Metabolic, behavioral and social determinants of youth-onset T2D

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ABSTRACT Youth-onset type 2 diabetes (YT2D) has emerged as one of the most important clinical and public health consequences of the current obesity epidemic. Not only have the rates of YT2D been increasing over the years, achieving and maintaining optimal glycemic control in this population poses unique challenges. Furthermore, disease progression in youth is faster than in adults, with a higher risk of developing diabetes complications earlier in the disease process than adults. Importantly, there are profound disparities in the burden of YT2D, with racial/ethnic minorities the most at risk. Despite these facts, the pathophysiology that leads to the development of YT2D is not well understood and even less is known about the social determinants of health (SDOH) associated with YT2D risk. Given that SDOH are major drivers of disease among racial/ethnic minorities, there is a critical need to assess the intersection of SDOH and biological factors in shaping the risk of developing YT2D. In response to RFA-DK-21-002, we propose to establish a cohort of children at risk of YT2D by recruiting from the Children’s Hospital at Montefiore Medical Center (CHAM) pediatric primary care practices (the largest provider of children’s health services in the Bronx). The Bronx is one of the most racially and ethnically diverse counties in the country; children in the Bronx have a high burden of obesity-related metabolic disorders and of social and economic adversities (e.g. food insecurity). Thus, our site is very well positioned to contribute to a better understanding of the factors that lead to inequities in YT2D risk and to inform development of more effective prevention and glycemic control strategies. Our overall objectives are to: (1) Develop more precise and clinically feasible prediction of which individuals are truly at risk for developing YT2D, by assessing the combined impact of metabolic and lifestyle factors, socio-economic status (SES), sociocultural factors, and other SDoH; (2) Increase understanding of the physiologic drivers of YT2D; (3) Provide a platform and supportive infrastructure for in-depth ancillary studies on critical aspects related to YT2D using cohort data and banked specimens