A Mixed Methods Investigation of Attitudes and Self-Care in Individuals with Type-1 Diabetes Mellitus with Intact and Impaired Awareness of Hypoglycemia

项目摘要 低血糖是胰岛素治疗不可避免的后果。1型糖尿病（T1DM）患者 依赖症状感知作为主要的生理防御，以防止发生严重的低血糖。高达 60%的T1DM患者对低血糖的交感肾上腺反应迟钝， 低血糖意识受损（IAH）。患有IAH的人有明显更高的可能性， 出现严重的危及生命的低血糖黑人和白色人之间存在种族差异 关于严重低血糖的发生率和IAH的患病率。此外，目前的补救办法 IAH依赖于先进的技术，这是一种黑人个体明显不太可能进行的干预形式。 领养为了降低严重低血糖事件和差异的风险，了解IAH的新方法 都是正当的低血糖意识可以通过显著的低血糖避免来恢复，然而， 我认为，许多人无法达到足够的回避，以恢复意识，由于自我照顾 导致频繁的医源性高胰岛素血症和由此产生的低血糖的行为。IAH患者 已经被证明持有独特的态度和信仰，可能会鼓励这些行为。该研究金基金 应用程序将确定IAH患者的不同态度和自我护理，描述常见的 IAH患者的态度和自我护理概况，并更深入地定性解释研究结果， 调查这些关系的职业调查路线。该研究的具体目的是（1）比较 T1DM伴和不伴IAH成人的态度和自我护理行为，（2）确定态度和 自我照顾行为模式，最符合IAH分类，和（3）探讨之间的关系， 在一个种族多样的T1DM合并和未合并IAH的成人组中， 更好地解释聚类分析中观察到的模式。数据将从宾夕法尼亚大学的患者样本中收集 Rodebaugh糖尿病中心，宾夕法尼亚大学卫生系统最大的糖尿病中心。数据 将首先进行协方差分析，比较IAH患者和非IAH患者的态度和自我护理行为 同时保持公认的协变量不变。然后，我们将使用Ward最小值进行聚类分析 方差法，以确定什么样的态度和自我护理模式符合最IAH分类， 成人T1DM最后，我们将对个人的访谈进行定性的定向内容分析， IAH谁被聚类到一组确定最符合IAH解释结果。该研究金基金 申请将为申请人提供必要的培训和研究经验，成为一个独立的 护士研究员，在T1DM患者的自我护理，态度和IAH方面具有发展专业知识。这 该提案与症状科学中的NINR创新问题倡议保持一致，因为它解决了心理社会如何 影响慢性病症状的因素。预计这项研究将有助于确定 作为一名新兴的护理科学家，我发展我的职业生涯。

Project Summary Hypoglycemia is an inevitable consequence of insulin therapy. Individuals with type-1 diabetes mellitus (T1DM) rely on symptom perception as the primary physiologic defense against developing severe hypoglycemia. Up to 60% of individuals with T1DM experience blunting of the sympathoadrenal response to hypoglycemia that results in impaired awareness of hypoglycemia (IAH). Those with IAH have a significantly higher likelihood of experiencing severe, life-threatening hypoglycemia. Racial disparities exist between Black and White individuals regarding incidence of severe hypoglycemia and prevalence of IAH. Further, current approaches to remedying IAH rely on advanced technologies, a form of intervention that Black individuals are significantly less likely to adopt. To reduce risk for severe hypoglycemic events and disparities, novel approaches to understanding IAH are warranted. Hypoglycemia awareness may be restored with significant hypoglycemia avoidance, yet we believe that many individuals are unable to achieve sufficient avoidance to restore awareness due to self-care behaviors that cause frequent iatrogenic hyperinsulinemia, and resultant hypoglycemia. Individuals with IAH have been shown to hold unique attitudes and beliefs that may encourage these behaviors. This fellowship application will determine differentiating attitudes and self-care of individuals with IAH, describe the common attitude and self-care profiles of individuals with IAH, and more deeply explain findings qualitatively to launch a line of inquiry for a career investigating these relationships. The specific aims of the study are to (1) compare the attitudes and self-care behaviors in adults with T1DM with and without IAH, (2) identify clusters of attitudes and self-care behavior patterns that correspond best with IAH classification, and (3) explore the relationship between attitudes and self-care in a racially diverse group of adults with T1DM complicated and uncomplicated by IAH to better explain patterns observed in cluster analysis. Data will be collected from a sample of patients at the Penn Rodebaugh Diabetes Center, the largest diabetes center in the University of Pennsylvania Health System. Data will first be analyzed with ANCOVA to compare attitudes and self-care behaviors of those with and without IAH while holding recognized covariates constant. Then, we will perform a cluster analysis using Ward’s minimum variance method to determine what attitude and self-care patterns correspond most with IAH classification in adults with T1DM. Finally, we will perform qualitative directed content analysis of interviews of individuals with IAH who were clustered into the group determined to correspond best with IAH to explain results. This fellowship application will provide the applicant training and research experiences necessary to become an independent nurse researcher with developing expertise in self-care, attitudes, and IAH in individuals with T1DM. This proposal aligns with NINR Innovative Questions Initiative in symptom science, as it addresses how psychosocial factors influence symptoms in chronic illness. This study is anticipated to help identify targetable points of intervention for future research as I develop my career as an emerging nurse scientist.