Persistent disparities based on race/ethnicity and socioeconomic status in healthcare are well documented in the United States. Social determinants of health are key drivers of health disparities, especially in the elderly. Type 2 diabetes (T2DM) is a chronic disease that is highly prevalent in the elderly, associated with significant racial/ethnic disparities, and impacted by social determinants of health. Elderly individuals with diabetes have high multimorbidity, complex treatment regimens, impaired functional status and are often impacted by psychosocial determinants of health such as food insecurity, housing insecurity, competing needs, stress/coping, cognitive dysfunction, limited social and financial resources, and social isolation. Behavioral activation is a cognitive behavior therapy, originally developed to address depression, that has shown promise in individuals with chronic medical conditions, including T2DM. Therefore, especially among racial/ethnic minority elderly patients with diabetes, interventions that directly addresses psychosocial issues and social context factors that can influence lifestyle behaviors in the treatment and management of diabetes are likely to improve clinical outcomes and general well-being. Preliminary data from our group has demonstrated that 8 sessions of culturally-modified, manualized, diabetes-modified, behavioral activation treatment that incorporates: 1) diabetes education, 2) addresses social determinants of health (e.g. food insecurity, housing insecurity, competing needs, stress/coping etc.), and 3) brief behavioral activation treatment achieved maintenance of glycemic control in older adults with T2DM. This project will evaluate the efficacy and cost- effectiveness of 8 sessions of in-home, group-based, manualized diabetes-modified behavioral activation treatment (Home DM-BAT) delivered by trained diabetes nurse educators to low income, minority elders living in independent senior housing. The proposed study will test new strategies for improving clinical outcomes for T2DM in minority elders by addressing both diabetes-specific factors and social determinants of health.
Diabetes disproportionately impacts ethnic minority elders and is associated with increased morbidity, mortality and disability. Key drivers of health disparities, and thus an important area for intervention, are the social determinants of health; and while psychosocial factors are important mutable social determinants of health, few large RCTs have tested interventions that address the unique psychosocial problems in minority elders and incorporate social determinants of health (e.g. food insecurity, housing insecurity, competing needs, stress/coping etc.). We propose to evaluate the effectiveness of 8 sessions of in-home, group-based, manualized diabetes-modified behavioral activation treatment (Home DM-BAT) delivered by trained diabetes nurse educators in independent senior housing, in low income and high minority zip codes, with the long-term goal of improving metabolic control and reducing diabetes complications and mortality in this population.
