Type 2 diabetes mellitus is currently viewed as one of the chronic disease with the most behavioral demands on the patient. Medication must be taken daily either orally or by injection, meals must be timed, types of food must be distinguished and determinations made regarding calories and fat content, exercise must be timed in relationship to meals, blood testing is often required two to three times a day as well as urine testing for ketones when glucose tests are high. Achieving and sustaining such behaviors require information and knowledge but skills, motivation and reinforcement and highly effective behavioral self-management. It is not surprising that studies on adherence found in diabetes education knowledge alone is no longer the panacea for changing behavior nor maintaining behaviors that require changes in life-style after program completion (Campbell, Redman, Mofitt, & Sanson-Fischer, 1996; Rubin, Peyrot, & Saudek, 1991). Glasgow & Osteen (1992) suggest a shift from a knowledge-attitude-belief model to patient-centered perspectives, self-efficacy, self-management, and empowerment. These psychosocial issues of living and coping with diabetes have also been neglected in treatment research outcomes. Because psychosocial variables significantly influence the course of a disease, we need to better understand what assists individuals to help themselves. As care is provided mainly by the persons with the disease, they are the ones who need the information, skills, motivation, to make decisions and choices. However, the family plays a large role in Asian-Pacific Islanders, they must also be looked upon as external influences in diabetes care. The following specific aims to address these issues are to: 1) determine the effectiveness of a cognitive/behavioral intervention program in enhancing adherence to self-management strategies for Asian Pacific Islanders with type 2 diabetes; 2) determine the effectiveness of cognitive/behavioral intervention program in improving health outcomes of quality of life and glycemic control for Asian/Pacific Islander with type 2 diabetes; and 3) identify unique responses to treatment of Asian/Pacific Islander with type 2 diabetes. The proposed design of the study is a two-arm randomized, controlled clinical trial with follow-up that examines behavioral and health outcomes in individuals with type 2 diabetes given the following interventions: a diabetic education program for Self-Management, using standard recommendations (Guidelines from ADA), versus the treatment group which would include the Standard Self-Management program plus Cognitive/Behavioral Interventions to enhance adherence (ENHANCE).
