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: 10614786
• 负责人: Cherlie Magny-Normilus
• 金额: $ 24.9万
• 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 2025-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10614786
• 关键词: Accelerometer; Address; Adherence; Adopted; Adult; Affect; African American population; Behavior; Biological Markers; Black Populations; 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 Groups; Morbidity - disease rate; Non-Insulin-Dependent Diabetes Mellitus; Outcome; Patient Self-Report; Performance; Persons; 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; cultural health; diabetes management; diabetes self-management; dietary; 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，并且还在持续增加，只有 32% 的 T2D 成年人达到了糖化血红蛋白 (A1c) 的目标。移民和种族/族裔群体实现 A1c 目标的比率较差。自我管理对于实现血糖控制至关重要。与其他族裔群体相比，海地移民拥有独特的移民经历，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的差异。与非裔美国人和古巴裔美国人相比，海地移民的 A1c 水平也较高。针对 PA-18-129 提交的本申请的目的是描述成年海地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。 K99 阶段的数据将为 R00 阶段开展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（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服药计数）及其与血糖生物标志物（通过连续血糖监测 (CGM) 进行的 A1c 和连续血糖变异性）的相关性；2) 描述自我管理行为的障碍 使用混合方法（定量调查和子样本访谈）对这 100 名患有 T2D 的海地成年移民进行自我管理，包括社会人口状况、健康状况（合并症）、社会心理因素（文化健康信仰、文化适应和歧视压力）和环境因素（获得护理、粮食不安全）； 3) 采用社区参与的方法，与 10 名患有 T2D 的成年海地移民一起制定 DSME 计划，以减少障碍并改善自我管理和血糖控制； 4) 对 60 名成年海地移民进行一项随机试点研究，以确定 DSME 计划与标准护理相比的可行性、可接受性和初步功效。我们将对 K99 和 R00 阶段的目标 3 使用描述性方法。对于目标 4，我们将使用随机试点研究设计。将收集体力活动的髋部活动记录仪测量、A1c 的血糖生物标志物和 CGM 的血糖变异性、自我管理的自我报告、客观和访谈测量。将使用多元回归、内容分析技术对数据进行分析，并根据目标 4 生成初步效应量。该项目具有重要意义，因为它有潜力增强对 T2D 负面健康结果高风险移民人群的 T2D 自我管理和血糖控制的了解。这项研究涉及 NINR 的关键主题“慢性病的自我管理”。卓有成效的导师委员会和候选人在该领域持续的研究关系将为这些调查创造理想的环境。