Identifying and Reducing Disparities in Outcomes Among Economically Vulnerable and Minority Young Adults with Type 1 Diabetes

迫切需要进一步了解护理方面的差异，并改善年轻人的结果（YA） 1型糖尿病（T1 D）低社会经济地位（SES）和少数民族地位。只有13%的青年人（18-30岁） T1 D在全国范围内实现美国糖尿病协会推荐的HbA 1c <7.0%的目标， 增加了以后生活中的长期风险暴露和死亡率。年轻人面临独特的挑战，包括 向成人的发育过渡和向成人护理的医疗保健过渡，使其成为一个关键时期， 及早干预。与他们的白色同龄人相比，具有低社会经济地位和少数民族/种族的T1 D的YA在 不良结局的风险不成比例地更高，包括血糖控制较差和 复发性糖尿病酮症酸中毒和精神共病。这可能部分是由于未被承认和 未处理的健康的社会决定因素。尽管存在这些明显的差异和总体结果不佳， 是的，很少有研究关注这些高风险的T1 D。因此，本项目的总体目标 建议1）确定导致高风险YA不良结局的健康社会决定因素， T1 D和2）开发和实施创新的量身定制的解决方案，以解决超出 传统的医疗环境。Shivani Agarwal，医学博士，M.P.H.是一名成年内分泌学家， 糖尿病和健康服务研究人员，他以前开发了一种成功的基于成人的医疗保健 对患有T1 D的YA进行过渡干预，将根据以下情况加强干预，以满足高风险YA的需求： 从这一提议中收集的信息。在特定目标1中，来自国家T1 D交换诊所YA的数据 网络将用于确定影响低SES和少数族裔血糖控制的社会决定因素 与社会经济地位较高的非少数族裔青少年T1 D相比。在具体目标2中，将进行定性访谈 在当地确定T1 D高风险YA的护理相关需求和挑战，并征求潜在的 解决方案在具体目标3中，基于对社会决定因素如何影响护理的更好理解， 参与，护理过程和血糖控制在高风险的YA与T1 D，Agarwal博士将使用一个 多学科多利益攸关方咨询小组，以加强她的过渡干预模式， 差距。她还将在一个试点项目中测试增强干预措施对成人护理保留的有效性 随机对照试验。完成后，这些研究将提供新的见解， T1 D高危YA患者的健康决定因素，为医疗保健转型提供新模式，以解决 差距。这项工作将成为R 01应用于多中心随机对照试验测试的基础 综合糖尿病过渡计划对常规护理的有效性。阿加瓦尔博士试图获得 除了定量、定性和干预外，还应掌握差距和糖尿病调查方面的重要技能 通过拟议的职业发展奖的方法。她的最终目标是成为一名独立的 差异和卫生服务研究人员专注于改善年轻成人糖尿病人群的健康状况。

There is a critical need to further understand disparities in care and improve outcomes in young adults (YA) with type 1 diabetes (T1D) of low socioeconomic (SES) and minority status. Only 13% of YA (ages 18-30) with T1D nationally achieve the American Diabetes Association-recommended HbA1c target of <7.0%, substantially increasing long-term risk exposure and mortality later in life. Young adults have unique challenges, including the developmental transition to adulthood and healthcare transition to adult care, making it a critical period to intervene early. Compared to their white peers, YA with T1D of low SES and minority race/ethnicity are at disproportionately higher risk for adverse outcomes, including worse glycemic control and increased rates of recurrent diabetic ketaoacidosis and psychiatric comorbidity. This may be in part due to unrecognized and unaddressed social determinants of health. Despite these stark discrepancies and poor overall outcomes in YA, very little research has focused on these high-risk YA with T1D. Thus, the overall objectives of this proposal are to 1) identify social determinants of health that contribute to poor outcomes in high-risk YA with T1D and 2) develop and implement innovative tailored solutions to address disparities that extend beyond the traditional healthcare environment. Shivani Agarwal, M.D., M.P.H. is an adult endocrinologist and early diabetes and health services researcher who has previously developed a successful adult-based healthcare transition intervention for YA with T1D, which will be enhanced to address high-risk YA needs based on information gleaned from this proposal. In Specific Aim 1, data from YA in the national T1D Exchange Clinic Network will be used to identify social determinants that impact glycemic control in low SES and minority compared to higher SES non-minority YA with T1D. In Specific Aim 2, qualitative interviews will be conducted locally to determine care-related needs and challenges for high-risk YA with T1D, and solicit potential solutions. In Specific Aim 3, based upon an improved understanding of how social determinants affect care engagement, care processes, and glycemic control in high-risk YA with T1D, Dr. Agarwal will use a multidisciplinary multiple stakeholder advisory panel to enhance her transition intervention model to address disparities. She will also test the enhanced intervention’s efficacy on retention in adult care in a pilot randomized controlled trial. When complete, these studies will offer new insight on meaningful, addressable determinants of health in high-risk YA with T1D, to inform a new model for healthcare transition to address disparities. This work will form the basis for an R01 application of a multi-site randomized controlled trial testing the efficacy of a comprehensive diabetes transition program against usual care. Dr. Agarwal seeks to acquire important skills in disparities and diabetes investigation in addition to quantitative, qualitative, and intervention methods through the proposed career development award. Her ultimate goal is to become an independent disparities and health services investigator focused on improving health in young adult diabetes populations.