Personal and social-built environmental factors of glucose variability among multi ethnic groups of adults with type 2 diabetes

多种族成人 2 型糖尿病患者血糖变异性的个人和社会环境因素

• 批准号: 10838114
• 负责人: Soohyun Nam
• 金额: $ 54.27万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10838114
• 关键词: Address; Adult; Affect; Behavior; Behavior Therapy; Blinded; Blood Glucose; Blood flow; Cardiac; Cardiometabolic Disease; Cardiovascular Diseases; Caring; Censuses; Chronic Kidney Failure; Climate; Clinical; Complications of Diabetes Mellitus; Connecticut; Continuous Glucose Monitor; Country; Data; Data Aggregation; Data Collection; Decision Making; Dehydration; Development; Diabetes Mellitus; Diet; Dietary intake; Eating; Eating Behavior; Ecological momentary assessment; Environment; Environmental Risk Factor; Ethnic Population; Frequencies; Future; Gluconeogenesis; Glucose; Glycosylated Hemoglobin; Glycosylated hemoglobin A; Goals; Green space; Health; Heat Waves; High temperature of physical object; Home heating; Hospitalization; Hour; Hyperglycemia; Impairment; Incidence; Individual; Infarction; Insulin Resistance; Intervention; Life Style; Life Style Modification; Link; Liver; Longevity; Machine Learning; Measurement; Measures; Mediating; Modeling; Myocardial Ischemia; Non-Insulin-Dependent Diabetes Mellitus; North America; Nutrient; Osmolar Concentration; Outcome; Parents; Participant; Patient Education; Persons; Physical activity; Physiological; Plasma; Policies; Population; Public Health; Questionnaires; Research; Resolution; Risk; Role; Seasons; Skin; Sleep; Social support; Stroke; Surface; Sweating; Temperature; Time; Vasodilation; Vulnerable Populations; actigraphy; behavioral response; built environment; cardiometabolism; climate change; climate impact; climate zone; climate-related health; cold temperature; comorbidity; demographics; diabetes control; dietary; epidemiologic data; epidemiology study; food insecurity; glycemic control; health equity; health equity promotion; hepatic gluconeogenesis; improved; individual patient; insight; lifestyle data; lifestyle factors; macrovascular disease; meteorological data; mortality; mortality risk; multi-ethnic; novel; randomized trial; regional difference; research study; response; risk prediction; sensor; social; social cohesion; social health determinants; spatiotemporal; time interval; vulnerable community; weather stations

Project Summary Extreme ambient temperature (Ta), which is becoming more common due to climate change, has been associated with the increased incidence of cardiometabolic disease and mortality. Dehydration induced by high Ta stimulates gluconeogenesis in the liver and promotes insulin resistance. Increased blood flow to the skin during heatwaves increases cardiac demand, resulting in cardiac ischemia, infarction, and stroke in individuals with pre-existing cardiovascular disease (CVD). Thus, individuals with diabetes are particularly vulnerable to heat waves due to impaired physiological responses to heat and CVD comorbidities. Glucose variability (GV), measured by continuous glucose monitoring (CGM), is fluctuations in blood glucose levels over a given interval of time (intra-day or inter-day) and is an important emerging parameter of dynamic glycemic control. Glycated hemoglobin (HbA1c), a marker of the average blood glucose levels over the previous 2 to 3 months, is the primary metric used to predict diabetic complications. However, in-depth analyses from large scale, randomized trials, and epidemiological studies have indicated that HbA1c alone may not sufficiently predict the risk of diabetes complications. To date, climate change and health (CCH) research has been done at the population- level with aggregated data and HbA1c levels. Although the previous studies provided valuable insight into climate change and diabetes care, the mean HbA1c level at the population level with aggregated data in different climate zones makes it difficult to understand the real impact of Ta on individual patients. There is an urgent need to address gaps in CCH research studying lifestyle behavioral responses to Ta under climate change, social-built environment, and diabetes outcomes with high spatiotemporal granularity. We will collect time-stamped lifestyle data using ecological momentary assessment (EMA) and actigraphy and perform 24-hour dietary recalls. CGM, a real-time, unobtrusive glucose measure will be blinded from participants during the 14-day observation period. We will collect hourly and daily Ta from weather stations, daily Ta estimates from the Daily Surface Weather Data on a 1-km Grid for North America, and develop a high resolution (1 km2) spatiotemporally resolved hourly Ta model in Connecticut using satellite data with a machine learning approach. Participants will also be asked to wear a personal Ta sensor. Leveraging data in GV and multi-level personal (demographic, comorbidities), lifestyle, and social-built environmental factors that our parent study provides, and linking them to Ta data, we propose the following specific aims: (1) identify the risk groups who are vulnerable to high or low Ta by examining demographics, comorbidities, lifestyle (physical activity, sleep, eating behaviors/diet), social-built environment and GV among multi-ethnic adults with T2D for 14 days each in 2 seasons, (2) examine the influence of Ta on time-varying lifestyle factors and GV, within-person across 14 days using the hourly Ta estimates at 1 km2 special resolution to inform future personalized behavioral interventions, and (3) evaluate the feasibility and utility of the wearable Ta sensor and compare the data with the model developed hourly Ta and observed hourly Ta data.

项目摘要 由于气候变化而变得越来越普遍的极端环境温度(Ta)一直是 与心脏代谢性疾病发病率和死亡率增加有关。高密度脂蛋白引起的脱水 TA刺激肝脏中的糖异生，促进胰岛素抵抗。增加皮肤的血流量 在热浪期间，心脏需求增加，导致个人心肌缺血、梗塞和中风。 患有先前存在的心血管疾病(CVD)。因此，糖尿病患者特别容易患上 热浪是由于对热和心血管疾病并存的生理反应受损所致。葡萄糖变异性(GV)， 由连续血糖监测(Cgm)测量的是给定时间间隔内血糖水平的波动。 这是动态血糖控制的一个重要的新兴参数。糖化 血红蛋白(HbA1c)是过去2至3个月平均血糖水平的标志，是 用于预测糖尿病并发症的主要指标。然而，从大范围、随机化的深入分析 试验和流行病学研究表明，仅有HbA1c可能不足以预测糖尿病的风险。 糖尿病并发症。到目前为止，气候变化与健康(CCH)研究已经在人群中进行- 具有聚集数据和HbA1c水平的水平。尽管之前的研究提供了对气候的宝贵见解 变化和糖尿病护理，人口水平的平均HbA1c水平，以及不同气候下的汇总数据 这些区域使人们很难理解TA对个别患者的真正影响。有迫切的需要 解决CCH研究在气候变化下生活方式对TA的行为反应方面的差距，社会构建 具有高时空粒度的环境和糖尿病后果。我们将收集带有时间印记的生活方式 使用生态瞬时评估(EMA)和活动描记的数据，并执行24小时饮食召回。CGM， 在14天的观察期内，参与者将无法进行实时、不显眼的血糖测量。 我们将从气象站收集每小时和每天的Ta，从每日地面天气数据收集每日Ta估计 在北美的1公里网格上，开发一个高分辨率(1平方公里)的时空分辨率每小时标记 在康涅狄格州使用卫星数据和机器学习方法的模型。参与者还将被要求 佩戴个人Ta传感器。利用GV和多层次个人(人口统计、并存)的数据， 生活方式，以及我们父母研究提供的社会环境因素，并将它们与Ta数据联系起来，我们 提出以下具体目标：(1)通过调查确定易受高或低Ta影响的风险群体 人口统计、合并症、生活方式(体力活动、睡眠、饮食行为/饮食)、社会营造的环境 和GV在两个季节每14天T2D的多民族成人中，(2)检查Ta对 时变的生活方式因素和14天内的GV，使用1平方公里的每小时Ta估计 为未来的个性化行为干预提供信息的解决方案，以及(3)评估 可穿戴的Ta传感器，并将数据与模型进行比较，制定了每小时Ta和观察每小时Ta的数据。