Self-Management and Glycemic Control in Adult Haitian Immigrants with Type 2 Diabetes

患有 2 型糖尿病的成年海地移民的自我管理和血糖控制

• 批准号: 10038367
• 负责人: Cherlie Magny-Normilus
• 金额: $ 9.15万
• 依托单位: BOSTON COLLEGE
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-13 至 2022-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10038367
• 关键词: Accelerometer; Address; Adherence; Adopted; Adult; Affect; African American; Behavior; Biological Markers; Blood Glucose; Caring; Caucasians; Chronic; Classification; Communication; Communities; Complement; Complications of Diabetes Mellitus; Cuban American; Data; Dedications; Development; Diet; Discrimination; Education; Educational Intervention; Environmental Risk Factor; Ethnic group; Evaluation; Exercise; Glucose; Glycosylated Hemoglobin; Glycosylated hemoglobin A; Goals; Gold; Habits; Haiti; Haitian; Health; Health Services Accessibility; Health Status; Healthcare Systems; Healthy Eating; Hip region structure; Immigrant; Individual; Insulin Resistance; Intervention; Interview; Investigation; Life Style; Linguistics; Literature; Masks; Measurement; Measures; Mentors; Methods; Minority; Morbidity - disease rate; Non-Insulin-Dependent Diabetes Mellitus; Outcome; Patient Self-Report; Performance; Phase; Physical activity; Pilot Projects; Population; Psychosocial Factor; Randomized; Recommendation; Research; Research Design; Research Support; Resources; Risk; Role; Self Management; Social Environment; Stress; Surveys; Techniques; Time; Training; United States; Work; actigraphy; comorbidity; diabetes management; diabetes self-management; disadvantaged population; experience; family support; food insecurity; glucose monitor; glycemic control; health belief; health care disparity; health care service utilization; high risk; improved; medication compliance; meetings; migration; mortality; perceived stress; pill; programs; psychosocial; public health relevance; racial and ethnic; research study; response; sociodemographics; socioeconomic disadvantage; standard care; treatment planning

Morbidity and mortality rates from type 2 diabetes (T2D) are high and continue to increase, with only 32% of adults who have T2D meeting targets for glycosylated hemoglobin (A1c). Immigrants and racial/ethnic groups have worse rates of achieving the target A1c goal. Self-management is critical in meeting glycemic control. Haitian immigrants have unique migration experiences compared to other ethnic groups that may impact their T2D self-management. Our preliminary work reveals differences in Haitian immigrants dietary and exercise habits compared with their practices in Haiti. Haitian immigrants also have higher A1c levels compared with African Americans and Cuban Americans. The purpose of this application submitted in response to PA-18-129 is to characterize self-management behaviors, barriers to T2D self-management, and glycemic control in adult Haitian immigrants. Our aim is to reduce health care disparities by developing a T2D self-management education intervention specific to adult Haitian immigrants. Data from the K99 phase will inform the development of a diabetes self-management education (DSME) program to be carried out during the R00 phase and establish feasibility, acceptability, and preliminary efficacy. Our aims are to: 1) Describe self-management behaviors of 100 adult Haitian immigrants with T2D as measured by multiple methods (diabetes self-management survey, 3-day diet recall, blood glucose level, physical activity via accelerometer, and pill counts) and their correlations with glycemic biomarkers (A1c and continuous glucose variability via continuous glucose monitoring (CGM); 2) Describe barriers to self-management in these 100 adult Haitian immigrants with T2D including socio-demographic status, health status (comorbidity), psychosocial factors (cultural health beliefs, acculturative and discrimination stress), and environmental factors (access to care, food insecurity) using mixed methods (quantitative surveys and interviews with a subsample); 3) Use community-engaged approaches with 10 adult Haitian immigrants with T2D to develop a DSME program to reduce barriers and improve self-management and glycemic control; and 4) Conduct a randomized pilot study with 60 adult Haitian immigrants to establish feasibility, acceptability, and preliminary efficacy of the DSME program compared to standard care. We will use descriptive approaches for the K99 and aim 3 of the R00 phase. For aim 4, we will use a randomized pilot study design. A hip actigraphy measures of physical activity, glycemic biomarkers from A1c and glucose variability via CGM, self-report, objective, and interview measures of self-management will be collected. Data will be analyzed using multiple regression, content analysis techniques, and preliminary effect sizes will be generated from aim 4. The project is significant in its potential to enhance understanding of T2D self-management and glycemic control in this immigrant population at high-risk for negative T2D health outcomes. This study addresses NINR’s key theme, “Self-Management of Chronic Conditions”. The accomplished mentor committee and the candidate’s ongoing research relationships in this field will create the ideal setting for these investigations.

2型糖尿病（T2D）的发病率和死亡率很高，并继续增加，只有32%的T2D成人达到糖化血红蛋白（A1c）的目标。移民和种族/民族群体实现A1 c目标的比例较差。自我管理在满足血糖控制方面至关重要。与其他族裔群体相比，海地移民有着独特的移民经历，这可能会影响他们的T2D自我管理。我们的初步工作揭示了海地移民的饮食和运动习惯与他们在海地的做法相比的差异。与非洲裔美国人和古巴裔美国人相比，海地移民的A1c水平也更高。本申请是针对PA-18 - 129提交的，旨在描述海地成年移民的自我管理行为、T2D自我管理障碍和血糖控制。我们的目标是通过开发专门针对海地成年移民的T2D自我管理教育干预措施来减少医疗保健差距。来自K99阶段的数据将为在R00阶段实施的糖尿病自我管理教育（DSME）计划的制定提供信息，并确定可行性、可接受性和初步疗效。我们的目标是：1）描述100名患有T2D的成年海地移民的自我管理行为，通过多种方法进行测量（糖尿病自我管理调查、3天饮食回忆、血糖水平、通过加速计进行的身体活动和药丸计数）及其与血糖生物标志物的相关性（A1c）和通过连续葡萄糖监测（CGM）的连续葡萄糖变异性; 2）描述这100名患有T2D的海地成年移民自我管理的障碍，包括社会人口统计学状况、健康状况（科摩罗）、心理社会因素（文化健康信念，文化适应和歧视压力）和环境因素（获得保健、粮食不安全）（定量调查和对次级样本的访谈）; 3）与10名患有T2D的海地成年移民一起使用社区参与的方法来制定DSME计划，以减少障碍并改善自我管理和血糖控制;对60名海地成年移民进行随机试验研究，以确定DSME方案与标准治疗相比的可行性、可接受性和初步疗效。我们将对R00阶段的K99和目标3使用描述性方法。对于目标4，我们将使用随机化初探性研究设计。将收集身体活动的髋关节活动记录测量、来自A1c的血糖生物标志物和通过CGM的血糖变异性、自我报告、客观和自我管理的访谈测量。将使用多元回归、内容分析技术分析数据，并根据目标4生成初步效应量。该项目具有重要的潜力，可以提高对T2D自我管理和血糖控制的理解，这些移民人群具有T2D健康结果的高风险。这项研究涉及NINR的关键主题“慢性疾病的自我管理”。成功的导师委员会和候选人在该领域正在进行的研究关系将为这些调查创造理想的环境。