Situational Problem Solving in Adolescents with Type 2 Diabetes: Enhancing an RCT

描述（由申请人提供）： 2型糖尿病（T2 DM）是青少年中日益严重的问题，特别是在少数民族人群中。我们从K23奖的初步研究已经检查了障碍，以最佳的管理与T2 DM青少年。我们目前的工作表明，患有T2 DM的青少年通常来自具有自我管理的文化，心理和社会经济障碍的家庭。这些青少年中的许多人有多个患有糖尿病或肥胖症的家庭成员，他们可以作为积极的，但也可以作为消极的榜样。此外，这些青少年在自我管理方面面临许多情境障碍，包括应对同伴压力、利益冲突和家庭互动。我们的研究表明，这些青少年和他们的家庭往往缺乏足够的解决问题的技能，以帮助克服可能阻碍自我管理的情境障碍。 包括患者、家庭、健康提供者和卫生系统水平组成部分的综合疾病管理干预可以大大改善青少年T2 DM的糖尿病护理。一个全面的糖尿病计划需要解决医疗管理问题和自我管理问题，发生在诊所访问期间和之间。一个有效的干预措施，重点放在病人和家庭一级的组成部分，可以通过促进利用医疗服务和成功地解决自我管理的障碍，对病人的长期健康产生深远的影响。然而，迄今为止，尚未对这一人群的综合疾病管理干预措施进行正式评价。 这一提议将加强我们先前计划的针对T2 DM青少年的综合疾病管理干预的随机试验。T2 DM青少年将随机接受常规治疗与综合干预，包括患者、家庭、提供者和系统水平干预，以改善患者自我管理、自我效能、A1 C和其他结局。拟议的增强措施将包括一项干预措施，以提高T2 DM青少年及其照顾者解决情境问题的技能。青少年和他们的照顾者将独立和协作地参与基于互联网的自我管理问题解决与营养，运动，血糖监测和药物依从性相关的学习周期。将在患有T2 DM的青少年中提供基于同伴的互动，以促进解决方案的产生和实施以及同伴支持。 R 03将是目前K23提案的重要补充，通过：（1）允许我们在计划的干预中增加解决问题的成分-我们认为这是整体干预成功的关键，（2）允许我们了解解决问题干预在青少年T2 DM中的独特作用，和（3）将提供有价值的额外结果，这些结果对于寻求未来的R 01资金以进行额外的研究以改善T2 DM青少年的护理至关重要。 2型糖尿病是青少年中日益严重的问题，特别是在少数民族人口中。我们的初步研究表明，这些青少年及其家庭往往缺乏足够的解决问题的技能，以帮助克服可能损害他们照顾自己的能力的情境障碍。这项研究将加强我们先前计划的试验，通过增加特定的基于互联网的工具，以提高青少年T2 DM及其照顾者的情景问题解决技能，为青少年T2 DM的综合疾病管理干预。

DESCRIPTION (provided by applicant): Type 2 diabetes (T2DM) is a growing problem among adolescents, particularly in minority populations. Our initial research from the K23 award has examined barriers to the optimal management of adolescents with T2DM. Our current work has demonstrated that adolescents with T2DM often come from families with cultural, psychosocial, and socioeconomic barriers to self-management. Many of these adolescents have multiple family members with diabetes or obesity that can act as positive, but also negative role models. In addition, these adolescents face many situational barriers to self management including dealing with peer pressures, competing interests and family interactions. Our research has indicated that these adolescents and their families often lack adequate problem solving skills to help overcome situational barriers that can impede self- management. A comprehensive disease management intervention that includes patient, family, health provider and health system level components could greatly improve diabetes care for adolescents with T2DM. A comprehensive diabetes program needs to address medical management issues and self-management issues that occur both during and between clinic visits. An efficacious intervention that focuses on patient and family level components could have profound impacts on patients' long-term health by fostering utilization of medical services and successful resolution of barriers to self-management. However, to date, there have been no formal evaluations of comprehensive disease management interventions for this population. This proposal will enhance our previously planned randomized trial of a comprehensive disease management intervention for adolescents with T2DM. Adolescents with T2DM will be randomized to usual care versus a comprehensive intervention that includes patient, family, provider, and system level interventions to improve patient self-management, self-efficacy, A1C and other outcomes. The proposed enhancement will include an intervention to improve the situational problem solving skills of adolescents with T2DM and their caregivers. Adolescents and their caregivers will independently and collaboratively engage in Internet-based self-management problem solving learning cycles related to nutrition, exercise, glucose monitoring, and medication adherence. Peer-based interaction among adolescents with T2DM will be provided to promote solution generation and implementation, and peer support. The R03 will be an essential addition to the current K23 proposal, by: (1) allowing us to add a problem solving component to our planned intervention - a component that we feel is essential for success of the overall intervention, (2) allow us to learn about the unique role of a problem solving intervention in adolescents with T2DM, and (3) will provide valuable additional results that will be essential for seeking future R01 funding to perform additional studies to improve care for adolescents with T2DM. Type 2 diabetes is a growing problem among adolescents, particularly in minority populations. Our initial research has demonstrated that these adolescents and their families often lack adequate problem solving skills to help overcome situational barriers that can impair their ability to take care of themselves. This study will enhance our previously planned trial of a comprehensive disease management intervention for adolescents with T2DM, by adding specific Internet-based tools to improve the situational problem solving skills of adolescents with T2DM and their caregivers.