Diabetes disparities in Latino subpopulations: linking biology to social epidemiology

摘要 申请 NIDDK 指导研究科学家发展奖 (K01) 的总体目标是 为候选人 Sandra Albrecht（博士、公共卫生硕士）提供不可或缺的培训和受保护的时间，以建立一个 生物医学和社会生态学交叉领域的独立、跨学科研究项目 领域，以更全面地了解 2 型进展和转变的潜在因素 拉丁裔亚人群中的糖尿病（T2D）。应对 T2D 和血糖不良的巨大负担 美国拉丁美洲人的控制，以解决有关该地区疾病风险和负担变化的未解答的问题 广泛的人群，并且由于缺乏该领域的纵向研究，研究目标是 1) 表征 非糖尿病拉丁裔亚群随时间的葡萄糖失调模式，并评估 推动这种变化的社会、环境和临床因素； (2) 表征 T2D 进展模式 随着时间的推移，在患有糖尿病的拉丁裔亚群中进行研究，并评估社会、环境和临床的作用 导致这种变化的因素； (3) 描述关键社会决定因素——医疗保健的有效性 利用 - 在特定的拉丁裔亚群中成功进行 T2D 管理，并评估其他人如何 社会、环境和临床因素会改变其有效性。目标 1 和 2 的数据将来自 以人口为基础的大型全国纵向研究，对拉丁裔亚群体进行了超样本研究：西班牙裔 社区健康研究/拉丁裔研究。 Aim 3 的数据将来自电子健康记录数据 北卡罗来纳州拥有庞大的医疗保健系统，该地区是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，评估自我报告的控制糖尿病的障碍 葡萄糖作为将社会因素纳入 T2D 临床管理的长期努力的一部分。匹配 在拟议的科学工作的范围内，候选人将寻求将她的专业知识融入社会领域 肥胖和糖尿病的流行病学，具有以下职业发展和培训领域：1）培训 葡萄糖失调的生理学； 2) 了解与 T2D 预防相关的临床问题 治疗； 3) 使用电子健康记录数据和健康信息学。此次培训将进一步加强 通过职业建设活动获得领导力和职业发展的重要工具，以及 调查结果的传播和翻译。专家强调需要制定更完整的 了解亚组特异性 T2D 生理学和亚组特异性潜在危险因素 T2D 的进展和进展。该 K01 项目将通过改善 T2D 的特征来影响公众健康 拉丁裔亚人群的结果，为量身定制的预防和治疗策略提供信息。项目构建 凭借候选人所在机构（北卡罗来纳大学教堂分校）的卓越资源和指导 Hill），对她进行关键新领域的培训，支持竞争性资金的申请，在 研究人员和更广泛的社区，增强教师的多样性，并获得研究独立性。

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.