The ADELANTE Trial: Testing a multi-level approach for improving household food insecurity and glycemic control among Latinos with diabetes

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Latinx communities bear a disproportionate burden of type 2 diabetes (T2DM). Unfortunately, accompanying this higher T2DM prevalence is a high prevalence of food insecurity that is roughly double that of their non- Latinx White counterparts. In the United States, 1 in 5 adolescents has prediabetes, a high-risk state for the development of diabetes. The prevalence of T2DM among adolescents is projected to more than double by 2060, with a substantial widening of racial and ethnic disparities. This makes diabetes prevention among racial/ethnic minority adolescents at risk for diabetes critical. The parent grant (R01MD016738) aims to determine whether a multi-level intervention to improve household food insecurity and glycemic control is effective for Latinx patients with diabetes. Latinx adults with food insecurity, T2DM, and overweight/obesity will be randomized to either: 1) 12 weeks of household deliveries of fiber-rich foods plus a 12-month culturally- adapted lifestyle behavioral intervention, or 2) a waitlist control arm, receiving the food deliveries after a 6- month delay. As part of the household approach, the parent study will recruit up to 2 household members (e.g., adult and adolescent) for each index participant to assess food insecurity, diet, and psychosocial outcomes among household members. Leveraging the adolescents recruited from the trial, the primary objective of this diversity supplement is to examine diabetes-related risk factors and risk perceptions among Latinx adolescents living in food insecure households with an adult with T2DM. The career development plan for this diversity supplement will provide the candidate with high-quality mentorship from experts in T2DM prevention, food insecurity, Latinx health, and adolescent health disparities. Aligned with this plan and using the R01 parent grant’s adolescent cohort, the research goals of the proposed diversity supplement are to: 1) assess diabetes risk (actual and perceived) and factors associated with increased diabetes risk among Latinx adolescents living in food-insecure households with an adult with T2DM and 2) explore diabetes risk perceptions, experiences with food insecurity, and engagement in health promotion activities among Latinx adolescents living in food-insecure households with an adult with T2DM using qualitative interviews. The outcomes of this study will greatly add to our understanding of the factors that affect diabetes risk and risk perception among Latinx adolescents living in food insecure households who may be at high risk for future development of diabetes and inform the development of an intervention to reduce diabetes risk among adolescents living in households with food insecurity. The mentorship, career development and scientific skills gained during this diversity supplement will advance the candidate towards independence investigating health- related social needs and strategies for addressing these needs and communicating diabetes risk information to racially and ethnically diverse patients across the life course.