Behavioral and Physiological Responses to Race-Related Stress in Diabetic Women

描述(由申请者提供)：非裔美国人(AA)女性携带不成比例的T2 DM及其一些并发症的负担。暴露在歧视中的压力可能会导致血压、血糖、胰岛素抵抗和自我护理行为的改变，从而增加并发症的风险。我们的目标是：1)建立一个原则证据，证明一生累计暴露于感知到的歧视与基础行为和生理因素有关，这些因素是导致患有T2 DM的AA女性并发症的基础；2)建立一个原则证据，证明终身累积暴露在感知到的歧视中，使个体对急性应激源的反应增强。3)探索终生累积暴露于可感知的歧视和压力反应性之间关系的候选修饰者；以及4)完善和扩展对这些变量的每日过程研究计划，以支持R01应用。40名患有2型糖尿病的AA女性和40名白人女性将参与其中。在第一天，参与者将进行24小时动态血压监测。在第二天，参与者将完成暴露于歧视、空腹血糖、胰岛素抵抗和血压的基线测量。然后，我们将让参与者在实验室进行公开演讲任务，以检测新陈代谢和心血管对急性应激源的反应。第三天，参与者将再次进行24小时动态血压监测。五个假设将被检验。HA1：种族因素会影响人们终身暴露在可感知到的歧视中。与白人女性相比，AA女性将报告更多的终身累积暴露于被感知的歧视。HA2：终生累积暴露于可感知的歧视会对静息血压、胰岛素抵抗和糖尿病自我照顾行为产生影响。终生受歧视的累积程度越高，静息血压越高，胰岛素抵抗越强，糖尿病自我护理行为越少。HA3：应激期对血压和血糖有影响。应激后血压和血糖将高于基线水平。HA4：终生累积暴露于被感知的歧视会影响对实验应激源的反应。更高的一生暴露于感知到的歧视将预示着对急性实验应激源更高的血糖和血压反应。HA5：终生累积暴露于被感知的歧视会对从实验应激源中延迟恢复产生影响。更高水平的终身暴露于感知到的歧视将预示着较少的夜间血压下降，以回应急性实验应激源。HA6：累积一生暴露于被感知的歧视和应激反应之间的联系的修饰者将会有趋势。本课程将探讨社会支持、社会支持和应对方式。如果成功，这一R21将导致R01申请进行具有更大生态有效性的日常过程研究。最终，这一系列研究将为干预措施提供信息，以帮助患有T2 DM的再生障碍性贫血妇女管理种族压力，从而减少糖尿病结局的差异。非裔美国人(AA)女性背负着不成比例的T2 DM及其一些并发症的负担。暴露在种族歧视的精神压力下可能会导致血压、血糖、胰岛素抵抗和自我照顾行为的改变，从而增加并发症的风险。这项研究将建立一个原则证据，证明在患有T2 DM的AA妇女中，一生累积暴露于可感知的歧视与导致并发症的行为和生理因素有关。最终，这一系列研究可能会导致干预措施，帮助患有T2 DM的再生障碍性贫血妇女更好地管理种族歧视的压力，从而降低糖尿病并发症的风险，并缩小糖尿病并发症的性别和种族差异。

DESCRIPTION (provided by applicant): African American (AA) women carry a disproportionate burden of T2DM and some of its complications. The stress of exposure to discrimination may contribute to altered blood pressure, glycemia, insulin resistance, and self-care behaviors, thereby increasing risk for complications. Our aims are to: 1) Establish proof of principle that cumulative lifetime exposure to perceived discrimination is related to baseline behavioral and physiological factors that underlie complications in AA women with T2DM; 2) Establish proof of principal that cumulative lifetime exposure to perceived discrimination primes individuals for heightened reactivity to acute stressors. 3) Explore candidate modifiers of the relationship between cumulative lifetime exposure to perceived discrimination and stress reactivity; and 4) Refine and expand plans for a daily process study of these variables with diabetic AA women to support an R01 application. Forty AA women and 40 White women with T2DM will participate. On day 1, participants will perform 24-hour ambulatory blood pressure monitoring. On day 2, participants will complete baseline measures of exposure to discrimination, fasting glucose, insulin resistance, and blood pressure. Then we will expose the participants to a public speaking task in the laboratory to detect metabolic and cardiovascular reactivity to the acute stressor. On day 3, participants will again perform 24-hour ambulatory blood pressure monitoring. Five hypotheses will be tested. Ha1: There will be an effect for race on cumulative lifetime exposure to perceived discrimination. AA women will report greater cumulative lifetime exposure to perceived discrimination than White women. Ha2: There will be an effect for cumulative lifetime exposure to perceived discrimination on resting blood pressure, insulin resistance, and diabetes self- care behaviors. Higher cumulative lifetime exposure to perceived discrimination will be associated with higher resting blood pressure, higher insulin resistance, and lower diabetes self-care behaviors. Ha3: There will be an effect for stressor period on blood pressure and glycemia. Post-stressor blood pressure and glycemia will be higher than baseline levels. Ha4: There will be an effect for cumulative lifetime exposure to perceived discrimination on reactivity to experimental stressor. Higher lifetime exposure to perceived discrimination will predict greater glycemic and blood pressure reactivity to an acute experimental stressor. Ha5: There will be an effect for cumulative lifetime exposure to perceived discrimination on delayed recovery from an experimental stressor. Higher levels of lifetime exposure to perceived discrimination will predict less nighttime blood pressure dipping in response to an acute experimental stressor. Ha6: There will be trends for modifiers of the association between cumulative lifetime exposure to perceived discrimination and stress reactivity. Social support, SES, and coping will be explored. If successful, this R21 will lead to an R01 application for a daily process study with greater ecological validity. Eventually, this line of research will inform interventions to help AA women with T2DM manage racial stress, thereby reducing disparities in diabetes outcomes. African American (AA) women carry a disproportionate burden of T2DM and some of its complications. Exposure to the mental stress of racial discrimination may contribute to altered blood pressure, glycemia, insulin resistance, and self-care behaviors, thereby increasing risk for complications. This study will establish proof of principle that cumulative lifetime exposure to perceived discrimination is related to behavioral and physiological factors that underlie complications in AA women with T2DM. Eventually this line of research may lead to interventions to help AA women with T2DM better manage the stress of racial discrimination, thereby decreasing risk for diabetes complications and attenuating gender and racial disparities in diabetes complications.