HOME DM-BAT: Home-based Diabetes-Modified Behavioral Activation Treatment for Low Income Seniors with T2DM Diversity Supplement

近三分之一的60岁及以上的成年人患有糖尿病，众所周知， 增加死亡和合并症的风险，如心血管疾病、慢性疼痛， 认知功能障碍（CI）。非洲裔美国人和西班牙裔/拉丁裔人的可能性大约是他们的两倍。 非西班牙裔白人的糖尿病。血糖控制不佳的少数老年人的比例一直是 与非西班牙裔白色老年人相比，虽然有大约1600万人 在美国，有一定程度认知障碍的人，少数民族受到的影响不成比例 65岁的非西班牙裔白色人中有6.9%、NHB人中有9.4%、西班牙裔人中有11.5%存在认知障碍， 老年人，被诊断患有阿尔茨海默氏症或痴呆症。认知障碍与增加 死亡率;此外，轻度认知障碍的人发展为阿尔茨海默氏痴呆症， 难以行使良好的判断力，保持活跃或社交，理解演讲或写作 沟通，记住名字和约会，完成日常任务和糖尿病 自我管理活动。日常生活活动的功能限制（即行走、洗澡、 穿衣）（ADL）和工具性日常生活活动（即家务、做饭、购物） (IADL的）可能会影响老年少数糖尿病患者的临床结果， 由于认知障碍而维持先前建立的自我护理例程。研究表明 几乎40%的老年糖尿病患者有功能限制。这些限制和残疾导致 功能受限的老年人的生活质量更差。此外，值得研究的是 文化因素的作用，如感知歧视，信任，控制点，和精神上的临床 （HbA 1C、LDL、血压）和行为（自我护理-饮食、运动和药物依从性） 结果和生活质量。有三个重要的未回答的问题，这项研究将 试图回答：1）什么程度的认知障碍和功能限制导致自我照顾能力差 行为，临床结果差，生活质量差的老年少数2型糖尿病患者？2)是什么 认知障碍和功能限制（ADL，IADL）导致的途径和机制 2型糖尿病患者的自我护理行为差、临床结果差和生活质量差 糖尿病？3)文化结构，如感知歧视，信任，控制点，和精神 个别和累积导致自我护理行为差，临床结果差，生活质量差， 2型糖尿病的治疗方法有哪些？这项研究将提供新的知识和 为未来的干预发展奠定基础，并将候选人定位为具有竞争力的 K 01在2年奖励结束时提交。

Nearly one third of adults aged 60 and older have diabetes, and it is known that elderly patients with diabetes have increased risk of mortality and comorbid conditions such as cardiovascular diseases, chronic pain, and cognitive impairment (CI). African Americans and Hispanics/Latinos are about two times as likely to have diabetes than non-Hispanic Whites. The proportion of minority elders with poor glycemic control has been found to be significantly higher compared to non-Hispanic White elders. While there are about 16 million people with some degree of cognitive impairment in the US, minorities are disproportionately impacted by cognitive impairment with 6.9% of Non-Hispanic White, 9.4% of NHB, and 11.5% of Hispanics aged 65 and older, having been diagnosed with Alzheimer’s or dementia. Cognitive impairment is associated with increased mortality; additionally, those with mild cognitive impairment progress to developing Alzheimer’s dementia and have difficulty exercising good judgement, remaining active or social, understanding speech or written communications, remembering names and appointments, and completing daily tasks and diabetes management self-care activities. Functional limitations in activities of daily living (i.e. walking, bathing, dressing) (ADL’s) and instrumental activities of daily living (i.e. housework, preparing meals, shopping) (IADL’s) may impact clinical outcomes in elderly minority patients with diabetes by reducing their ability to maintain previously established self-care routines due to cognitive impairment. Research has shown that almost 40% of older people with diabetes have functional limitations. These limitations and disabilities result in a poorer quality of life for older adults with functional limitations. Additionally, it is worthwhile to examine the role of cultural factors such as perceived discrimination, trust, locus of control, and spirituality on clinical (HbA1C, LDL, blood pressure) and behavioral (self-care – diet, exercise, and medication adherence) outcomes, and quality of life in this group. There are three important unanswered questions that this study will attempt to answer: 1) What degree of cognitive impairment and functional limitations lead to poor self-care behaviors, poor clinical outcomes and poor quality of life in elderly minorities with type 2 diabetes? 2) What are the pathways and the mechanisms by which cognitive impairment and functional limitations (ADLs, IADLs) lead to poor self-care behaviors, poor clinical outcomes and poor quality of life in elderly minorities with type 2 diabetes? 3) Do cultural constructs such as perceived discrimination, trust, locus of control, and spirituality individually and cumulatively lead to poor self-care behaviors, poor clinical outcomes and poor quality of life in elderly minorities with type 2 diabetes and if so via what process? This study will provide new knowledge and set the groundwork for future intervention development as well as position the candidate to be competitive for a K01 submission at the end of the 2-year award.