A Stepped Care Behavioral Intervention Trial for Young Children with T1D

 描述（由申请人提供）：1型糖尿病（T1 D）在幼儿（年龄<6岁）中的发病率正在上升。ADA和其他糖尿病护理组织提供的疾病管理指南将检查血糖、注射胰岛素、监测饮食和体力活动以保持严格的血糖控制的责任交给了这些儿童的父母和照顾者。不幸的是，这发生在生命中的脆弱时期，当孩子的行为不可预测时，他们的T1 D难以控制，养育压力升高，照顾者因正常的儿童照顾程序而紧张。T1 D教育和支持往往高度集中在诊断/住院期间，需要父母快速掌握知识和技能。并不是所有的家庭都对这种教学模式做出了同样好的反应，许多家庭需要更多的指导实践，解决问题的帮助和行为支持，而不是一刀切的患者教育方法。我们的研究将试图通过临床行为学， 通过使用实时血糖控制和[父母抑郁指数]对幼儿父母的T1 D进行阶梯式护理干预，以在必要时加强管理支持。新诊断为T1 D的幼儿（<6岁）的主要照顾者将被随机分配到3步阶梯式护理（治疗）或常规护理（比较）条件。阶梯式护理包括：T1 D管理支持由训练有素的外行家长顾问提供（第1步），T1 D育儿策略和进餐时间行为管理由学士水平的行为助理提供（第2步），个性化的糖尿病教育/管理计划与认证的糖尿病护士教育家和[咨询糖尿病团队临床心理学家]（第3步）。生物医学和心理社会测量（包括A1 c，抑郁症状，进餐时间行为，养育压力，生活质量）将在基线和诊断后长达15个月的3个月间隔进行。这项工作的结果将最终导致一种更实用的T1 D教育和管理方法，可以更容易地转化为各种临床实践环境，以支持幼儿的T1 D管理。

 DESCRIPTION (provided by applicant): The incidence of type 1 diabetes (T1D) in young children (age <6 years) is rising. Disease management guidelines offered by the ADA and other diabetes care organizations place a high burden of responsibility onto these children's parents and caregivers to check blood sugar, administer insulin, and monitor diet and physical activity to maintain tight glycemic control. Unfortunately, this occurs at a vulnerable time in life when children's behavior is unpredictable, their T1D is difficult to control, parenting stress is elevatd, and caregivers are strained by normal child caretaking routines. T1D education and support tends to be highly concentrated at diagnosis/during the inpatient stay, and requires rapid knowledge and skill acquisition on the part of parents. Not all families respond equally well to this teaching model, and many need more guided practice, problem-solving assistance, and behavioral supports than can be offered in a one-size-fits-all patient education approach. Our research will attempt to better meet the needs of individual families through a clinical behavioral stepped care intervention for T1D in parents of young children by using real-time glycemic control and [parental depression indices] to intensify management support when indicated. Primary caregivers of young children (<6 years) newly diagnosed with T1D will be randomized to either a 3- step stepped care (treatment) or usual care (comparison) condition. Stepped care components include: T1D management support delivered by trained lay parent consultants (Step 1), T1D parenting strategies and mealtime behavior management delivered by bachelor's level behavioral assistants (Step 2), and individualized diabetes education/management planning with a certified diabetes nurse educator and [consultation with a diabetes team clinical psychologist] (Step 3). Biomedical and psychosocial measurements (including A1c, depressive symptoms, mealtime behavior, parenting stress, quality of life) will occur at baseline and 3-month intervals for up to 15 months post-diagnosis. The results of this work will ultimately lead to a more practical approach to T1D education and management that can be translated more easily into a variety of clinical practice settings to support young children's T1D management.