Understanding & Overcoming Food Insecurity in Diabetes Patients

 描述(申请人提供)：食品不安全，定义为由于成本而难以负担足够的饮食，影响到2900万美国糖尿病患者中的20%以上。粮食不安全是有效糖尿病护理的一个重要社会经济障碍：它与糖尿病控制较差以及急诊科就诊和住院增加有关。通过鼓励消费高热量、高单一碳水化合物和饱和脂肪的食物，而不是更昂贵的新鲜农产品和全谷物，粮食不安全可能会破坏对糖尿病管理至关重要的健康饮食。该项目将通过确定粮食不安全如何影响目前的糖尿病管理，并检查使用不同战略克服它的临床效果，帮助我们加深对粮食不安全和糖尿病之间关系的了解。关于潜在干预的机制的根本问题仍然没有得到回答。为了解决这些知识差距，首席研究员(PI)提出了一个职业发展计划，将严格的方法论培训与创新的研究议程相结合。该计划有三个科学目标：1)确定食品不安全对生活方式改变干预的影响：REAL健康糖尿病试验(R18 DK102737 NCT02320253)，这是前瞻性生活方式干预措施在社区卫生中心的务实改编，2)评估营养援助计划在初级保健网络中使用对糖尿病控制的影响，以及3)进行试点随机对照试验，以评估为食物不安全的糖尿病伴高血糖患者提供定制医疗膳食的可行性。这项研究计划是对国家糖尿病、消化和肾脏疾病研究所将临床研究转化为实践的战略重点的补充，通过克服患者在现实世界环境中面临的障碍，减少特殊人群中的差异，使护理更加以患者为中心，并在护理系统内进行创新。这一职业发展奖的长期目标是将PI确立为独立研究人员，具有了解社会经济障碍如何影响糖尿病管理和克服这些障碍的实用干预措施的专业知识。职业发展活动包括通过正规课程进行高级分析方法培训和干预设计，以及由非常合格的资深科学家团队进行指导。成功完成这一职业发展提案将填补重要的知识空白，并有助于改善糖尿病管理，减少食品不安全患者的糖尿病并发症。

 DESCRIPTION (provided by applicant): Food insecurity, defined as difficulty affording an adequate diet owing to cost, affects over 20% of the 29 million Americans with diabetes. Food insecurity is an important socioeconomic barrier to effective diabetes care: it is associated with worse diabetes control and increased emergency department visits and hospitalization. By incentivizing consumption of calorie-dense foods high in simple carbohydrates and saturated fats, instead of more expensive fresh produce and whole grains, food insecurity may undermine healthy diets that are crucial for diabetes management. This project will help advance our knowledge of the relationship between food insecurity and diabetes by identifying how food insecurity affects current diabetes management and examining the clinical effects of using different strategies to overcome it. Fundamental questions regarding the mechanisms underlying potential interventions remain unanswered. To address these gaps in knowledge, the principal investigator (PI) proposes a career development program that blends rigorous methodologic training with an innovative research agenda. This plan has three scientific objectives: 1) To determine the impact of food insecurity on a lifestyle change intervention: the REAL HEALTH Diabetes trial (R18 DK102737 NCT02320253), a pragmatic adaptation of the Look AHEAD lifestyle intervention to community health centers, 2)To estimate the effect of nutrition assistance program use on diabetes control for patients in a primary care network, and 3) To conduct a pilot randomized controlled trial to assess the feasibility of home-delivered medically tailored meals for food insecure diabetes patients with hyperglycemia. This research program complements the National Institute of Diabetes and Digestive and Kidney Diseases' strategic focus on translating clinical research to practice by overcoming barriers faced by patients in real-world settings, reducing disparities in special populations, making care more patient-centered, and innovating within systems of care. The long-term goal of this career development award is to establish the PI as an independent researcher with expertise in understanding how socioeconomic barriers affect diabetes management and pragmatic interventions to overcome them. Career development activities include training in advanced analytic methods and intervention design through formal coursework as well as mentorship by an exceptionally qualified team of senior scientists. Successful completion of this career development proposal will fill important knowledge gaps, and help improve diabetes management and reduce diabetes complications in patients with food insecurity.