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

拉丁裔社区承担着不成比例的2型糖尿病（T2 DM）负担。不幸的是， 这种较高的T2 DM患病率是粮食不安全的高患病率，大约是非糖尿病患者的两倍。 拉丁裔白色对应。在美国，五分之一的青少年患有前驱糖尿病，这是糖尿病的高风险状态。 糖尿病的发展。青少年中T2 DM的患病率预计将增加一倍以上， 2060年，种族和民族差距大幅扩大。这使得糖尿病的预防成为 有患糖尿病危险的种族/少数民族青少年。父母补助金（R 01 MD 016738）旨在 确定改善家庭粮食不安全和血糖控制的多层次干预是否 对拉丁裔糖尿病患者有效。患有食物不安全、T2 DM和超重/肥胖的拉丁裔成年人将 被随机分配到：1）12周的富含纤维的食物的家庭分娩加上12个月的文化- 适应的生活方式行为干预，或2）候补对照组，在6- 延迟一个月作为家庭方法的一部分，父母研究将招募最多2名家庭成员 (e.g.,成人和青少年），以评估粮食不安全，饮食和心理社会 家庭成员的结果。利用从试验中招募的青少年， 这一多样性补充的目的是检查糖尿病相关的风险因素和风险认知， 生活在粮食不安全家庭中的拉丁裔青少年与患有T2 DM的成年人。职业发展计划 这种多样性补充将为候选人提供T2 DM专家的高质量指导 预防、粮食不安全、拉丁裔健康和青少年健康差距。与此计划保持一致，并使用 R 01父母补助金的青少年队列，拟议的多样性补充的研究目标是：1） 评估糖尿病风险（实际和感知）以及与拉丁裔糖尿病风险增加相关的因素 与T2 DM成人生活在食物不安全家庭的青少年; 2）探索糖尿病风险 拉丁美洲人对粮食不安全的看法、经历和参与健康促进活动 青少年生活在粮食不安全的家庭与成人T2 DM使用定性访谈。的 这项研究的结果将大大增加我们对影响糖尿病风险和风险的因素的理解。 生活在粮食不安全家庭中的拉丁裔青少年的看法，他们未来可能面临高风险 糖尿病的发展，并告知干预措施的发展，以减少糖尿病的风险， 生活在粮食无保障家庭的青少年。导师制、职业发展和科学技能 在此期间获得的多样性补充将推动候选人走向独立调查健康- 相关的社会需求和满足这些需求的战略，并将糖尿病风险信息传达给 在整个生命过程中，种族和民族多样化的患者。

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.