Although in-home caregivers (ICGs) help improve diabetes mellitus (DM) outcomes, they may lack the resources needed to do this optimally, and are at risk for psychosocial decline and "caregiver burnout." Complicating matters, millions of chronically-ill older Americans live alone and receive "long-distance caregiving" without any supporting structure or resources to ensure its effectiveness. Preliminary data indicate that DM patients will engage in automated telemonitoring consistently for sustained periods. The resulting data seems to validly detect changes over time in health status and self-management. We propose to link patients with a non-household family member or close friend (the "CarePartner;" CP) who is willing to support the patient's health and self-management in close coordination with the patient's ICG (if one exists) and clinician(s). Through automated telemonitoring, patients will provide weekly updates on their DM health and self-management. Summaries of this will be emailed to CPs along with guidance on helping the patient address reported problem(s);clinicians will be alerted about medically-urgent problems. We found a similar intervention to be feasible and potentially effective in another challenging setting, i.e., congestive heart failure self-management. For this proposal, we developed DM-related telephone scripts and detailed participant guidelines. In this resubmission, we now include pilot data that not only indicates that DM patients are very receptive to the intervention, but also addresses a Reviewer concerns by suggesting that the intervention is unlikely to create or worsen interpersonal conflicts between CPs, ICGs, and patients. We now propose a community-based effectiveness RCT.
Specific Aim 1 is to compare the effects of CP intervention to telemonitoring alone (control) upon 12-month glycemic control and DM-related distress for patients with poorly-controlled DM (i.e., initial HbA1c >8.0%).
Specific Aim 2 is to examine secondary effects on DM self-management, health-related quality of life, systolic blood pressure, caregiver burden, relationship quality, and cost of DM care. We have already recruited clinical sites serving large numbers of low-income and underinsured patients, whom this intervention was especially designed to benefit. If this intervention proves effective without increasing costs or clinician burden, then its implementation could yield major public health benefits, especially for vulnerable and underserved DM patients. Broader societal benefit may occur through increased helping behavior and strengthened social ties. Followup work could adapt the intervention for use with comorbid conditions and other chronic conditions requiring self-management.
Although many older Americans with diabetes receive caregiving assistance from someone they live with, this situation often leads to caregiver stress and burnout. Many other diabetes patients live by themselves, but could use this type of assistance to remain healthy and avoid complications. This project addresses both problems by linking diabetes patients with someone from outside their home who they already know well, and training this CarePartner to help the patient achieve good diabetes control. If successful, this program could prevent diabetes complications for many thousands of older Americans who would otherwise be socially isolated and medically under-served.
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