The prevalence of type 2 diabetes is rapidly increasing, creating a compelling need to develop, evaluate and disseminate effective programs for the prevention and self-management of this disease. Recent research has shown the efficacy of lifestyle changes on dietary and physical activity behavior for the prevention and self-management of diabetes. Programs are needed to translate these findings into effective community interventions. This has led NIDDK to release the program announcement entitled """"""""Translational Research for the Prvention and Control of Diabetes"""""""" (PA-02-153). Two of the three objectives of this program announcement call for the evaluation of clinical and behavioral programs to 1) improve methods of diabetes self-management, and 2) promote healthy lifestyles what will reduce the risk of diabetes and obesity. Our proposal addresses the objectives of the translational research program announcement through intervention with married couples where one of the spouses has been diagnosed with type 2 diabetes. These married couples offer several advantages for intervention including 1) self-management and prevention can be addressed through change in the same behaviors, 2) spousal partners can provide support to one another, 3) behaviors are aggregated in families, and 4) these partners may be highly motivated to alter lifestyle behaviors. This intervention will be evaluated using a randomized experimental design in which spousal pairs, with one diabetic spouse, will be recruited from the diabetes registry of Kaiser Permanente Southern California, stratified on type of diabetes medication used and gender of the diabetic spouse, within primary care practice, and randomly assigned to a special intervention (SI) or a usual care (UC) control condition. In the SI condition, spouses will meet with an educator and will complete a 30-minute computer program guiding each spouse to set a goal for behavior change, define barriers to the goal and solutions to the barriers, and will generate an action plan. Each spouse will also complete an assessment of the spousal support activities, home environment change, and wider environmental linkages that can facilitate completion of the action plan. Both spouses will then select one factor from each of these categories that will support completion of the action plans. Tailored newsletters will be mailed three- and six-weeks after the educator visit. Support telephone calls will be made one week and one month after completion of the educator visit. This sequence will be completed for one behavior (e.g., diet) and then repeated for the second behavior (e.g., physical activity). Spousal partners in the UC condition will complete a computerized Health Risk Assessment and receive general health education in a visit with an educator. Assessments will occur at baseline, 4-, and 12-months post baseline. Changes in HbA1c (diabetic spouse only), dietary and physical activity behavior will constitute the primary outcomes. The ratio of total cholesterol to HDL cholesterol, BMI, blood pressure, quality of life and mediational variables (e.g., perceived self-efficacy, spousal support) will also be measured.
