Diabetes disparities in Latino subpopulations: linking biology to social epidemiology

摘要 NIDDK指导研究科学家发展奖（K 01）申请的总体目标是 提供候选人，桑德拉Albrecht，博士，公共卫生硕士，与不可或缺的培训和保护的时间来建立一个 在生物医学和社会生态学的接口独立，跨学科的研究计划 领域，以提供更完整的理解的因素，潜在的进展和从2型 糖尿病（T2 D）在拉丁美洲亚群。应对2型糖尿病和低血糖的惊人负担 控制在美国拉丁美洲人，以未回答的问题，有关变化的疾病风险和负担，在这一点上， 广泛的人口，并在这一领域的纵向研究的缺乏，研究的目的是1）表征 在非糖尿病拉丁裔种族亚组中，随着时间的推移，葡萄糖调节异常的模式，并评估 社会、环境和临床因素驱动变异;（2）表征T2 D进展模式 随着时间的推移，在糖尿病拉丁裔种族亚组，并评估社会，环境和临床的作用， 驱动这种变化的因素;（3）描述一个关键的社会决定因素-医疗保健的有效性 利用率-在特定拉丁裔亚群中成功进行T2 D管理，并评估其他 社会、环境和临床因素改变了有效性。目标1和2的数据将来自 一项大型的全国性纵向人群研究，对拉丁裔亚组进行了过采样：西班牙裔 社区健康研究/拉丁美洲人的研究。目标3的数据将来自一个电子健康记录数据， 北卡罗来纳州的大型医疗保健系统，拉丁裔人口快速增长的地区。作为这一目标的一部分， 将招募拉丁裔糖尿病受试者进行一项试点研究，评估自我报告的实现控制的障碍。 作为将社会因素纳入T2 D临床管理的长期努力的一部分。以匹配 建议的科学工作的范围，候选人将寻求将她的专业知识融入社会 肥胖和糖尿病流行病学与以下职业发展和培训领域：1）培训 葡萄糖调节异常的生理学; 2）了解与T2 D预防相关的临床问题， 治疗;和3）使用电子健康记录数据和健康信息学。这种培训将得到加强 通过职业建设活动，获得领导力和专业成长的基本工具，以及 传播和翻译调查结果。专家们强调，需要一个更完整的 了解亚组特异性T2 D生理学和亚组特异性风险因素 T2 D的进展和T2 D的进展。该K 01项目将通过改善T2 D的特征来影响公共卫生 拉丁裔亚群的结果，为量身定制的预防和治疗策略提供信息。该项目建立 凭借候选人所在院校（北卡罗来纳州查珀尔大学）的特殊资源和指导 希尔），在关键的新领域对她进行培训，支持竞争性资金的申请， 研究人员和更广泛的社区，增加教师的多样性，并实现研究的独立性。

Abstract The overall goal for this application for an NIDDK Mentored Research Scientist Development Award (K01) is to provide the candidate, Sandra Albrecht, PhD, MPH, with indispensable training and protected time to build an independent, transdisciplinary research program at the interface of the biomedical and socio-ecological domains to provide a more complete understanding of the factors underlying progression to and from type 2 diabetes (T2D) in Latino subpopulations. Responding to the staggering burden of T2D and poor glucose control in U.S. Latinos, to unanswered questions regarding variation in disease risk and burden within this broad population, and to the dearth of longitudinal studies in this area, the research aims are to 1) Characterize patterns of glucose dysregulation over time in non-diabetic Latino ethnic subgroups, and evaluate the role of social, environmental, and clinical factors in driving that variation; (2) Characterize patterns of T2D progression over time in diabetic Latino ethnic subgroups, and evaluate the role of social, environmental, and clinical factors in driving that variation; and (3) Characterize the effectiveness of a key social determinant – healthcare utilization - for successful T2D management within a specific Latino subpopulation, and evaluate how other social, environmental, and clinical factors modify that effectiveness. Data for Aims 1 and 2 will come from a large national longitudinal population-based study with oversamples of Latino subgroups: the Hispanic Community Health Study/Study of Latinos. Data for Aim 3 will come from electronic health record data from a large healthcare system in North Carolina, a region with a fast growing Latino population. As part of this aim, Latino diabetic subjects will be recruited for a pilot study evaluating self-reported barriers to achieving control of glucose as part of a long-term effort to integrate social factors into the clinical management of T2D. To match the scope of the proposed scientific work, the candidate will seek to integrate her expertise in the social epidemiology of obesity and diabetes with the following career development and training areas: 1) training in the physiology of glucose dysregulation; 2) understanding of clinical issues relevant to T2D prevention and treatment; and 3) use of electronic health records data and health informatics. This training will be augmented with career-building activities to acquire essential tools for leadership and professional growth, as well as dissemination and translation of findings. Experts have emphasized the need for a more complete understanding of subgroup-specific T2D physiology and of subgroup-specific risk factors underlying progression to and from T2D. This K01 project will impact public health by improving characterization of T2D outcomes in Latino subpopulations to inform tailored prevention and treatment strategies. The project builds upon exceptional resources and mentoring at the candidate's institution (University of North Carolina at Chapel Hill), to train her in key new areas, bolster applications for competitive funding, disseminate findings among researchers and the wider community, augment faculty diversity, and attain research independence.