Identifying and Reducing Disparities in Outcomes Among Economically Vulnerable and Minority Young Adults with Type 1 Diabetes

迫切需要进一步了解护理方面的差异，并改善年轻人(YA)的结果 具有低社会经济(SES)和少数民族地位的1型糖尿病(T1D)。只有13%的YA(18-30岁)有 T1D在全国范围内实现美国糖尿病协会建议的HbA1c目标为7.0%，大幅提高 增加长期风险暴露和晚年死亡率。年轻人面临着独特的挑战，包括 成年期的发展过渡和医疗保健向成人护理的过渡，使其成为 及早介入。与他们的白人同龄人相比，具有低SES和少数族裔/民族T1D的YA处于 不良结果的风险高得不成比例，包括血糖控制更差和 复发性糖尿病酮症酸中毒和精神共病。这在一定程度上可能是由于未被识别和 未解决的健康的社会决定因素。尽管存在这些明显的差异和糟糕的总体结果， 是的，很少有研究集中在这些患有T1D的高风险YA上。因此，这一计划的总体目标是 建议是1)确定导致高危YA患者预后不良的社会健康决定因素 T1D和2)开发和实施创新的量身定制的解决方案，以解决超出 传统的医疗保健环境。Shivani Agarwal，医学博士，M.P.H.是一位成年内分泌学家，很早 糖尿病和健康服务研究人员，他之前开发了一种成功的成人医疗保健 针对YA和T1D的过渡干预将得到增强，以满足基于以下方面的高风险YA需求 从这项提案中收集到的信息。在特定目标1中，来自全国T1D交流诊所的YA数据 将利用网络来确定影响低社会经济地位和少数族裔血糖控制的社会决定因素 与较高的SES相比，非少数族裔的YA具有T1D。在具体目标2中，将进行定性访谈 在当地确定患有T1D的高危YA患者的护理相关需求和挑战，并挖掘潜力 解决办法。在具体目标3中，基于对社会决定因素如何影响护理的更好理解 对于患有T1D的高危YA患者的参与、护理过程和血糖控制，Agarwal博士将使用 多学科多利益相关者咨询小组，以增强她的过渡干预模式，以解决 差距。她还将在一项试点项目中测试增强干预措施在成人护理中的效果 随机对照试验。完成后，这些研究将为有意义的、可寻址的 T1D高危YA患者的健康决定因素，为医疗转型提供新的模式以解决 差距。这项工作将为R01多点随机对照试验的应用奠定基础 与常规护理相比，全面的糖尿病过渡计划的疗效。阿加瓦尔博士寻求获得 除了定量、定性和干预外，在差异和糖尿病调查方面的重要技能 方法通过拟设的职业发展奖。她的最终目标是成为一名独立人士。 差异和卫生服务调查员专注于改善年轻成人糖尿病人群的健康。

There is a critical need to further understand disparities in care and improve outcomes in young adults (YA) with type 1 diabetes (T1D) of low socioeconomic (SES) and minority status. Only 13% of YA (ages 18-30) with T1D nationally achieve the American Diabetes Association-recommended HbA1c target of <7.0%, substantially increasing long-term risk exposure and mortality later in life. Young adults have unique challenges, including the developmental transition to adulthood and healthcare transition to adult care, making it a critical period to intervene early. Compared to their white peers, YA with T1D of low SES and minority race/ethnicity are at disproportionately higher risk for adverse outcomes, including worse glycemic control and increased rates of recurrent diabetic ketaoacidosis and psychiatric comorbidity. This may be in part due to unrecognized and unaddressed social determinants of health. Despite these stark discrepancies and poor overall outcomes in YA, very little research has focused on these high-risk YA with T1D. Thus, the overall objectives of this proposal are to 1) identify social determinants of health that contribute to poor outcomes in high-risk YA with T1D and 2) develop and implement innovative tailored solutions to address disparities that extend beyond the traditional healthcare environment. Shivani Agarwal, M.D., M.P.H. is an adult endocrinologist and early diabetes and health services researcher who has previously developed a successful adult-based healthcare transition intervention for YA with T1D, which will be enhanced to address high-risk YA needs based on information gleaned from this proposal. In Specific Aim 1, data from YA in the national T1D Exchange Clinic Network will be used to identify social determinants that impact glycemic control in low SES and minority compared to higher SES non-minority YA with T1D. In Specific Aim 2, qualitative interviews will be conducted locally to determine care-related needs and challenges for high-risk YA with T1D, and solicit potential solutions. In Specific Aim 3, based upon an improved understanding of how social determinants affect care engagement, care processes, and glycemic control in high-risk YA with T1D, Dr. Agarwal will use a multidisciplinary multiple stakeholder advisory panel to enhance her transition intervention model to address disparities. She will also test the enhanced intervention’s efficacy on retention in adult care in a pilot randomized controlled trial. When complete, these studies will offer new insight on meaningful, addressable determinants of health in high-risk YA with T1D, to inform a new model for healthcare transition to address disparities. This work will form the basis for an R01 application of a multi-site randomized controlled trial testing the efficacy of a comprehensive diabetes transition program against usual care. Dr. Agarwal seeks to acquire important skills in disparities and diabetes investigation in addition to quantitative, qualitative, and intervention methods through the proposed career development award. Her ultimate goal is to become an independent disparities and health services investigator focused on improving health in young adult diabetes populations.