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

描述（由申请人提供）：非裔美国人（AA）女性承受着不成比例的T2 DM及其一些并发症负担。暴露于歧视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）建立原则证据，即感知歧视的累积终生暴露与T2 DM AA女性并发症的基线行为和生理因素相关; 2）建立原则证据，即感知歧视的累积终生暴露使个体对急性应激源的反应性增强。3)探索终身累积暴露于感知歧视和压力反应之间的关系的候选修饰符;和4）完善和扩展计划，这些变量与糖尿病AA女性的日常过程研究，以支持R 01应用程序。40名AA女性和40名白色T2 DM女性将参与研究。在第1天，参与者将进行24小时动态血压监测。在第2天，参与者将完成歧视暴露、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中接受公开演讲任务，以检测代谢和心血管对急性应激源的反应。在第3天，参与者将再次进行24小时动态血压监测。将检验五个假设。Ha 1：种族会影响到感知歧视的累积终生暴露。AA妇女将报告更大的累积终身暴露于感知歧视比白色妇女。Ha2：终生累积暴露于感知歧视对静息血压、胰岛素抵抗和糖尿病自我护理行为有影响。更高的累积终身暴露于感知歧视将与更高的静息血压，更高的胰岛素抵抗和更低的糖尿病自我护理行为相关。危害3：应激时间对血压和心率有影响。应激后的血压和收缩压将高于基线水平。Ha 4：感知歧视的终生累积暴露对实验应激源的反应性有影响。更高的终身暴露于感知歧视将预测更大的血糖和血压反应急性实验应激。Ha 5：终生累积暴露于感知歧视对从实验压力源中延迟恢复会有影响。较高水平的终身暴露于感知歧视将预测夜间血压下降，以应对急性实验应激。Ha 6：对于认知歧视的累积寿命暴露与应激反应之间的关联，将有修饰符的趋势。社会支持，SES和应对将被探讨。如果成功，该R21将导致R 01申请，用于具有更大生态有效性的日常工艺研究。最终，这一系列研究将为帮助患有T2 DM的AA女性管理种族压力的干预措施提供信息，从而减少糖尿病结局的差异。非裔美国人（AA）女性承担着不成比例的T2 DM及其一些并发症的负担。暴露于种族歧视的精神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。本研究将确立以下原则证据：在患有T2 DM的AA女性中，感知歧视的累积终生暴露与导致并发症的行为和生理因素相关。最终，这一系列研究可能会导致干预措施，以帮助患有T2 DM的AA女性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，并减少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.