Background
Racial and ethnic minority adults with diabetes living in under-resourced communities face multiple barriers to sustaining self-management behaviors necessary to improve diabetes outcomes. Peer support and decision support tools each have been associated with improved diabetes outcomes.
Methods
289 primarily African American adults with poor glycemic control will be recruited from the Detroit Veteran’s Administration Hospital and randomized to Technology-Enhanced Coaching (TEC) or Peer Coaching alone. Participants in both arms will be assigned a peer coach trained in autonomy-supportive approaches. Coaches are diabetes patients with prior poor glycemic control who now have good control. All participants meet face-to-face initially with their coach to review diabetes education materials and develop an action plan. Educational materials in the TEC arm are delivered via a web-based, educational tool tailored with each participant’s personalized health data (iDecide). Over the next six months, Coaches call their assigned participants once a week to provide support for weekly action steps. Data are also collected on an Observational Control group with no contact with study staff. Changes in A1c, blood pressure, other patient-centered outcomes and mediators and moderators of intervention effects will be assessed.
Discussion
Tailored e-Health tools with educational content may enhance the effectiveness of peer coaching programs to better prepare patients to set self-management goals, identify action plans, and discuss treatment options with their health care providers. The study will provide insights for scalable self-management support programs for diabetes and chronic illnesses that require high levels of sustained patient self-management.
AFQT scores than MCI-discordant pairs; MCI-discordant pairs had lower scores than normal-concordant pairs. Within-pair AFQT differences were observed only in dizygotic discordant pairs; normal twins scored higher. Overall results were similar for age 55 AFQT even after adjusting for age 20 scores. Conclusions: Neuropsychologically-defined MCI is present in the sixth decade of life (50s) in non-clinically referred, community-dwelling adults. A unique feature of the discordant twin design enabled us to identify unobserved heterogeneity. The subgroups of normal twins are phenotypically the same, but differed in premorbid cognitive ability based on genetic risk (i.e., having a normal or MCI co-twin). Differences based on genetic risk for the MCI phenotypes followed the same pattern. Premorbid ability is not the entire story, however, because differences persist even after adjusting for premorbid ability. Finally, genetic influences cannot cause differences in genetically-identical monozygotic twins. Therefore, the fact that premorbid cognitive differences within discordant pairs were accounted for by only dizygotic twins suggests that the link between premorbid cognitive ability and MCI is due to some degree of shared genetic influences.
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