Impact of Disparities in Food Security on Glycemic Control and Health Care Utilization Among Youth and Young Adults with Diabetes

项目摘要/摘要 尽管最近在治疗方面取得了进展，但太多的年轻人和年轻人(YYA)患有1型糖尿病(T1D) 和2型糖尿病(T2D)，特别是那些少数族裔/民族的人，不能实现最佳的血糖控制 从而使他们面临更高的急性和慢性并发症风险。在社会决定因素中， 健康、家庭粮食不安全(HFI)可能是实现血糖控制的关键障碍，并可能导致 增加了医疗保健的利用率和成本，但几乎所有有限的研究都是横断面的 在患有T2D的老年人中进行。此外，少数族裔受到肾综合征出血热的影响不成比例， 这可能是糖尿病结局存在类似差异的原因。我们的初步工作表明，HFI是一种 在患有糖尿病的YYA中普遍存在这种现象，影响19%的T1D和38%的T2D。 这些比率大大超过了2015年全国预估的12.7%。我们建议进行一项纵向研究， 搜索食品安全(SFS)队列研究，旨在作为正在进行的CDC/DDT- 和NIH/NIDDK资助的青年糖尿病研究4，这是一项种族/民族多元化的糖尿病研究 在年轻时被确诊。SFS研究的目的是：(1)启动对1,187名YYA的粮食不安全队列研究 年龄在15-35岁(53%的少数人)，通过在正在进行的T1D和T2D中添加两个数据收集时间点 Search 4研究；(2)前瞻性评估HFI对患有以下疾病的青少年血糖控制变化的影响 T1D和T2D；(3)量化营养、心理健康和行为途径的中介作用 哪些食物不安全可能会影响患有T1D和T2D的YYA患者的血糖控制变化；以及(4)前瞻性 评价HFI对卫生服务利用、医疗和非医疗卫生服务变化的影响 T1D和T2D的YYA成本。将SFS数据与搜索收集的大量数据结合使用将 高效地实现这些目标。这项拟议的研究将是第一项研究 粮食不安全对不同人口的血糖控制、卫生保健利用和费用的影响 美国YYA与T1D和T2D。我们的跨学科团队由公认的专家Liese博士和Mdoza博士领导 在糖尿病、流行病学、儿科医学、差异和粮食不安全方面的研究，并得到 团队由儿科内分泌学、心理学、健康行为学、健康经济学、 生物统计学和因果推理模型。这项研究有可能改变糖尿病的政策和临床 通过确定需要对患有糖尿病的年青人的粮食不安全进行更深入的评估， 重新评估糖尿病管理和对食物不安全患者的营养建议，以及 将食品援助资源纳入糖尿病患者的常规护理。它还将通知 在未来的糖尿病研究试验中，调整干预措施，以解决粮食不安全问题，特别是针对少数群体。

PROJECT SUMMARY / ABSTRACT Despite recent advances in therapy, far too many youth and young adults (YYAs) with type 1 diabetes (T1D) and type 2 diabetes (T2D), particularly those of minority race/ethnicity, do not achieve optimal glycemic control thus placing them at increased risk of acute and chronic complications. Among the social determinants of health, household food insecurity (HFI) may be a key barrier to achieving glycemic control and may lead to increased health care utilization and costs, but virtually all of the limited research was cross-sectional and conducted in older adults with T2D. Moreover, racial/ethnic minorities are disproportionately affected by HFI, which may underlie similar disparities in diabetes outcomes. Our preliminary work suggests that HFI is a common phenomenon in YYAs with diabetes, affecting 19% of YYAs with T1D and 38% of those with T2D. These rates significantly exceed the 2015 national estimate of 12.7%. We propose a longitudinal study, the SEARCH Food Security (SFS) cohort study, which is designed as an ancillary study to the ongoing CDC/DDT- and NIH/NIDDK-funded SEARCH for Diabetes in Youth 4 study, a racially/ethnically diverse study of diabetes diagnosed in youth. The aims of the SFS study are to: (1) Initiate a food insecurity cohort study of 1,187 YYAs aged 15-35 years (53% minority) with T1D and T2D by adding two data collection time points to the ongoing SEARCH 4 study; (2) Prospectively evaluate the influence of HFI on changes in glycemic control in YYAs with T1D and T2D; (3) Quantify the mediating role of nutritional, mental health, and behavioral pathways through which food insecurity may affect changes in glycemic control in YYAs with T1D and T2D; and (4) Prospectively evaluate the influence of HFI on changes in health care utilization and medical and non-medical health care costs in YYAs with T1D and T2D. Using the SFS data in tandem with extensive data collected by SEARCH will be highly efficient for addressing these aims. The proposed study will be the first cohort study to examine the impact of food insecurity on glycemic control, health care utilization, and costs among a diverse population of US YYAs with T1D and T2D. Our transdisciplinary team is led by Drs. Liese and Mendoza, recognized experts in diabetes, epidemiology, pediatric medicine, disparities, and food insecurity research, and is supported by a team comprising expertise in pediatric endocrinology, psychology, health behaviors, health economics, biostatistics, and causal inference modeling. The study has the potential to alter diabetes policy and clinical practice by establishing the need for more in-depth assessments of food insecurity among YYAs with diabetes, re-assessment of diabetes management and nutrition recommendations for food-insecure patients, and integration of food assistance resources into routine care for persons with diabetes. It will also inform the tailoring of interventions to address food insecurity, especially for minorities, in future diabetes research trials.