Food and Resources Expanded to Support Health and Type 2 Diabetes (FRESH-T2D)

扩大食品和资源以支持健康和 2 型糖尿病 (FRESH-T2D)

• 批准号: 10580984
• 负责人: Melanie Daniela Hingle
• 金额: $ 29.46万
• 依托单位: UNIVERSITY OF ARIZONA
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-01-20 至 2025-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10580984
• 关键词: Address; Adherence; Adult; Affect; American; Arizona; Behavior; Belief; Blood Glucose; Body Weight; COVID-19 pandemic; Carbohydrates; Certification; Chronic; Chronic Disease; Collaborations; Communities; Coping Skills; County; Custom; Data; Diabetes Mellitus; Diet; Dietitian; Disease Management; Disparity; Education; Educational Intervention; Ensure; Evaluation; Federally Qualified Health Center; Fiber; Food; Food Assistance Programs; Food Packaging; Future; Glycosylated hemoglobin A; Goals; Health; Health Resources; Healthy Eating; Home; Household; Human Resources; Incidence; Individual; Intake; Intervention; Life Style; Low Income Population; Low income; Medical; Methods; Modeling; Monitor; Morbidity - disease rate; National Institute of Diabetes and Digestive and Kidney Diseases; Neighborhood Health Center; Non-Insulin-Dependent Diabetes Mellitus; Nutrient; Nutritional; Nutritionist; Outcome; Participant; Patients; Persons; Pharmaceutical Preparations; Pilot Projects; Problem Solving; Process; Public Health; Randomized; Randomized Controlled Clinical Trials; Recipe; Recommendation; Research; Resources; Risk; Risk Reduction; Security; Self Care; Series; Severities; System; Testing; Underinsured; Uninsured; Visit; Waiting Lists; Work; acceptability and feasibility; blood glucose regulation; care coordination; care seeking; clinically relevant; coping; cost; design; diabetes educator; diabetes self-management; dietary; economic disparity; education resources; evidence base; food insecurity; food resource; food security; fruits and vegetables; glycemic control; health related quality of life; improved; intervention program; mortality; nutrition; patient engagement; patient oriented; personalized medicine; prevent; recruit; response; retention rate; social factors; social health determinants; uptake

In 2020, more than 38.5 million (10.5%) U.S. households were without reliable access to sufficient quantities of affordable, nutritious food due to limited money or other resources. Food insecurity, poor nutrition, and economic disadvantage are critical social determinants of health that contribute to disparities in type 2 diabetes mellitus (T2DM), a serious diet-sensitive chronic disease affecting more than 20% of food insecure adults. Coping strategies favor inexpensive, ultra-processed foods that substantially diminish diet quality and are associated with increased incidence and severity of T2DM, including poorer glycemic control and excess body weight. Given that numerous social factors and systems contribute to and perpetuate food insecurity and poor diabetes outcomes, there is a demonstrable need for multilevel (individual, household, community) food-focused interventions to effectively and sustainably address the diet quality of persons with, or at risk of, T2DM. To our knowledge, no studies have rigorously tested whether intervention programs explicitly designed to improve both food and nutrition security of low-income persons with T2DM are feasibly delivered by personnel at a Federally Qualified Health Center (FQHC), acceptable to patients seeking care in their medical home, or are capable of producing clinically relevant changes in T2DM endpoints. These are questions we will explore in our proposed randomized wait-list controlled pilot study— Food and Resources Expanded to Support Health and Type 2 Diabetes (FRESH-T2DM)— in which our previously developed food and diabetes self-management education (DSME) intervention (FRESH) will be delivered to 50 adult FQHC patients with T2DM and food insecurity twice monthly, for 6 months. The FRESH intervention consists of bimonthly food provision; a series of recipes that feature FRESH foods; diabetes self-management education (DSME) resources; and four, 30-minute visits with an FQHC Registered Dietitian Nutritionist and Certified Diabetes Educator who will help participants utilize FRESH resources to meet personalized treatment goals. We will build upon our prior work and existing collaborations with colleagues at El Rio Community Health Center, a Federally Qualified Health Center serving >110,000 underinsured, uninsured patients and the Community Food Bank of Southern Arizona, a regional food bank serving 180,000 Arizonans across 5 counties to: (Specific Aim 1) Assess the feasibility, acceptability, and participant uptake of our FRESH intervention, delivered to 50 food insecure adults with T2DM at their medical home, El Rio Community Health Center, and (Specific Aim 2) Explore changes in blood glucose control, diet quality, food security, diabetes self-care behaviors, and health-related quality of life among participants at 3 and 6 months. Completion of our pilot study —submitted in response to NIDDK PAS-20-160 —will produce data to inform the rationale and design of a future definitive randomized controlled clinical trial, including recruitment, retention, adherence, and cost data. Our long-term goal is to produce a tested, efficacious model of coordinated care capable of replication and scaling across other FQHCs and food bank networks.

2020年，超过3850万（10.5%）美国家庭无法可靠地获得足够数量的 由于资金或其他资源有限，我们无法提供负担得起的营养食品。粮食不安全、营养不良和经济 不利因素是造成2型糖尿病差异关键的健康社会决定因素 2型糖尿病（T2DM）是一种严重的饮食敏感性慢性疾病，影响超过20%的食物不安全成年人。应对 策略倾向于廉价的超加工食品，这些食品大大降低了饮食质量， T2DM的发病率和严重程度增加，包括血糖控制较差和体重过重。给定 认识到许多社会因素和制度造成粮食不安全和糖尿病贫穷并使其长期存在 结果，显然需要多层次（个人、家庭、社区）以粮食为重点的 采取干预措施，有效和可持续地解决T2DM患者或有风险患者的饮食质量问题。对我们 知识，没有研究严格测试干预计划是否明确旨在改善两者 低收入T2DM患者的食物和营养安全由联邦政府的工作人员提供是可行的。 合格的健康中心（CIMHC），可接受在其医疗之家寻求护理的患者，或有能力 产生T2DM终点的临床相关变化。这些都是我们将在我们的建议中探讨的问题。 随机等待名单对照试点研究-食品和资源扩大，以支持健康和类型 2型糖尿病（FRESH-T2DM）-其中我们以前开发的食物和糖尿病自我管理教育 （DSME）干预（FRESH）将提供给50名患有T2DM和食物不安全的成年T2DM HC患者 每月两次，持续6个月。FRESH干预包括每两个月提供一次食物;一系列食谱 包括新鲜食物、糖尿病自我管理教育（DSME）资源和四次30分钟的访问 与一位健康中心注册营养师营养师和认证糖尿病教育家谁将帮助参与者利用 FRESH资源，以满足个性化的治疗目标。我们将在现有的基础上， 与El Rio社区健康中心的同事合作，这是一个联邦合格的健康中心， > 110，000保险不足，无保险的患者和亚利桑那州南部社区食品银行，一个区域性的 为5个县的18万亚利桑那人提供服务的食品银行：（具体目标1）评估可行性，可接受性， 和参与者对我们的FRESH干预措施的摄取，在他们的医疗中心向50名食物不安全的T2DM成年人提供 家庭，埃尔里约社区卫生中心，和（具体目标2）探索血糖控制，饮食的变化 质量，食品安全，糖尿病自我护理行为，以及3岁和12岁的参与者的健康相关生活质量。 6个月完成我们的试点研究-响应NIDDK PAS-20 - 160提交-将产生数据， 告知未来确定性随机对照临床试验的原理和设计，包括招募， 保留、遵守和成本数据。我们的长期目标是建立一个经过测试的，有效的协调模式， 能够在其他粮农组织协调中心和粮食银行网络中复制和推广的护理。