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）女性承担着不成比例的2型糖尿病及其并发症负担。暴露于歧视的压力可能导致血压、血糖、胰岛素抵抗和自我保健行为的改变，从而增加并发症的风险。我们的目标是：1)建立原则证明，累积终生暴露于感知歧视与基线行为和生理因素相关，这些因素是AA型2型糖尿病女性并发症的基础；2)建立原则性证据，证明终身暴露于感知歧视会使个体对急性应激源的反应增强。3)探索终身累积歧视暴露与应激反应关系的候选修饰因子；4)完善和扩展这些变量在糖尿病AA女性中的日常过程研究计划，以支持R01应用。40名AA女性和40名患有2型糖尿病的白人女性将参加。在第一天，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中进行公开演讲任务，以检测他们对急性应激源的代谢和心血管反应。在第3天，参与者将再次进行24小时动态血压监测。将测试五个假设。Ha1：种族会影响一生中对感知到的歧视的累积暴露。与白人女性相比，嗜酒者协会的女性一生中受到歧视的累积程度更高。Ha2：对感知歧视的终生累积暴露对静息血压、胰岛素抵抗和糖尿病自我护理行为有影响。较高的感知歧视的终生累积暴露将与较高的静息血压、较高的胰岛素抵抗和较低的糖尿病自我护理行为相关。Ha3：应激期会对血压和血糖有影响。应激后血压和血糖会高于基线水平。Ha4：对感知歧视的累积终身暴露会对实验应激源的反应性产生影响。终生暴露于感知歧视的程度越高，对急性实验应激源的血糖和血压反应性就越高。Ha5：对感知歧视的终生累积暴露会对实验性应激源的延迟恢复产生影响。终生暴露于感知歧视的水平越高，在急性实验压力源的反应中，夜间血压下降的幅度就越小。Ha6：在感知到的歧视和应激反应之间的累积终身暴露之间的关联将有修正因子的趋势。将探讨社会支持、SES和应对。如果成功，R21将导致R01应用于具有更大生态有效性的日常过程研究。最终，这一研究将为帮助AA型2型糖尿病女性管理种族压力提供干预措施，从而减少糖尿病结局的差异。非裔美国人（AA）妇女患2型糖尿病及其并发症的负担不成比例。暴露在种族歧视的精神压力下可能导致血压、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。本研究将建立原则证明，累积终生暴露于感知歧视与行为和生理因素有关，这些因素是AA型2型糖尿病女性并发症的基础。最终，这条研究路线可能会导致干预措施，帮助AA型2型糖尿病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.