There is a tremendous burden of type 2 diabetes mellitus and cardiovascular disease among persons with schizophrenia. Patients with schizophrenia have a cardiovascular mortality rate that is two to three times higher than that of the general population. There have been no studies to date of interventions which improve diabetes outcomes in this vulnerable population. This application is a request for a Mentored Patient-Oriented Research Career Development Award (K23) to prepare Dr. Lydia Chwastiak to become an independent investigator in the area of management of chronic medical illness in patients with serious mental illness. She will achieve this goal through directed coursework, mentoring from accomplished researchers, involvement with two focused research projects and submission of scholarly manuscripts. Specifically, she will receive training in the design and implementation of behavioral interventions to improve chronic medical illness management and outcomes among patients with schizophrenia. The proposed research involves two projects. In this first two years of the award, Dr. Chwastiak will conduct secondary analyses of large datasets in order to inform the development of an intervention to improve diabetes self- care among patients with schizophrenia and type 2 diabetes. These analyses will utilize data from the 1999 Large Health Survey of Veteran Enrollees, the largest and most detailed survey of veterans using VA health services. The primary aim of the study is to demonstrate how poor self-care mediates poor cardiovascular outcomes in patients with schizophrenia and diabetes. The second study is a stage 1 psychotherapy development project, which will develop a community mental health center-based Brief Motivational Interviewing (BMI) intervention that aims to improve diabetes self-care among patients with schizophrenia and type 2 diabetes. This second project will be conducted in two phases over years 2-5 of the award. In phase 1, the BMI Intervention will be developed and manualized. In phase 2, we will evaluate the efficacy of the intervention through a randomized controlled pilot study in which 60 subjects with schizophrenia and type 2 diabetes are assigned to either BMI or brief education sessions. The primary measures of efficacy of BMI, relative to brief education sessions, will be the overall level of self-care and the level of self-care across five domains (diet, exercise, medication adherence, monitoring of blood glucose, and tobacco use). These behaviors will be assessed using a validated measure of diabetes self-care behaviors from the Diabetes Quality Improvement Project. Secondary process and outcome measures will include glycemic control, blood pressure control, lipid control, utilization of diabetes-related services, and knowledge of diabetes. The career development plan is a carefully staged approach to provide Dr. Chwastiak with the skills and data necessary to develop an R01 and become an independent investigator by the end of the award.
