Impact of Disparities in Food Security on Glycemic Control and Health Care Utilization Among Youth and Young Adults with Diabetes

粮食安全差异对青少年糖尿病患者的血糖控制和医疗保健利用的影响

• 批准号: 10512079
• 负责人: ANGELA D LIESE
• 金额: $ 1.77万
• 依托单位: UNIVERSITY OF SOUTH CAROLINA AT COLUMBIA
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-04-01 至 2023-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10512079
• 关键词: Acute; Address; Affect; Ancillary Study; Behavior; Behavioral; Biometry; Buffers; Caring; Centers for Disease Control and Prevention (U.S.); Child; Childhood; Chronic; Cohort Studies; Cost efficiency; Cross-Sectional Studies; Data; Data Collection; Data Security; Diabetes Mellitus; Diabetic Diet; Diabetic Ketoacidosis; Diagnosis; Disadvantaged; Disadvantaged minority; Elderly; Endocrinology; Epidemiology; Ethnic Origin; Food; Frequencies; Funding; Future; Glycosylated hemoglobin A; Goals; Health; Health Care Costs; Health behavior; High Prevalence; Hispanic; Hospitalization; Household; Hypoglycemia; Individual; Insulin-Dependent Diabetes Mellitus; Intervention; Lead; Light; Longitudinal Studies; Mediating; Medical; Medicine; Mental Health; Minority; Modeling; Monitor; Morbidity - disease rate; National Institute of Diabetes and Digestive and Kidney Diseases; Non-Insulin-Dependent Diabetes Mellitus; Not Hispanic or Latino; Nutrition Therapy; Nutritional; Nutritive Value; Outcome; Pathway interactions; Patient Self-Report; Patients; Persons; Pharmaceutical Preparations; Physical activity; Policies; Population; Population Heterogeneity; Premature Mortality; Prevention; Psychology; Race; Recommendation; Research; Resources; Risk; Role; SEARCH for Diabetes in Youth; Self Management; Site; Time; United States Centers for Medicare and Medicaid Services; United States National Institutes of Health; Work; Youth; adverse outcome; aged; clinical practice; clinically relevant; cost; design; diabetes management; ethnic diversity; ethnic minority; experience; food insecurity; food security; glucose monitor; glycemic control; health care service utilization; health economics; minority children; non-diabetic; physical conditioning; prevent; prospective; racial and ethnic; routine care; screening; social health determinants; type I and type II diabetes; virtual; young adult

PROJECT SUMMARY / ABSTRACT Despite recent advances in therapy, far too many youth and young adults (YYAs) with type 1 diabetes (T1D) and type 2 diabetes (T2D), particularly those of minority race/ethnicity, do not achieve optimal glycemic control thus placing them at increased risk of acute and chronic complications. Among the social determinants of health, household food insecurity (HFI) may be a key barrier to achieving glycemic control and may lead to increased health care utilization and costs, but virtually all of the limited research was cross-sectional and conducted in older adults with T2D. Moreover, racial/ethnic minorities are disproportionately affected by HFI, which may underlie similar disparities in diabetes outcomes. Our preliminary work suggests that HFI is a common phenomenon in YYAs with diabetes, affecting 19% of YYAs with T1D and 38% of those with T2D. These rates significantly exceed the 2015 national estimate of 12.7%. We propose a longitudinal study, the SEARCH Food Security (SFS) cohort study, which is designed as an ancillary study to the ongoing CDC/DDT- and NIH/NIDDK-funded SEARCH for Diabetes in Youth 4 study, a racially/ethnically diverse study of diabetes diagnosed in youth. The aims of the SFS study are to: (1) Initiate a food insecurity cohort study of 1,187 YYAs aged 15-35 years (53% minority) with T1D and T2D by adding two data collection time points to the ongoing SEARCH 4 study; (2) Prospectively evaluate the influence of HFI on changes in glycemic control in YYAs with T1D and T2D; (3) Quantify the mediating role of nutritional, mental health, and behavioral pathways through which food insecurity may affect changes in glycemic control in YYAs with T1D and T2D; and (4) Prospectively evaluate the influence of HFI on changes in health care utilization and medical and non-medical health care costs in YYAs with T1D and T2D. Using the SFS data in tandem with extensive data collected by SEARCH will be highly efficient for addressing these aims. The proposed study will be the first cohort study to examine the impact of food insecurity on glycemic control, health care utilization, and costs among a diverse population of US YYAs with T1D and T2D. Our transdisciplinary team is led by Drs. Liese and Mendoza, recognized experts in diabetes, epidemiology, pediatric medicine, disparities, and food insecurity research, and is supported by a team comprising expertise in pediatric endocrinology, psychology, health behaviors, health economics, biostatistics, and causal inference modeling. The study has the potential to alter diabetes policy and clinical practice by establishing the need for more in-depth assessments of food insecurity among YYAs with diabetes, re-assessment of diabetes management and nutrition recommendations for food-insecure patients, and integration of food assistance resources into routine care for persons with diabetes. It will also inform the tailoring of interventions to address food insecurity, especially for minorities, in future diabetes research trials.

项目总结/摘要 尽管最近在治疗方面取得了进展，但太多的1型糖尿病（T1 D）青年和年轻人（YYAs） 和2型糖尿病（T2 D），特别是少数种族/民族的糖尿病患者， 从而使他们患急性和慢性并发症的风险增加。在社会决定因素中， 健康，家庭粮食不安全（HFI）可能是实现血糖控制的关键障碍，并可能导致 增加了医疗保健的利用率和成本，但几乎所有有限的研究都是横断面的， 在患有T2 D的老年人中进行。此外，种族/族裔少数群体受到HFI的影响不成比例， 这可能是糖尿病结局相似差异的基础。我们的初步工作表明，HFI是一个 在患有糖尿病的YYAs中，这是一种常见现象，影响了19%的T1 D YYAs和38%的T2 D YAs。 这些比率大大超过了2015年全国估计的12.7%。我们建议进行纵向研究， * 粮食安全群组研究，旨在作为正在进行的疾病控制和预防中心/滴滴涕的辅助研究， 和NIH/NIDDK资助的青少年糖尿病研究4，一项种族/民族多样化的糖尿病研究 年轻时诊断。SFS研究的目的是：（1）启动对1 187个青年人的粮食不安全队列研究 年龄15-35岁（53%少数民族）的T1 D和T2 D患者，在正在进行的数据收集中增加两个时间点 （2）Profectin评估HFI对YYAs患者血糖控制变化的影响， T1 D和T2 D;（3）通过以下途径量化营养、心理健康和行为途径的介导作用： 哪些食物不安全可能影响T1 D和T2 D的YYAs患者血糖控制的变化;以及（4）Proximal 评估HFI对卫生保健利用以及医疗和非医疗卫生保健变化的影响 T1 D和T2 D的YYAs成本。将SFS数据与由WARDELL收集的大量数据结合使用 高效地实现这些目标。这项拟议的研究将是第一项研究 粮食不安全对血糖控制、卫生保健利用和费用的影响， T1 D和T2 D的美国YYAs。我们的跨学科团队由公认的专家Liese博士和门多萨博士领导 在糖尿病，流行病学，儿科医学，差距，和粮食不安全的研究，并支持一个 由儿科内分泌学、心理学、健康行为学、卫生经济学、 生物统计学和因果推理建模。这项研究有可能改变糖尿病政策和临床 通过建立对患有糖尿病的YYAs的粮食不安全进行更深入评估的必要性， 重新评估糖尿病管理和食物不安全患者的营养建议，以及 将粮食援助资源纳入糖尿病患者的日常护理中。它还将通知 在今后的糖尿病研究试验中，调整干预措施，以解决粮食不安全问题，特别是对少数群体而言。