Linking education, produce provision, and community referrals to improve diabetes care (LINK)

将教育、农产品供应和社区转诊联系起来，以改善糖尿病护理 (LINK)

• 批准号: 10420768
• 负责人: Joshua J Joseph
• 金额: $ 66.35万
• 依托单位: OHIO STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-04-01 至 2027-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10420768
• 关键词: Academic Medical Centers; Address; Adult; Caring; Clinic; Clinical Research; Communities; Community Health Aides; Community Health Education; Control Groups; Cost Analysis; Data; Diabetes Mellitus; Dose; Education; Educational Background; Educational Intervention; Effectiveness; Employment; Evaluation; Face; Focus Groups; Food; Food Access; Glucose; Glycosylated hemoglobin A; Group Interviews; Health; Health system; Healthcare; Healthcare Systems; Housing; Incidence; Individual; Intervention; Link; Medical center; Methods; National Health and Nutrition Examination Survey; National Institute of Diabetes and Digestive and Kidney Diseases; Non-Insulin-Dependent Diabetes Mellitus; Occupations; Ohio; Outcome; Participant; Pathway interactions; Patients; Pattern; Persons; Population; Prevalence; Protocols documentation; Provider; Randomized; Randomized Controlled Trials; Schedule; Secure; Testing; Transportation; Universities; Wait Time; Work; base; blood glucose regulation; combat; community engaged research; contextual factors; cooking; cost effectiveness; cost-effectiveness ratio; design; diabetes control; diabetes education; diabetes self-management; ethnic diversity; ethnic minority population; experience; food insecurity; food resource; glycemic control; health equity; healthcare community; housing instability; improved; incremental cost-effectiveness; innovation; interest; long-term sequelae; low socioeconomic status; member; microcosting; mortality; peer; process evaluation; programs; racial and ethnic; racial population; response; screening; social; social stigma; success; uptake

Project Summary The combined impacts of type 2 diabetes mellitus (T2D) and food insecurity can be devastating. According to recent NHANES data, 19% of adults with T2D are food-insecure, and T2D prevalence is higher among those with food insecurity. Individuals with T2D and food insecurity have worse diabetes self-management and glycemic control compared to food-secure peers. While addressing food insecurity is important in T2D care, individuals with food insecurity may also have other non-medical, health-related social needs (e.g., transportation barriers, housing instability, job insecurity) that may decrease their ability to attain glucose targets and impact other diabetes-related health outcomes. Partnerships between healthcare systems and community-based organizations have emerged as a promising approach to improve diabetes control in food- insecure populations. Given the design limitations of prior studies, there remains a critical need for randomized controlled trials (RCTs) to test the combined impact of diabetes education, food provision, and addressing unmet social needs on glycemic control in people with T2D experiencing food insecurity. Leveraging existing programs and relationships, we propose to test the combined effects of a food referral program, social needs screening and referral, and diabetes education intervention on hemoglobin A1c in a population of racially/ethnically diverse participants with food insecurity and T2D with A1c ≥7.5% identified at OSUWMC. We plan to use a community-engaged research approach with community members and stakeholders informing the design and focus of the interventions. Aim 1: Using a pragmatic randomized controlled trial (pRCT), to test the effect of produce provision, diabetes education, and community referrals on A1c levels in individuals with T2D experiencing food insecurity. Aim 2: To assess the cost-effectiveness of each of the interventions that comprise the pRCT. Aim 3: To utilize a process evaluation to understand the contextual factors that impact the uptake, effectiveness, and sustainability of the interventions. Impact: Our proposed study aligns with the NIDDK’s interest in clinical studies addressing T2D treatment, complications, and health equity, as our project directly examines health system-based approaches to address non-medical, health-related social needs to improve health outcomes. Innovative solutions are warranted to combat the long-term sequelae of uncontrolled T2D combined with food insecurity that contribute to the two-fold higher all-cause mortality in T2D that disproportionality impacts lower socio-economic status and racial/ethnic minority populations. Food insecurity, unmet social needs, and diabetes education are critical issues that must be addressed to improve T2D treatment, care, and equity. Our study will provide essential evidence that will support both scalable and sustainable partnerships to address these conditions.

项目摘要 2型糖尿病（T2 D）和粮食不安全的综合影响可能是毁灭性的。根据 最近的NHANES数据显示，19%的T2 D成年人食物不安全，T2 D患病率在这些人中较高， 粮食不安全。患有T2 D和食物不安全的个体的糖尿病自我管理较差， 血糖控制与食物安全的同龄人相比。虽然解决粮食不安全问题在T2 D护理中很重要， 粮食不安全的个人也可能有其他非医疗、健康相关的社会需求（例如， 交通障碍、住房不稳定、工作不安全），可能会降低他们获得葡萄糖的能力 目标和影响其他糖尿病相关的健康结果。医疗保健系统之间的伙伴关系， 以社区为基础的组织已经成为改善食品中糖尿病控制的一种有前途的方法， 不安全的人口。鉴于先前研究的设计局限性，仍然迫切需要随机化 对照试验（RCT），以测试糖尿病教育，食品供应和解决的综合影响， 在食物不安全的T2 D患者中，血糖控制的社会需求未得到满足。利用现有 计划和关系，我们建议测试食品转介计划，社会需求， 糖尿病筛查和转诊以及糖尿病教育干预对血红蛋白A1 c的影响 在OSUWMC确定的食物不安全和A1 c ≥7.5%的T2 D的种族/民族多样化参与者。我们 计划使用社区参与的研究方法，让社区成员和利益相关者提供信息 干预措施的设计和重点。目的1：使用实用的随机对照试验（pRCT），以检验 生产供应，糖尿病教育和社区转诊对患有糖尿病的个人A1 c水平的影响 T2 D面临粮食不安全问题。目标2：评估每项干预措施的成本效益， 包括pRCT。目标3：利用过程评价来了解影响过程的背景因素。 干预措施的采用、有效性和可持续性。影响：我们提出的研究符合 NIDDK对T2 D治疗、并发症和健康公平性的临床研究感兴趣， 直接审查基于卫生系统的方法，以解决非医疗、与健康相关的社会需求， 改善健康成果。有必要采取创新的解决办法，以消除不受控制的 2型糖尿病加上粮食不安全，导致2型糖尿病的全因死亡率高出两倍， 种族主义影响较低的社会经济地位和种族/少数民族人口。粮食不安全， 未满足的社会需求和糖尿病教育是改善2型糖尿病必须解决的关键问题 治疗、护理和公平。我们的研究将提供必要的证据，支持可扩展性和 建立可持续的伙伴关系，以解决这些问题。