Multi-component Intervention for Diabetes in Adults With Serious Mental Illness (MIDAS)

Multi-component Intervention for Diabetes in Adults With Serious Mental Illness (MIDAS)

Persons with schizophrenia and other serious mental illnesses have a high risk for type 2 diabetes and an increased risk of premature mortality compared to the general population. The goals of the proposed study are to implement a multimodal lifestyle intervention to reduce that risk in these individuals living in residential care facilities, a common housing modality for people with serious mental illnesses. If successful, this intervention will lead to reduction in excess medical comorbidity and mortality in persons with serious mental illnesses.

Study Overview

• Status: Recruiting
• Conditions: Obesity; Diabetes; Schizophrenia; Serious Mental Illness; Lifestyle Risk Reduction
• Intervention / Treatment: Behavioral: Multi-component Intervention for Diabetes in Adults with Serious Mental Illness

Detailed Description

Serious mental illnesses (SMI), including schizophrenia, bipolar disorder, and schizoaffective disorder, are associated with increased medical comorbidity and premature mortality from diabetes and cardiovascular disease. Unhealthy lifestyles, including energy-dense (obesogenic) diet, sedentary behavior, and cigarette smoking are important risk factors for diabetes and accelerated biological aging. All of these risk factors are potentially modifiable. There is considerable literature documenting the effectiveness of strategies to prevent and manage diabetes in the general population; yet, these interventions are rarely offered to people with SMI. Residential Care Facilities (RCFs), called Board-and-Care Homes in California, are a common housing modality for patients with SMI; they provide a venue that can maximize efficiency and sustainability of a lifestyle intervention. The goals of the proposed four-year study are to tailor a multi-component intervention to this high-risk group. The study will be a hybrid effectiveness-implementation (Hybrid Type 1) trial of a Multi-component Intervention for Diabetes risk reduction in Adults with SMI (MIDAS) in licensed RCFs in San Diego county. As a Hybrid Type 1 study, the primary emphasis will be on determining the effectiveness of the intervention to achieve desired health outcomes while also systematically collecting data on its implementation within RCFs that will inform implementation strategy refinement. Main components of MIDAS include: (1) Education about diabetes and lifestyle, (2) Dietary intervention at the facility and resident level, (3) Increased physical activity, and (4) Smoking cessation / reduction. The investigators will employ a modified cluster-randomized stepped wedge and adaptive trial design involving 210 residents with SMI and 120 staff members from 12 RCFs. The RCFs will be divided randomly into four cohorts of three RCFs each. Each cohort will be tested over a 15-month period that includes three phases: a three-month initial control phase (no intervention, from baseline month 0 to end of month 3), a six-month intervention phase (months 4 through 9), and a six-month follow-up phase (no intervention, months 10 through 15). All the study participants will be assessed quarterly during the 15-month period. Our investigators will train RCF staff (especially the Activity Director and cook) to increase physical activity and reduce smoking, and to implement healthful dietary modifications among the residents, using evidence-based interventions. During the intervention phase, the RCF Activity Director will conduct twice-weekly manualized group sessions on education about diabetes, nutrition, exercise, and smoking cessation/reduction, to deliver a multi-component group intervention. We will also explore if there are improvements in blood-based research biomarkers of insulin resistance and inflammation in the RCF residents with SMI. This project is responsive to RFA-MH-17-608, and related to NIMH Strategic Objective #3.3B: testing interventions for effectiveness in community practice settings. If successful, MIDAS will be sustained and disseminated, and would lead to reduction in excess medical comorbidity and mortality associated with SMI.

• Study Type: Interventional
• Enrollment (Anticipated): 210
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Dilip V Jeste, MD; Phone Number: (858) 534-4020; Email: djeste@ucsd.edu
• Study Contact Backup: Name: Danielle K Glorioso, LCSW; Phone Number: (858) 246-0767; Email: dglorioso@ucsd.edu

Study Locations

• United States
  • California
    • La Jolla, California, United States, 92093
      • Recruiting
      • University of California, San Diego Division of Geriatric Psychiatry
      • Contact: Danielle K Glorioso, LCSW; Phone Number: 858-246-0767; Email: dglorioso@ucsd.edu
      • Contact: Cynthia Ibarra, MA; Phone Number: (858) 822-6005; Email: cyibarra@ucsd.edu
      • Principal Investigator: Dilip V Jeste, MD

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 65 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Participants: A total of 12 RCFs (30 to 45 beds each), 210 resident participants, and 120 staff members (1 manager, 2 activity directors, 1 cook, and 6 other staff members per facility) will be enrolled.

Inclusion and Exclusion Criteria:

Residential Care Facilities (RCFs):

Inclusion Criteria:

1. Licensed by California Division of Social Services' Community Care Licensing
2. Serves only individuals with SMI
3. Has >15 residents currently living in the facility
4. Willing to participate

Staff Participants:

Inclusion Criteria:

1. Age >21 years
2. Fluent in English
3. Written informed consent to participate

Exclusion Criteria:

(1) Plans to leave the RCF during the next year.

Resident Participants:

Inclusion Criteria:

1. Age 18 - 65 years
2. Chart diagnosis of an SMI, mainly schizophrenia, schizoaffective disorder, or bipolar disorder
3. Current treatment with antipsychotics
4. Fluent in English
5. Written informed consent to participate in this study

Exclusion Criteria:

1. Chart diagnosis of dementia or intellectual disability disorder
2. Active substance abuse (non-tobacco)
3. Medical problems that interfere with ability to complete assessments and intervention

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Sequential Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
No Intervention: Control Phase; 3-month initial control phase (no intervention, month 1-3)
Experimental: Intervention Phase; 6-month intervention phase - MIDAS Intervention Delivered. Followed by 6-month follow-up phase (no intervention, months 10-15).	Behavioral: Multi-component Intervention for Diabetes in Adults with Serious Mental Illness; Main components of MIDAS include: (1) Education about diabetes and lifestyle, (2) Dietary intervention at the facility and resident level, (3) Increased physical activity, and (4) Smoking cessation / reduction.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Body Mass Index (BMI in kg/m^2)	Change in Body Mass Index	Baseline to 9 months and sustained at 15 months
Waist Circumference	Change in Waist Circumference	Baseline to 9 months and sustained at 15 months
Fasting Glucose	Change in Fasting Glucose	Baseline to 9 months and sustained at 15 months
Hemoglobin A1c or HbA1c	Change in Hemoglobin A1c or HbA1c	Baseline to 9 months and sustained at 15 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Diet/Nutrition - Plasma Carotenoid Levels	Plasma Carotenoid levels reflect changing dietary vegetable and fruit intake.Nutrition Data Systems for REsearch (NDS-R) Protocol	Baseline to 9 months and sustained at 15 months
Diet/Nutrition - Serum Lipid Levels	Plasma Carotenoid levels reflect changing dietary vegetable and fruit intake.	Baseline to 9 months and sustained at 15 months
Objective Measure of Physical Activity	For 7 days during each assessment period, participants will wear the GT3X+ Actigraph, which measures movement and intensity of activity, and has good validation with VO2max. It provides estimates of activity by seconds, that can be categorized into minutes spent in sedentary, light, moderate, and vigorous activity using calibration thresholds.	Baseline to 9 months and sustained at 15 months
Smoking - Expired Breath Carbon Monoxide (CO) Levels	Change in Smoking - Objective Measure of Cigarette Use: Expired Breath Carbon Monoxide (CO) level (parts per million) is measured with a handheld device. CO monitoring is used primarily as a check on recent smoking, though it has also been used to indicate reductions in smoking.	Baseline to 9 months and sustained at 15 months
Smoking - Change in Smoking through Recall	Change in Smoking - Quantity and frequency of cigarette use for the prior week using a timeline followback procedure. Smoking reduction calculated by % change in average cigarettes/day across assessments.	Baseline to 9 months and sustained at 15 months

Collaborators and Investigators

• Sponsor: University of California, San Diego

Study record dates

Study Major Dates

• Study Start (Actual): December 28, 2018
• Primary Completion (Anticipated): May 31, 2022
• Study Completion (Anticipated): May 31, 2022

Study Registration Dates

• First Submitted: July 5, 2018
• First Submitted That Met QC Criteria: August 9, 2018
• First Posted (Actual): August 13, 2018

Study Record Updates

• Last Update Posted (Actual): September 17, 2021
• Last Update Submitted That Met QC Criteria: September 15, 2021
• Last Verified: September 1, 2021

More Information

Terms related to this study

• Keywords: Diabetes; Schizophrenia; Obesity; Serious mental illness; Lifestyle Risk Reduction
• Additional Relevant MeSH Terms: Glucose Metabolism Disorders; Metabolic Diseases; Endocrine System Diseases; Schizophrenia Spectrum and Other Psychotic Disorders; Diabetes Mellitus; Schizophrenia; Mental Disorders
• Other Study ID Numbers: MH15127

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No