Delay discounting as a target for self-regulation in prediabetes

 描述(申请人提供)：要预防有糖尿病前期症状的肥胖者的2型糖尿病，需要发展更健康的生活方式。对于糖尿病前期患者来说，合理的方法是吃得更健康，更活跃，减肥，并控制他们的共病。然而，初步研究表明，2型糖尿病患者会对未来不屑一顾，并从事最大化当前快乐和短期收益的行为；因此，在这一人群中，改善未来健康所需的日常选择很少。延迟折扣(DD)描述了较小的即时奖励与较大的延迟奖励之间的选择。这一行为过程与各种各样的健康选择有关，从预防健康到坚持行为和药物养生，包括用于2型糖尿病的养生。我们认为，DD为一种类型的自我调节提供了一个目标，这种自我调节可以改善各种健康行为和医疗依从性。我们实验室的研究表明，片段性未来思维(EFT)是一种减少对即时满足的偏见的预测形式，它激活了参与计划和预测的大脑区域，从而使未来的奖励具有更高的价值，延迟折扣的程度降低。在跨期决策过程中，提示个人考虑未来的事件可以减少DD的发生率、在实验室内外进食和吸烟行为。这笔赠款的首要目标是使用实验医学方法将DD和EFT的基础研究转化为临床干预措施，以防止从糖尿病前期过渡到2型糖尿病的诊断。我们正在使用资助机制RFA-RM-14-020，“行为变化的科学：自我调节目标的分析开发和验证(UH2/UH3)”，因为这提供了整合观察性、实验室和现场研究的机会，以评估DD和疾病自我管理之间的关系，了解这些关系的机制，跨越多个分析水平，并改进干预措施，为临床试验做准备。E建议进行一系列观察、实验室和现场研究，以确定DD作为行为目标，以改善糖尿病前期成年人的行为和药物依从性以及代谢控制，这些人是发展成2型糖尿病的高风险人群。具体目标1将研究DD、执行功能和fMRI测量的脑激活之间的横截面关系，以预测被诊断为糖尿病前期患者的依从性和代谢控制。具体目标2将在实验室评估EFT对糖尿病前期参与者的DD、fMRI测量的大脑激活和能量摄入的影响。具体目标3将评估EFT对DD和fMRI测量的大脑激活的影响，在模拟贫困的情况下，这会增加对未来的贴现。具体目标4扩展了EFT对DD、执行功能、健康行为改变、共病条件下的用药依从性和血糖控制的影响的研究，在本申请的UH3部分的现场研究中，EFT与对照组进行了6个月的目标接触。

 DESCRIPTION (provided by applicant): The prevention of Type 2 diabetes in an obese person with pre-diabetes requires developing a healthier lifestyle. The rational approach for someone with pre-diabetes would be to eat healthier, be more active, lose weight, and manage their comorbidities. However, preliminary research suggests that individuals with Type 2 diabetes discount the future and engage in behaviors that maximize current pleasure and short-term gain; thus, daily choices needed to improve future health are rare in this population. Delay discounting (DD) describes the choice of smaller immediate versus larger delayed rewards. This behavioral process is related to a wide variety of health choices, ranging from preventive health to behavioral and medical regimen adherence, including regimens used for Type 2 diabetes. We believe that DD provides a target for one type of self- regulation that can improve a wide variety of health behaviors and medical adherence. Research from our laboratories has shown that episodic future thinking (EFT), a form of prospection which reduces the bias towards immediate gratification, activates brain regions involved in planning and prospection such that future rewards have increased value and the extent of delay discounting is reduced. Cueing individuals to think about future events during inter-temporal decision-making reduces the rate of DD, eating in and outside of the laboratory, and smoking behavior. The overarching goal of this grant is to use an experimental medicine approach to translate basic research on DD and EFT into clinical interventions to prevent the transition from pre-diabetes to a diagnosis of Type 2 diabetes. We are using the grant mechanism RFA-RM-14-020, "Science of Behavior Change: Assay Development and Validation for Self-Regulation Targets (UH2/UH3)" as this provides for the opportunity to integrate observational, laboratory and field studies to assess relationships between DD and disease self-management, understand mechanisms of these relationships across multiple levels of analysis, and refine interventions in preparation for a clinical trial. e propose a series of observational, laboratory and field studies to identify DD as a behavioral target to improve behavioral and medical adherence and metabolic control in adults with pre-diabetes who are at high risk for development of Type 2 diabetes. Specific Aim 1 will examine the cross sectional relationship between DD, executive function, and fMRI-measured brain activation to predict adherence and metabolic control in persons diagnosed with pre-diabetes. Specific Aim 2 will assess the effects of EFT on DD, fMRI measured brain activation and energy intake in participants with pre-diabetes in the laboratory. Specific Aim 3 will assess the effects f EFT on DD and fMRI measured brain activation under simulations of poverty that increase discounting of the future. Specific Aim 4 extends the study of the effects of EFT on DD, executive function, health behavior change, medication adherence for comorbid conditions and glycemic control after a 6-month target engagement with EFT versus control in a field study for the UH3 component of this application.