Understanding Health Disparities in the Progression of Type 2 Diabetes

众所周知，与生活方式相关的可改变的行为，包括吸烟、饮酒、饮食和身体锻炼 运动极大地增加了大多数常见身体健康状况的风险。最近，几乎是流行病 与这些健康行为有关的疾病患病率增加，特别是2型高血压 糖尿病、心血管疾病(CVD)，以及这些疾病在种族之间日益扩大的负担差异 强调了制定有效预防战略的紧迫性--然而，很少有 干预研究对生活方式和行为产生了长期的变化。处理中的遗漏 现有的行为干预模型，我们认为需要的是对行为干预的检查 健康行为、来源和应对反应之间相互关系的背景变化 慢性压力及其对身心健康的影响。这项提议是由一项强有力的 有文献表明，美国黑人更有可能从事不健康的行为(即吸烟 吸烟、高脂肪和高碳水化合物的饮食、过度饮酒)，以及，意料之中的经历 与这些行为相关的常见身体健康状况的不成比例的负担，包括 心血管疾病和糖尿病，相对于非西班牙裔白人--然而，矛盾的是，基于人群和临床 研究一直发现，与白人相比，黑人患上大多数 精神障碍，即使在经历更高的心理痛苦的时候也是如此。我们的理论是，一个明确的 一套与健康有关的压力应对策略(例如，吸烟，高脂肪和碳水化合物饮食， 过量饮酒等)具有双管齐下的效果，这有助于解释这种违反直觉的模式。 首先，我们认为这些行为作用于下丘脑-垂体-肾上腺(HPA)轴和相关的应激- 影响应激相关的主观体验和发展的激素系统 精神障碍。第二，我们认为这些不良行为对病理生理的影响， 再加上一生中紧张的生活条件的直接影响，导致不成比例的 黑人慢性身体健康问题的负担。简而言之，我们建议黑人和其他人 来自高压力人群的个体“买”了他们相对积极的心理健康比率 以身体健康每况愈下为代价的疾病。因此，这个框架表明， 坚持传统的预防性护理，特别是改变行为生活方式，可能会导致 反常的结果是：身体健康有所改善，但心理健康却在恶化。我们将延长这条线 传统预防性护理在三类2型糖尿病患者中的效果研究与评估 患者：1)先期或临界期；2)起病早；3)控制不良。在建议的加速 纵向设计，我们将研究压力、健康行为和身体健康之间的相互关系。 糖尿病进展的三个不同阶段的心理健康状况。

It is well-established that modifiable, lifestyle-related behaviors including smoking, alcohol, diet, and physical activity greatly contribute to the risk of most common physical health conditions. The recent, almost epidemic increase in the prevalence of diseases associated with these health behaviors, especially hypertension, type 2 diabetes, cardiovascular disease (CVD), and growing disparities in the burden of these conditions across racial and ethnic groups, highlights the urgency of developing effective prevention strategies - however, few intervention studies have produced long-term changes in lifestyle and behaviors. Addressing an omission in existing behavioral intervention models, we propose that what is needed is an examination of behavioral change in the context of the interrelationships among health behaviors, sources of and coping responses to chronic stress, and their influence on physical and mental health. This proposal is motivated by a robust literature that indicates blacks in the US are more likely to engage in poor health behaviors (i.e., tobacco smoking, diets high in fat and carbohydrates, excessive alcohol use) and, expectedly, experience disproportionate burdens of common physical health conditions associated with these behaviors, including CVD and diabetes, relative to non-Hispanic whites - paradoxically, however, population-based and clinic studies have consistently found that blacks, in comparison to whites, have the same or lower rates of most mental disorders, even while experiencing higher rates of psychological distress. We theorize that a defined set of health-related stress-coping strategies (i.e., tobacco smoking, diets high in fat and carbohydrates, excessive alcohol use, etc) have a two-pronged effect that helps to account for this counterintuitive patterning. First, we suggest that these behaviors act on the hypothalamic-pituitary-adrenal (HPA) axis and related stress- hormonal systems which influences the subjective experience and development of stress-associated psychiatric disorder. Second, we believe that the effects of these poor behaviors on pathophysiology, combined with direct effects of stressful living conditions over the life-course, contribute to disproportionate burden of chronic physical health problems among blacks. Succinctly, we propose that blacks and other individuals from highly stressed populations "buy" their relative, comparatively positive rates of mental disorders at the expense of their deteriorating physical health. Therefore, this framework suggests that adherence to traditional preventative care, specifically involving changes in behavioral lifestyle, can lead to a perverse result: improvements in physical health but worsening of mental health. We will extend this line of research and assess the effect of traditional preventative care among three categories of type 2 diabetes patients: 1) pre- or borderline; 2) early onset; and, 3) poorly-controlled. In the proposed accelerated longitudinal design we will examine the inter-relationships among stress, health behaviors, and physical and mental health at three distinct points of diabetes progression.