This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Performance of self-care recommendations is key to the successful treatment of diabetes. However, many patients have difficulty adhering to diabetes self-care recommendations. Recent results from our own studies and others have identified specific barriers to diabetes self-care. To evaluate the efficacy of a diabetes educator-led group intervention, the Breaking Down Barriers Program, that addresses barriers and therefore leads to improved adherence to diabetes self-care recommendations, we propose to randomize 222 (111 type 1 and 111 type 2) diabetes patients to one of three conditions: 1) the Breaking Down Barriers Program, 2) a cholesterol attention control condition, or 3) a 'usual care' control condition. The first two arms include a group diabetes education program while the usual care arm includes individual appointments with diabetes educators. To maintain the integrity of intervention, each will be taught by a separate team of RN and RD educators. Diabetes educators teaching the Breaking Down Barriers Program will receive special behavioral training that is based on their clinical expertise and education in nursing and nutrition. If we find that the Breaking Down Barriers Program is effective in terms of improving self-care behaviors and ultimately physiologic outcomes, we plan to develop training materials to allow the intervention to be used by diabetes educators. The Breaking Down Barriers study is a randomized controlled trial investigating the efficacy of behavioral-based and structured education on diabetes self-care behaviors and glycemic control. In March 2006 a control cohort was added. The purpose of this addendum is to evaluate problem-solving strategies (executive function) and learning styles using The Rey-Osterrieth Complex Figure Test (ROCF), among individuals with diabetes who are in good glycemic control (HbA1c7.0%). We will then compare results from this group of subjects with results from subjects in the Breaking Down Barriers to Diabetes Self-Care study. We hypothesize that individuals with HbA1c7.0% are able to problem solve, use different executive function strategies, and adhere to the rigorous demands of their diabetes self-management plan better than poorly controlled patients.
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