Joint Patient and Caregiver Intervention for Older African Americans with Poorly Controlled Type 2 Diabetes (Joint Home-DM-BAT)

年长的非裔美国人(AA)有更高的2型糖尿病(T2 DM)患病率和更高的患病风险 糖尿病相关并发症和死亡率。此外，较老的AA更有可能需要 照顾者管理他们的糖尿病和照顾者每天提供大量的昂贵的护理 身体和社会支持，以及护理协调。然而，非正式/无报酬的照顾者通常几乎没有什么 或者没有接受过管理糖尿病或解决与患者相关的社会风险因素的正式培训 结果。因此，迫切需要为非正规照顾者提供适当的培训和培训。 糖尿病管理战略，以减轻照顾者负担，提高他们的生活质量，这样他们就可以 继续照顾患有T2 DM的老年AA患者。行为激活是一种认知行为疗法，最初 这是为治疗抑郁症而开发的，在患有慢性疾病的人身上显示出了希望， 包括T2 DM。我们目前正在完成一项由NIH资助的随机对照试验(R01DK118038)，以评估疗效和 为老年人提供8次家庭电话行为激活治疗的成本效益 成人糖尿病患者(Home DM-BAT)。研究中40%的AA有非正式的照顾者。护理者有 要求以与参与者联合培训班的形式提供糖尿病管理方面的正式培训。我们 与参与者和照顾者二元组一起进行焦点小组，他们的反馈指导了决策 进行这项R21研究，并制定了拟议的干预措施。拟议的研究将测试初步的 基于家庭、患者和照顾者联合干预(联合Home-DM-BAT)对患者临床的影响 结果(血红蛋白A1c、血压和低密度脂蛋白-胆固醇)和生活质量以及照顾者的质量 生活和照顾者的负担。这项研究通过将糖尿病教育与简明的 行为激活治疗，解决健康的社会决定因素，并将培训和 对非正式照顾者的支持。最后，这项研究对患者和护理人员的反馈做出了回应，并允许 将生活体验纳入老年2型糖尿病腹主动脉硬化患者的干预开发。

Older African Americans (AAs) have higher prevalence of type 2 diabetes (T2DM) and increased risk of diabetes related complications and mortality. In addition, older AAs are more likely to require help from caregivers to manage their diabetes and caregivers provide numerous hours of costly care daily providing physical and social support, and care coordination. However, informal/unpaid caregivers frequently have little or no formal training on managing diabetes or addressing the social risk factors associated with patient outcomes. Therefore, there is an urgent need to provide informal caregivers with appropriate training and strategies for diabetes management to reduce caregiver burden and improve their quality of life, so they can continue to care for older AAs with T2DM. Behavioral activation is a cognitive behavior therapy, originally developed to address depression, that has shown promise in individuals with chronic medical conditions, including T2DM. We are currently completing an NIH funded RCT (R01DK118038) to evaluate the efficacy and cost-effectiveness of 8 sessions of in-home, telephone-delivered, behavioral activation treatment for older adults with diabetes (Home DM-BAT). 40% of AAs in the study have informal caregivers. Caregivers have requested formal training on managing diabetes in the form of joint training sessions with participants. We conducted focus groups with participant-caregiver dyads and their feedback has guided the decision to conduct this R21 study and shaped the proposed intervention. The proposed study will test the preliminary efficacy of home-based, joint patient and caregiver intervention (Joint Home-DM-BAT) on patient clinical outcomes (hemoglobin A1c, blood pressure, and LDL-Cholesterol) and quality of life and caregiver quality of life and caregiver burden. This study fills a gap in the literature by combining diabetes education with brief behavioral activation treatment, addressing social determinants of health, and incorporating training and support for informal caregivers. Finally, this study is responsive to patient and caregiver feedback and allows incorporation of the lived experience into intervention development for older AAs with T2DM.