Personal and social-built environmental factors of glucose variability among multi ethnic groups of adults with type 2 diabetes

多种族成人 2 型糖尿病患者血糖变异性的个人和社会环境因素

• 批准号: 10656493
• 负责人: Soohyun Nam
• 金额: $ 54.27万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-01 至 2026-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10656493
• 关键词: Address; Adult; Affect; Affective; Age; Alcohol consumption; Behavior; Blinded; Blood Glucose; Body mass index; Cardiovascular Diseases; Characteristics; Clinical; Complications of Diabetes Mellitus; Continuous Glucose Monitor; Data; Data Collection; Development; Diabetes Mellitus; Diet; Eating; Ecological momentary assessment; Elderly; Environment; Environmental Risk Factor; Ethnic Origin; Ethnic Population; Exercise; Fasting; Frequencies; Future; Glucose; Glycosylated Hemoglobin; Glycosylated hemoglobin A; Goals; Health Personnel; High Prevalence; Hour; Hyperglycemia; Income; Individual; Insulin-Dependent Diabetes Mellitus; Intake; Intervention; Knowledge; Life Style; Link; Measures; Mediating; Neighborhoods; Non-Insulin-Dependent Diabetes Mellitus; Nutrient; Outcome; Participant; Patients; Persons; Pharmaceutical Preparations; Physical activity; Pilot Projects; Protocols documentation; Provider; Public Health; Publishing; Quality of life; Questionnaires; Race; Research; Risk; Risk Factors; Role; Sleep; Smoking; Social support; Stress; Teenagers; Time; Well in self; actigraphy; adherence rate; blood glucose regulation; built environment; clinical application; clinical decision-making; clinical practice; comorbidity; demographics; diabetes distress; diabetes self-management; dietary; effective therapy; epidemiology study; ethnic minority; experience; food insecurity; glucose metabolism; glycemic control; high risk; hypothalamic-pituitary-adrenal axis; improved; insight; lifestyle data; lifestyle factors; macrovascular disease; middle age; moderate-to-vigorous physical activity; mortality; multi-ethnic; personalized intervention; prospective; racial discrimination; racial diversity; racial minority; randomized trial; response; risk prediction; sedentary; sex; sleep quality; social; social cohesion; time interval

PROJECT SUMMARY The pivotal goals of diabetes treatment are to minimize diabetes complications and improve quality of life for individuals with diabetes. In-depth analyses from large scale, randomized trials and epidemiological studies have indicated that glycated hemoglobin (HbA1c), the primary metric for assessing glycemic control, alone may not sufficiently predict the risk of diabetes complications. Near-normal HbA1c level did not consistently improve diabetes complications. People with similar HbA1c values can have markedly different glucose profiles with varying frequencies and amplitudes of hypo- and hyper-glycemia. Glucose variability (GV) refers to fluctuations in blood glucose levels throughout the day (intra-day GV) or over days (inter-day GV) and is an emerging predictor of diabetes complications. GV can be measured in real-time through continuous glucose monitoring (CGM). Considerable research in CGM to understand GV has led to the growing use of CGM in clinical practice among individuals with type 1 diabetes. However, few studies address factors that affect GV in type 2 diabetes (T2D), leaving large gaps in knowledge about how to mitigate GV and improve diabetes outcomes in T2D. Roles of individuals’ lifestyle behaviors, emotional well-being and social-built environments in glucose control have been well documented. Also, real-time data on lifestyle such as day-to-day sleep, physical activity and diet are being generated. However, how these factors are associated with GV has yet to be examined. This study will be one of the first to prospectively examine the temporal relationships among sleep, physical activity, diet, emotional well-being, and GV, incorporating between-person associations and within-person variability among adults of diverse race/ethnicity with T2D. We will use a real-time, data capture strategy, ecological momentary assessment to measure lifestyle factors and emotional well-being. Three 24-hr dietary recalls will be conducted to collect nutrient-level data. We will also use actigraphy as objective measures of sleep and physical activity paired with CGM, a real-time, unobtrusive glucose measure that will be blinded from participants during a study period of 14 days. The specific aims of the study are to: (1) identify risk factors associated with high GV among diverse adults with T2D by examining between-person associations among demographics, clinical factors, lifestyle (sleep, physical activity, diet) factors, the variability of each lifestyle factor, emotional well-being, social-built environmental factors and inter-day GV, (2) identify ‘within- person predictors’ of GV to inform the development of personalized diabetes interventions by examining within- person associations among sleep, physical activity, diet, emotional well-being and intra-day GV, and (3) examine which lifestyle factors either mediate or moderate the relationship between emotional well-being and GV among diverse adults with T2D. The findings from the proposed study will guide clinical decision-making for healthcare providers to facilitate effective treatment using CGM and inform the development of personalized interventions to mitigate GV and improve diabetes outcomes.

项目摘要 糖尿病治疗的关键目标是最大限度地减少糖尿病并发症并改善生活质量， 患有糖尿病的人。来自大规模随机试验和流行病学研究的深入分析 已经表明，糖化血红蛋白（HbA 1c），用于评估血糖控制的主要指标，单独 可能不足以预测糖尿病并发症的风险。接近正常的HbA 1c水平并不总是 改善糖尿病并发症。HbA 1c值相似的人可能具有明显不同的葡萄糖谱 具有不同的频率和幅度的低和高频率。葡萄糖变异性（GV）是指 血糖水平在一天中（日内GV）或几天内（日间GV）的波动，并且是一种 糖尿病并发症的新预测因素。GV可以通过连续葡萄糖实时测量 监测（CGM）。在CGM中进行了大量研究以了解GV，导致CGM在以下方面的使用越来越多： 1型糖尿病患者的临床实践。然而，很少有研究涉及影响GV的因素， 2型糖尿病（T2 D），在如何减轻GV和改善糖尿病方面存在巨大的知识缺口 T2 D的结果。个人生活方式行为、情感健康和社会构建环境的作用 在葡萄糖控制中的作用已被充分记录。此外，生活方式的实时数据，如日常睡眠， 身体活动和饮食正在产生。然而，这些因素如何与GV相关还没有得到证实。 接受检查。这项研究将是第一个前瞻性地研究时间关系， 睡眠、身体活动、饮食、情绪健康和GV，结合人与人之间的关联， 不同人种/种族的T2 D成人中的人内变异性。我们将使用实时数据采集 战略，生态瞬时评估，以衡量生活方式的因素和情绪福祉。三个24小时 将进行膳食召回，以收集营养水平数据。我们还将使用体动计作为客观指标 睡眠和身体活动的测量与CGM配对，CGM是一种实时，不显眼的血糖测量， 在14天的研究期间对参与者设盲。研究的具体目的是：（1）识别风险 通过检查人与人之间的关联，在不同的T2 D成人中与高GV相关的因素 在人口统计学、临床因素、生活方式（睡眠、体力活动、饮食）因素中， 生活方式因素，情绪健康，社会建立的环境因素和日间GV，（2）确定“内- GV的个人预测因素，通过检查 人之间的关联睡眠，体力活动，饮食，情绪健康和日内GV，和（3） 检查哪些生活方式因素可以调解或调节情绪幸福感与 不同T2 D成人中的GV。这项研究的结果将指导临床决策 为医疗保健提供者，以促进使用CGM的有效治疗，并告知个性化的发展 干预措施，以减轻GV和改善糖尿病的结果。