Racial/Ethnic Disparities in Management of Diabetes

描述（由申请人提供）：糖尿病（DM）是美国发病率和死亡率的主要原因。据估计，美国目前有1820万人患有糖尿病（500万人未确诊），在过去20年里增长了大约100%。发病率正在上升，发生在更年轻的年龄，糖尿病的负担最严重地落在少数民族成年人身上。据估计，2000年在美国出生的人一生中患糖尿病的风险现在是三分之一。尽管新的治疗方案的成功发展，进展在糖尿病的管理一直难以捉摸；只有7.3%的糖尿病患者达到了血糖、血压和胆固醇的治疗目标，自1988年以来几乎没有改善。推动本研究的概念模型预测，个体易感性、促成性和需求特征将解释糖尿病管理中的差异。本研究的主要目的是更好地理解促进或阻碍糖尿病有效管理的因素，并根据需要，有助于开发文化多样性的材料/策略，以解决不同少数群体糖尿病管理的具体方面。来自三次独立的BRFSS调查（2001年、2002年和2003年）的数据将用于检验从该模型中得出的假设。非西班牙裔白人、非西班牙裔美国人和西班牙裔18岁及以上的糖尿病患者将是研究的重点。关键因变量包括糖尿病临床和自我管理的15个指标。OLS多元回归和logistic回归是基本的分析策略。该分析计划将由16名本科生（和有限数量的研究生）在一个学期的4学分讲座/实验课程中实施，由研究人员讲授，并在博士级研究助理的协助下进行。研究结果将通过糖尿病研究日在当地传播，并通过同行评议的期刊文章在全国传播。AREA （R15）是支持本研究的理想机制。

DESCRIPTION (provided by applicant): Diabetes mellitus (DM) is a major cause of morbidity and mortality in the U.S. An estimated 18.2 million people in the U.S. now have DM (5 million are undiagnosed), reflecting an approximate 100% increase over the past two decades. The incidence is escalating, occurs at younger ages, and the burdens of DM fall most heavily on minority adults. Estimates of the lifetime risk of developing DM among people bom in the U.S. in 2000 are now one-in-three. Despite the successful development of new treatment regimens, progress in the management of DM has been elusive; only 7.3% of people diagnosed with DM meet treatment goals for blood glucose, blood pressure and cholesterol, and there has been little improvement since 1988. The conceptual model that drives this research study predicts that individual predisposing, enabling and need characteristics will explain disparities in the management of DM. The main objective of the study is to gain a better understanding of factors that facilitate or impede effective management of DM and, as needed, contribute to development of culturally-diverse materials/strategies for addressing specific aspects of management of DM in different minority groups. Data from three separate BRFSS surveys (2001, 2002 and 2003) will be used to test hypotheses derived from the model. Non-Hispanic Whites, non- Hispanic African Americans and Hispanics 18 years of age and older with DM will be the focus of the research. Key dependent variables include 15 indicators of clinical and self-management of DM. OLS multiple regression and logistic regression are the basic analytic strategies. The analytic plan will be implemented by 16 undergraduate (and a limited number of graduate) students during a semester-long, 4 credit-hour lecture/lab course taught by the investigators, with the assistance of a doctoral-level research assistant. Results will be disseminated locally via a Diabetes Research Day and nationally through peer- reviewed journal articles. The AREA (R15) is an ideal mechanism to support the proposed research.