Building Self-regulation Capacity in AA T2DM Women: Feasibility of an Ecological Momentary Intervention

All visits will take place at the University of Illinois at Chicago (UIC) College of Nursing Clinical Diabetes and Exercise Laboratory. At time 1 (T1), participants will complete baseline assessments. Participants will complete health and biological assessments, including measures of glucose control (A1C), body mass index (BMI) and a diabetes health history, including, diabetes knowledge, and current DSM behaviors. The investigators will collect assessments of autonomous motivation, diabetes distress, depression, self-efficacy for diabetes self-care, and neighborhood related stress at baseline (T1) and upon completion of the 6-week intervention at time 2 (T2).

Intervention Week 1. Education and Fitbit set-up/instructions. The women will begin the intervention as soon as five women are enrolled and T1 assessments are completed. The investigators chose the group setting for the education to encourage social interaction and support, which has been associated with DSM in a similar population to ours. The education will consist of two 2-3-hour blocks of interactive diabetes education that will be personalized in response to the cluster members' DM knowledge, health, and self-care history. Education will follow the 2017 National Standards for Diabetes Self-Management and Support. Education sessions will be culturally adapted to reflect needs of AA participants, including feelings of powerlessness, access to care and family roles. Dr. Fritschi (PI) is a certified diabetes educator (CDE) and has worked with low-income, urban diabetes patients since 1994. She will adapt and deliver the education.

Session 1 (2-3 hours): Diabetes self-management education (DSME) will include target glucose ranges, medications, foot care, and dietary and exercise effects on glucose levels.

Session 2 (2-3 hours): At the start of the session, subjects will be given a wrist-worn activity tracker (Fitbit Charge 3 accelerometer) that will be able to assess real-time steps and heart rate. The Fitbit will also be able to track specific activities (e.g., cycling, yoga) that the participant may choose to track. Participants will be taught how to download the Fitbit app into their smart phones and set up personal accounts. The Fitbit Charge 3 was chosen because it has a larger screen and easier app than other devices, and Co-investigator Dr. Ulf Bronas has used the Fitbit extensively in his prior research. Group education will include interactive, hands-on learning about performing foot checks prior to walking; stretching exercises; and creative methods for accumulating steps when the weather or environment doesn't permit walking outside. Participants will individually meet with the exercise physiologist (Dr. Bronas) for a practical educational session using a treadmill-walking bout to determine heart rate goals for moderate and brisk walking. They will be given a written, personalized exercise plan for steps and target heart rate. The group will be coached in setting SMART (specific, measurable, achievable, relevant, and time-bound) goals for the following week. The goals may include Fitbit data, such as goals for step counts, stairs climbed, or minutes of activity.

The Fitbit is a cost-effective wrist-worn activity tracker that is commercially available. Fitbit data provide information on daily level of physical activities and heart rate. Measures include number of steps taken, four levels of activity (sedentary, light, moderate, and moderate-vigorous), distance traveled, and an activity score. Fitbits have been shown to be reliable and valid for step counts and total daily energy expenditure in free-living conditions. The advantages of using a Fitbit tracker are its cost-effectiveness and its ability to measure walking unobtrusively. The investigators are using it as a motivator and an option for individuals to set activity goals. Because patients are more likely to wear the Fitbit continuously, There will be fewer missing data, and activity bouts can be tracked.