Diabetes disparities in Latino subpopulations: linking biology to social epidemiology

摘要 申请NIDDK导师研究科学家发展奖(K01)的总体目标是 为候选人Sandra Albrecht博士和公共卫生硕士提供不可或缺的培训和受保护的时间，以建立 独立的、跨学科的生物医学和社会生态学研究项目 域，以便更完整地理解与类型2相互转化的因素 拉丁裔亚群中的糖尿病(T2D)。应对T2D和低血糖的惊人负担 美国拉丁裔的控制，关于疾病风险和负担的变化的悬而未决的问题 广泛的人群，由于这一领域缺乏纵向研究，研究目的是1)表征 非糖尿病拉丁裔亚群中随时间变化的血糖失调模式，并评估 推动这种变异的社会、环境和临床因素；(2)描述T2D进展的模式 随着时间的推移，糖尿病拉丁裔亚群，并评估社会、环境和临床的作用 驱动这种变化的因素；以及(3)表征关键社会决定因素--医疗保健的有效性 利用率-在特定的拉丁裔群体中实现成功的T2D管理，并评估其他 社会、环境和临床因素改变了这一效果。目标1和目标2的数据将来自 对拉美裔亚群进行过抽样的大型全国性纵向人口研究：拉美裔 社区健康研究/拉丁裔研究。AIM 3的数据将来自来自 北卡罗来纳州的大型医疗系统，这是一个拉丁裔人口快速增长的地区。作为这一目标的一部分， 拉丁裔糖尿病受试者将被招募进行一项试点研究，评估自我报告的实现控制糖尿病的障碍 作为将社会因素整合到T2D临床管理中的长期努力的一部分。匹配 在拟议的科学工作范围内，候选人将寻求将她的专业知识整合到社会 肥胖症和糖尿病流行病学与以下职业发展和培训领域：1)培训 血糖失调的生理学；2)了解与T2D预防和治疗相关的临床问题 治疗；以及3)使用电子健康记录数据和健康信息学。这一培训将得到加强 开展职业生涯建设活动，以获得领导能力和专业成长的必要工具，以及 传播和翻译调查结果。专家们强调，有必要建立一个更完整的 了解亚组特有的T2D生理学和亚组特有的危险因素 往返于T2D的进展。这个K01项目将通过改善T2D的特性来影响公众健康 在拉丁裔亚群中的结果，以提供量身定制的预防和治疗战略。该项目将构建 基于候选人所在机构的特殊资源和指导(北卡罗来纳大学教堂分校 希尔)，在关键的新领域对她进行培训，支持竞争资金的申请，在 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.