Glycemic Relapse Prevention: Maintenance Dose Assessment

描述(由申请人提供)： 广泛的、长期的目标是产生和测试假说，从而产生指导改善糖尿病患者护理的理论。该项目的具体目标是：1)比较3种精确定义的不同后续管理策略在达到可接受的血糖控制后预防血糖复发的相对有效性；2)确定可预测复发预防成功或失败的患者特征，以便更好地了解最有可能对给定维持计划做出反应的目标群体。这个项目解决了我们在实现良好的血糖控制后如何保持血糖控制方面的知识空白。此外，该项目从数量上解决了预防复发所需的维持剂量问题。该项目具有重要的与健康相关的意义，因为它允许我们将实验成功转化为主要糖尿病护理发生的初级保健环境。研究设计是150名受试者的对照试验，随机分为三个不同强度的治疗组：1)常规持续标准护理；2)常规标准护理加上每3个月与一名针对所有四种自我护理行为(饮食、活动、血糖自我监测和用药管理)的护士进行电话互动；或3)除1个月间隔外，与#2相同的干预。因此，该项目在选择已经达到适当的血糖控制的受试者方面是独一无二的，尽管不是理想的，以便评估“维持”而不是“诱导”剂量的糖尿病护理的有效性。其次，这条调查路线并没有试图回答病例管理或增加资源是否能改善血糖控制的问题。相反，这一系列的调查试图“揭开”维持血糖控制所需的糖尿病护理的性质和强度。

DESCRIPTION (provided by applicant): The broad, long-term objectives are to generate and test hypotheses leading to theories that guide improved care of patients with diabetes. The specific aims of this project are: 1) to compare the relative effectiveness of 3 precisely defined different follow-up management strategies for preventing glycemic relapse after acceptable glycemic control is achieved; 2) to determine patient characteristics that are predictive of successful/failed relapse prevention in order to better understand the target group most likely to respond to a given maintenance plan. This project addresses a gap in our knowledge as how to maintain glycemic control after good glycemic control has been achieved. In addition, this project quantitatively addresses the maintenance dose required to prevent such relapse. The project has important health-relatedness as it allows us to translate the experimental success to the primary care setting where the majority of diabetes care occurs. The research design is a controlled trial of 150 subjects randomized into one of three varying intensity treatment arms: 1) routine ongoing standard care; 2) routine standard care plus every 3 month phone interaction with a nurse practitioner who targets all four self care behaviors (diet, activity, self monitoring of blood glucose and medication management) ; or 3) identical intervention as #2 except at a 1 month interval. This project, therefore, is unique in selecting subjects at entry who have already achieved adequate, albeit not ideal, glycemic control so as to assess the effectiveness of a "maintenance", not "induction", dose of diabetes care. Second, this line of inquiry does not attempt to answer the question of whether case management or increased resources improve glycemic control. Rather, this line of inquiry seeks to "unpack" the nature and intensity of diabetes care required to maintain glycemic control.