Linking education, produce provision, and community referrals to improve diabetes care (LINK)

项目摘要 2型糖尿病(T2D)和粮食不安全的综合影响可能是毁灭性的。根据 NHANES最近的数据显示，患有T2D的成年人中有19%的人食物不安全，T2D在这些人中的患病率更高 粮食不安全。患有T2D和食物不安全的人糖尿病自我管理能力更差， 与食物安全的同龄人相比，血糖控制。虽然解决粮食不安全问题在T2D护理中很重要， 粮食不安全的个人也可能有其他非医疗、健康相关的社会需求(例如， 交通障碍、住房不稳定、工作不安全)，这些因素可能会降低他们获取葡萄糖的能力 目标和影响其他与糖尿病相关的健康结果。医疗保健系统和医疗系统之间的伙伴关系 以社区为基础的组织已经成为改善食品中糖尿病控制的一种有前途的方法- 没有安全感的人群。考虑到先前研究的设计限制，仍然迫切需要随机 对照试验(RCT)，以测试糖尿病教育、食品供应和治疗的综合影响 食物不安全的T2D患者在血糖控制方面未得到满足的社会需求。利用现有的 计划和关系，我们建议测试食物转介计划、社会需求的综合效果 人群中血红蛋白A1c的筛查转诊和糖尿病教育干预 种族/民族多元化的参与者有食物不安全和T2D，在OSuwmc发现A1c≥7.5%。我们 计划使用社区参与的研究方法，让社区成员和利益相关者向 干预措施的设计和重点。目的1：使用实用的随机对照试验(PRCT)，验证 农产品供应、糖尿病教育和社区转诊对糖尿病患者A1c水平的影响 T2D经历了粮食不安全。目标2：评估每项干预措施的成本效益 包括革命制度改革委员会。目标3：利用过程评估来了解影响 干预措施的接受度、有效性和可持续性。影响：我们建议的研究与 NIDDK对解决T2D治疗、并发症和健康公平的临床研究的兴趣，作为我们的项目 直接检查基于卫生系统的方法，以满足非医疗、与卫生相关的社会需求 改善健康状况。需要创新的解决方案来对抗失控的长期后遗症 T2D与粮食不安全相结合，导致T2D的全因死亡率增加两倍， 不成比例影响较低的社会经济地位和种族/少数民族人口。粮食不安全， 未得到满足的社会需求和糖尿病教育是改善T2D必须解决的关键问题 治疗、关怀和公平。我们的研究将提供基本的证据，支持可扩展和 建立可持续的伙伴关系来解决这些问题。

Project Summary The combined impacts of type 2 diabetes mellitus (T2D) and food insecurity can be devastating. According to recent NHANES data, 19% of adults with T2D are food-insecure, and T2D prevalence is higher among those with food insecurity. Individuals with T2D and food insecurity have worse diabetes self-management and glycemic control compared to food-secure peers. While addressing food insecurity is important in T2D care, individuals with food insecurity may also have other non-medical, health-related social needs (e.g., transportation barriers, housing instability, job insecurity) that may decrease their ability to attain glucose targets and impact other diabetes-related health outcomes. Partnerships between healthcare systems and community-based organizations have emerged as a promising approach to improve diabetes control in food- insecure populations. Given the design limitations of prior studies, there remains a critical need for randomized controlled trials (RCTs) to test the combined impact of diabetes education, food provision, and addressing unmet social needs on glycemic control in people with T2D experiencing food insecurity. Leveraging existing programs and relationships, we propose to test the combined effects of a food referral program, social needs screening and referral, and diabetes education intervention on hemoglobin A1c in a population of racially/ethnically diverse participants with food insecurity and T2D with A1c ≥7.5% identified at OSUWMC. We plan to use a community-engaged research approach with community members and stakeholders informing the design and focus of the interventions. Aim 1: Using a pragmatic randomized controlled trial (pRCT), to test the effect of produce provision, diabetes education, and community referrals on A1c levels in individuals with T2D experiencing food insecurity. Aim 2: To assess the cost-effectiveness of each of the interventions that comprise the pRCT. Aim 3: To utilize a process evaluation to understand the contextual factors that impact the uptake, effectiveness, and sustainability of the interventions. Impact: Our proposed study aligns with the NIDDK’s interest in clinical studies addressing T2D treatment, complications, and health equity, as our project directly examines health system-based approaches to address non-medical, health-related social needs to improve health outcomes. Innovative solutions are warranted to combat the long-term sequelae of uncontrolled T2D combined with food insecurity that contribute to the two-fold higher all-cause mortality in T2D that disproportionality impacts lower socio-economic status and racial/ethnic minority populations. Food insecurity, unmet social needs, and diabetes education are critical issues that must be addressed to improve T2D treatment, care, and equity. Our study will provide essential evidence that will support both scalable and sustainable partnerships to address these conditions.