Understanding & Overcoming Food Insecurity in Diabetes Patients

 描述（由申请人提供）：食品不安全，定义为由于成本难以提供足够的饮食，影响了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：它与糖尿病控制恶化和急诊就诊和住院率增加有关。通过鼓励消费高热量食物，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当前的糖尿病管理，并检查使用不同策略克服它的临床效果，帮助我们推进粮食不安全和糖尿病之间的关系的知识。为了解决这些知识差距，主要研究者（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）确定粮食不安全对改变生活方式干预措施的影响：真实的健康糖尿病试验（R18 DK102737 NCT02320253），前瞻性生活方式干预对社区卫生中心的务实适应，2）评估营养援助计划对初级保健网络中患者糖尿病控制的影响，及3）进行一项先导性随机对照试验，以评估为食物不安全的糖尿病高血糖患者提供家庭医疗定制膳食的可行性。该研究计划补充了国家糖尿病和消化及肾脏疾病研究所的战略重点，即通过克服患者在现实环境中面临的障碍，减少特殊人群的差异，使护理更加以患者为中心，并在护理系统中进行创新，将临床研究转化为实践。这个职业发展奖的长期目标是建立PI作为一个独立的研究人员，在了解社会经济障碍如何影响糖尿病管理和务实的干预措施，以克服他们的专业知识。职业发展活动包括通过正式课程进行先进分析方法和干预设计方面的培训，以及由一个非常合格的资深科学家团队提供指导。成功完成这项职业发展计划将填补重要的知识空白，并有助于改善糖尿病管理，减少粮食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.