效的压力管理干预，可能还需要利用新的治疗策略，如正念。这项拟议研究的目标是为16-20岁患有T1D的OAYA开发一种有效的糖尿病管理干预措施，采用分阶段的干预开发方法。在第一阶段，我们将使用一种创新的技术(电子激活记录器；EAR)来更准确地识别T1D OAYA中影响DM的应激源。在第二阶段，我们将使用这些数据来调整以前用于OAYA的现有CBT干预措施，以提高其有效性。我们还将采用正念方法(基于正念的压力减轻；MBSR)用于OAYA和T1D。接下来，我们将测试两种缓解压力和改善DM的方法的有效性信号，以及评估实施的可行性和满意率。在第三阶段，我们将在T1D控制较差的OAYA患者中进行一项试点随机临床试验(RCT)，比较最成功的第二阶段压力管理方法和注意力控制条件。 公共卫生相关性：糖尿病管理不善的大龄青少年和年轻人患糖尿病短期和长期并发症的风险很高，也是医疗保健资金的大量使用者。这项拟议研究的主要目的是开发和测试一种新的压力管理干预措施的有效性，以使用分阶段的干预开发方法来改善糖尿病管理。如果成功，压力管理干预将有可能改善脆弱人群的健康结果和生活质量。

DESCRIPTION (provided by applicant): Suboptimal diabetes management (DM) is an important factor in the development of poor metabolic control. Adolescence and young adulthood are developmental periods marked by increased risk for poor DM. Therefore, interventions to improve illness management difficulties in older adolescents and young adults (OAYA) with T1D have the potential to significantly improve health outcomes and quality of life. Exposure to stress significantly increases vulnerability to poor health outcomes. A significant body of both cross-sectional and longitudinal studies demonstrates that stress affects both DM and metabolic control in persons with T1D. Despite the large number of studies showing the importance of reducing stress, to date, stress management interventions have been ineffective in improving health outcomes for adolescents and adults with T1D. There are two significant problems with stress management treatments as currently applied to T1D. First, CBT-based interventions have largely relied on participant self-report to determine which life events are causing stress and, thus, impairing DM. However, self-reports of illness management behaviors are notoriously biased/inaccurate. Therefore, stress management interventions for OAYA may have unsuccessful not due to the ineffectiveness of cognitive behavioral treatment approaches per se, but rather due to inadequate targeting of those stressors that are most responsible for derailing DM. Second, a new generation of behavioral therapies called mindfulness approaches focus on changing the meaning of psychological events that people experience, rather than on changing or modifying the events themselves. Therefore, effective stress management interventions for OAYA with T1D may also need to utilize new treatment strategies such as mindfulness. The goal of the proposed study is to develop a potent diabetes management intervention for OAYA aged 16-20 with T1D using a phased approach to intervention development. In Phase 1, we will use an innovative technology (Electronically Activated Recorder; EAR) to more accurately identify stressors that affect DM in OAYA with T1D. In Phase 2, we will use this data to adapt existing CBT interventions previously used with OAYA to increase their efficacy. We will also adapt a mindfulness approach (Mindfulness Based Stress Reduction; MBSR) for use with OAYA with T1D. Next, we will test for signals of efficacy for each of the two approaches to reduce stress and improve DM, as well as evaluating implementation feasibility and satisfaction rates. In Phase 3, we will conduct a pilot randomized clinical trial (RCT) among OAYA with poorly controlled T1D comparing the most successful Phase 2 stress management approach to an attention control condition. PUBLIC HEALTH RELEVANCE: Older adolescents and young adults with poor diabetes management are at high risk for short and long-term diabetes complications and are also heavy users of health care dollars. The primary purpose of the proposed study is to develop and test the efficacy of a novel stress management intervention to improve diabetes management using a phased approach to intervention development. If successful, the stress management intervention would have the potential to improve health outcomes and quality of life in a vulnerable population.