Adapting a Diabetes Self-Management Support Intervention for Adults with Cognitive Dysfunction

About This Grant

Project Summary/Abstract The population of American adults is aging, leading to a growing number of adults experiencing both diabetes and cognitive dysfunction. Diabetes is a recognized risk factor for cognitive dysfunction and for progressing from mild cognitive dysfunction to dementia. Managing diabetes is a cognitively complex endeavor that requires understanding one’s condition, glycemic monitoring, adhering to medication regimens, and maintaining diet and exercise routines. Adults with cognitive dysfunction may struggle to meet these demands. This relationship may be reciprocal, with increased disease severity worsening cognitive dysfunction, which in turn impairs disease management and worsens severity over time. There is an urgent need to develop interventions that (1) integrate evidence-based rehabilitation methods to support diabetes management and (2) are scalable to reach the growing population of adults with diabetes and cognitive dysfunction. This proposal represents the first effort, to our knowledge, to leverage rehabilitation techniques to provide a technology- delivered self-management support intervention for adults with type 2 diabetes and cognitive dysfunction and their support persons. During this K01, the principal investigator (PI) will address these gaps in the extant literature while participating in a mentored training experience that will prepare her as an independent investigator who adapts interventions to the unique needs of people with cognitive dysfunction to support them in managing diabetes. Specific training goals include: (1) deepen content knowledge and experience in clinical diabetes management, (2) develop skills in mixed methods for intervention adaptation, (3) hone expertise in cognitive screening in primary care and community settings, and (4) lead a clinical trial and strengthen responsible conduct of research skills. The proposed research includes two specific aims. Aim 1: The PI will follow the ADAPT-ITT framework to iteratively adapt an existing technology-delivered intervention for adults with cognitive dysfunction based on end user feedback. Aim 2: The PI will conduct a pilot trial to determine feasibility and acceptability of the intervention and study design. Improvements, if needed, will be made prior to proposing a fully-powered clinical trial for a future R01. At the conclusion of this work, the PI will have robust preliminary data on an adapted self-management support intervention for adults with type 2 diabetes and cognitive dysfunction to inform an R01-funded clinical trial. This work is consistent with NIDDK’s strategic goals to (1) leverage technology to make healthcare more feasible and (2) take a precision medicine approach to support health across the lifespan. This K01 will accelerate the PI’s independent research career adapting interventions that incorporate evidence-based rehabilitation techniques with diabetes management and are scalable to support the growing group of adults with type 2 diabetes and cognitive dysfunction.