Older African Americans (AAs) have higher prevalence of type 2 diabetes (T2DM) and increased risk of diabetes related complications and mortality. In addition, older AAs are more likely to require help from caregivers to manage their diabetes and caregivers provide numerous hours of costly care daily providing physical and social support, and care coordination. However, informal/unpaid caregivers frequently have little or no formal training on managing diabetes or addressing the social risk factors associated with patient outcomes. Therefore, there is an urgent need to provide informal caregivers with appropriate training and strategies for diabetes management to reduce caregiver burden and improve their quality of life, so they can continue to care for older AAs with T2DM. Behavioral activation is a cognitive behavior therapy, originally developed to address depression, that has shown promise in individuals with chronic medical conditions, including T2DM. We are currently completing an NIH funded RCT (R01DK118038) to evaluate the efficacy and cost-effectiveness of 8 sessions of in-home, telephone-delivered, behavioral activation treatment for older adults with diabetes (Home DM-BAT). 40% of AAs in the study have informal caregivers. Caregivers have requested formal training on managing diabetes in the form of joint training sessions with participants. We conducted focus groups with participant-caregiver dyads and their feedback has guided the decision to conduct this R21 study and shaped the proposed intervention. The proposed study will test the preliminary efficacy of home-based, joint patient and caregiver intervention (Joint Home-DM-BAT) on patient clinical outcomes (hemoglobin A1c, blood pressure, and LDL-Cholesterol) and quality of life and caregiver quality of life and caregiver burden. This study fills a gap in the literature by combining diabetes education with brief behavioral activation treatment, addressing social determinants of health, and incorporating training and support for informal caregivers. Finally, this study is responsive to patient and caregiver feedback and allows incorporation of the lived experience into intervention development for older AAs with T2DM.

Older AAs have higher prevalence of diabetes, increased morbidity, mortality, and disability; are more likely to require help from informal/unpaid caregivers to manage their diabetes; and preliminary data from our group show that ~40% of older AAs with T2DM require assistance from informal/unpaid caregivers. However, informal/unpaid caregivers frequently have little or no formal training on managing diabetes or addressing the social risk factors associated with patient outcomes and preliminary data from our group show that informal caregivers are requesting formal training on managing diabetes in the form of joint training sessions with study participants. The proposed study will test the preliminary efficacy of home-based, joint patient and caregiver intervention (Joint Home-DM-BAT) on patient clinical outcomes (hemoglobin A1c, blood pressure, and LDL- Cholesterol) and quality of life and caregiver quality of life and caregiver burden.