Real-World Assessment of Daily Functioning in Veterans with Type 2 Diabetes

2型糖尿病(T2D)与相当大的功能损害和生活质量下降有关。 持续的日常自我管理行为，如身体活动、服药依从性、 监测血糖是维持日常功能、生活质量和血糖控制所必需的。 然而，大多数退伍军人没有达到日常自我管理的目标，特别是体力活动。这是 有问题，因为体力活动是T2D自我管理的基石，并代表着基本的 功能的组成部分。自我管理发生在患者自身环境的背景下。因此， 在医疗保健就诊时的评估可能会遗漏自我管理行为的大量变异性，因为 以及影响自我管理的共病症状和社会背景因素的日常波动。 指导这项提议的概念模型基于时间自我调节理论，并假设 由于T2D通常是无症状的，不良自我管理的后果和一致的好处 目前，自我管理并不突出。对于患有T2D的退伍军人来说，情绪等共病症状， 痛苦和压力是自我管理的常见时变短暂障碍，尤其是 影响体力活动。社会背景是与自我管理相关的另一组公认的因素 在患有T2D的人中。关于外显自我管理的障碍和促进者的研究大多是横断面的 并假设共病症状和背景因素是静态的。目前的研究并没有解决 这些共病症状和社会背景因素影响体力活动的时变性 以及个人内部的其他自我管理行为。因此，当前提案的总体目标是 了解与以下各项特别相关的日常时变因素(共病症状、社会背景) 这会影响体力活动、T2D自我管理、日常功能和生活质量。 我们将招募95名退伍军人(5名测试参与者和90名分析样本)参加T2D，并将使用 生态瞬时评估(EMA)，一种实时数据收集方法。参赛者将获得5 即时EMA调查和每天1次EMA调查，退伍军人将在其中报告并发疾病 症状(情绪、压力、疼痛、创伤后应激障碍)、社会支持、社会互动、身体活动和其他自我 管理行为，在14天的自然环境中，在预先编程的间隔内随机进行 采样周期。加速度计还将评估体力活动。有了这些数据，我们将解决四个目标：目标 1)使用EMA检查日常共病症状(抑郁)之间的人内时变关系 情绪、压力、疼痛、创伤后应激障碍)和一天内进行体育活动的时间；目的2)使用EMA检查 个人内部的社会背景因素(社会支持、社会互动)和每天花费在身体上的时间 活动；探索性目标1)探索人内其他时变因素之间的关系，社会 情境因素、人与人之间的人口统计和T2D特定特征与T2D自我管理 可能影响日常功能和生活质量的行为；以及探索性目标2)利用密集的 纵向数据，使用网络分析来探索研究变量之间的时间关系。 成功完成这项CDA将为申请人提供必要的培训和数据，以 追求VA价值，以进一步研究T2D自我的现实障碍和促进者的复杂性 管理层。当前研究的结果将有助于开发评估工具和临床 干预措施。从本研究开发的评估工具可以为临床决策提供信息 考虑到在医疗预约之外发生的自我管理障碍。临床 应用包括量身定做的适应性技术支持的干预措施，提供正确的类型和 在适当的时间，通过适应个人不断变化的内部和背景状态，提供大量的支持。

Type 2 diabetes (T2D) is associated with considerable functional impairment and reduced quality of life. Consistent daily engagement in self-management behaviors, such as physical activity, medication adherence, and monitoring blood glucose is required to maintain daily functioning, quality of life, and glucose control. However, most Veterans do not meet daily self-management targets, particularly physical activity. This is problematic as physical activity is a cornerstone of T2D self-management and represents a fundamental component of functioning. Self-management occurs in the context of patients’ own environments. Thus, assessments at healthcare visits likely miss significant amounts of variability in self-management behaviors as well as daily fluctuations in comorbid symptoms and social contextual factors that influence self-management. The conceptual model guiding the proposal is based on temporal self-regulation theory and posits that because T2D is generally asymptomatic, consequences of poor self-management and benefits of consistent self-management are not salient in the moment. For Veterans with T2D, comorbid symptoms such as mood, pain, and stress are common time-varying momentary barriers to self-management that may particularly impact physical activity. Social context is another well-established set of factors related to self-management among people with T2D. Most research on barriers and facilitators of T2D self-management is cross-sectional and assumes comorbid symptoms and contextual factors are static. Current research does not address the time-varying nature in which these comorbid symptoms and social contextual factors impact physical activity and other self-management behaviors within individuals. Thus, the overarching aim of the current proposal is to understand daily, time-varying factors (comorbid symptoms, social context) that are particularly relevant to Veterans and that influence physical activity, T2D self-management, daily functioning, and quality of life. We will enroll 95 (5 test participants and 90 for the analytic sample) Veterans with T2D and will use ecological momentary assessment (EMA), a method of real-time data collection. Participants will receive 5 momentary EMA surveys and 1 daily EMA survey per day, in which Veterans will report on comorbid symptoms (mood, stress, pain, PTSD), social support, social interactions, physical activity and other self- management behaviors, randomly, during pre-programmed intervals in their natural environment over a 14-day sampling period. Accelerometry will also assess physical activity. With these data, we will address 4 aims: Aim 1) Use EMA to examine within-person time-varying relationships among daily comorbid symptoms (depressed mood, stress, pain, PTSD) and within-day time spent doing physical activities; Aim 2) Use EMA to examine within-person social contextual factors (social support, social interactions) and daily time spent doing physical activities; Exploratory Aim 1) Explore relationships among other within-person time-varying factors, social contextual factors, between-person demographic and T2D specific characteristics, and T2D self-management behaviors that may impact daily functioning and quality of life; and Exploratory Aim 2) Leverage intensive longitudinal data to explore temporal relationships among study variables using network analysis. The successful completion of this CDA will provide the applicant with the necessary training and data to pursue a VA Merit to further examine the complexity of real-world barriers and facilitators of T2D self- management. Results from the current study will help to develop both assessment tools and clinical interventions. Assessment tools developed from the present study can inform clinical decision making that takes into account barriers to self-management that occur outside of medical appointments. Clinical applications include tailored, adaptive technology-supported interventions that provide the right type and amount of support, at the right time by adapting to an individual’s changing internal and contextual state.