A Remotely Delivered Episodic Future Thinking Intervention to Improve Management of Type 2 Diabetes

项目总结 2型糖尿病的成功治疗需要坚持医生推荐的药物， 饮食和锻炼养生法。这些与坚持有关的行为大多不会带来短期效果 更确切地说，可能是有害的(例如，限制卡路里和体力消耗)。然而，治疗 坚持治疗对未来的健康大有裨益，使患者能够阻止或逆转疾病。 进展和避免与糖尿病相关的并发症(如肾脏疾病或糖尿病视网膜病变)。因此， 2型糖尿病的成功治疗需要一个人目前的行为以未来的结果为指导。 不幸的是，越来越多的证据表明，2型糖尿病患者和有此风险的人 无序使未来迅速贬值(一种称为延迟贴现的现象)，过去和现在的数据 建议有助于治疗不依从。因此，干预措施显示出增加了对未来的估值 可能会提高遵从性。一种这样的干预是断断续续的未来思维(EFT)，这是一种预测形式 参与者生动地想象未来可能发生的事件。最近和正在进行的工作表明 EFT激活了与规划和预测相关的神经系统，提高了 未来并减少广泛的不适应健康行为(例如，超重/肥胖的饮食摄入 人口和吸烟者的吸烟情况)。该项目的总体目标是使用远程交付的 EFT干预改善2型糖尿病患者的治疗依从性和依从性相关结果。在……里面 具体目标1，2型糖尿病(定义为血红蛋白A1C≥8%)控制不佳的参与者将 在为期四周的试验中，在自然环境中进行EFT或控制思维条件。 将在基线以及为期4周和6个月的后续实验室访问中评估成果衡量标准， 并将包括服药依从性、饮食摄入量、体重指数、血糖控制、血压和 延迟折扣。在试验期间，我们还将远程评估身体活动、服药依从性、饮食 入场，并延迟打折。在具体目标2中，我们将检查远程交付的EFT的可接受性 干预。为了使干预措施在临床环境中有效，它应该易于使用，并具有帮助作用 患者应该很清楚。因此，参与者将从多个维度对EFT或控制条件进行评级 可接受性，包括易用性、有用性和帮助。评级将另行获得 干预措施和测量的组成部分，以隔离干预措施本身的可接受性。高 干预评级将表明，EFT可以在临床环境中以高治疗保真度实施 并且更有可能在治疗提供者中传播并被患者采用。

PROJECT SUMMARY Successful management of type 2 diabetes requires adhering to physician-recommended medication, dietary, and exercise regimens. Most of these adherence-related behaviors provide little to no short-term benefit and rather may be aversive (e.g., caloric restriction and physical exertion). However, treatment adherence provides critical health benefits in the future, allowing patients to halt or reverse disease progression and avoid diabetes-related complications (e.g., renal disease or diabetic retinopathy). Thus, successful management of type 2 diabetes requires one's present behavior to be guided by future outcomes. Unfortunately, accumulating evidence indicates that individuals with type 2 diabetes and those at risk for this disorder rapidly devalue the future (a phenomenon known as delay discounting), which past and present data suggest contributes to treatment nonadherence. Thus, interventions shown to increase valuation of the future are likely to improve adherence. One such intervention is episodic future thinking (EFT), a form of prospection in which participants vividly imagine events that might occur in their future. Recent and ongoing work indicate that EFT, which activates neural systems associated with both planning and prospection, improves valuation of the future and reduces a wide range of maladaptive health behaviors (e.g., dietary intake in overweight/obese populations and cigarette smoking in smokers). The overall goal of this project is to use a remotely delivered EFT intervention to improve treatment adherence and adherence-related outcomes in type 2 diabetes. In Specific Aim 1, participants with poorly controlled type 2 diabetes (defined as hemoglobin A1C ≥8%) will engage in either EFT or a control thinking condition in the natural environment during a four-week trial. Outcome measures will be assessed at baseline, as well as 4-week and 6-month follow-up laboratory visits, and will include medication adherence, dietary intake, body mass index, glycemic control, blood pressure, and delay discounting. During the trial, we will also remotely assess physical activity, medication adherence, dietary intake, and delay discounting. In Specific Aim 2, we will examine acceptability of the remotely delivered EFT intervention. For an intervention to be effective in clinical settings, it should be easy to use and its helpfulness should be clear to patients. Thus, participants will rate the EFT or control conditions along several dimensions of acceptability, including ease of use, usefulness, and helpfulness. Ratings will be obtained separately for components of both the intervention and measurement to isolate acceptability of the intervention itself. High intervention ratings would suggest that EFT may be implemented with high treatment fidelity in clinical settings and is more likely to be disseminated among treatment providers and adopted by patients.