Metabolic, behavioral and social determinants of youth-onset T2D

摘要 青年起病的2型糖尿病(YT2D)已成为最重要的临床和公共卫生问题之一 当前肥胖症流行的后果。不仅YT2D的比率在过去的几年里一直在增加 多年来，在这一人群中实现和维持最佳的血糖控制构成了独特的挑战。 此外，年轻人的疾病发展速度比成年人快，患糖尿病的风险更高。 并发症比成人更早出现在疾病的过程中。重要的是，两国之间存在着严重的差距 YT2D的负担，种族/少数族裔面临的风险最大。尽管有这些事实，但病理生理学 导致YT2D的发展还不清楚，对其社会决定因素更是知之甚少 与YT2D风险相关的健康(SDOH)。鉴于SDOH是疾病的主要驱动力， 种族/少数族裔，迫切需要评估SDOH和生物因素在 形成了开发YT2D的风险。针对RFA-DK-21-002，我们建议建立一个队列 蒙蒂菲奥里医学中心(Cham)儿童医院招募有YT2D风险的儿童 儿科初级保健实践(布朗克斯最大的儿童保健服务提供者)。布朗克斯是 全国种族和民族最多元化的县之一；布朗克斯的儿童负担很重 与肥胖有关的代谢紊乱以及社会和经济逆境(例如，粮食不安全)。因此，我们的 SITE处于非常有利的地位，有助于更好地了解导致YT2D不平等的因素 并为制定更有效的预防和血糖控制战略提供信息。我们的整体 目标是：(1)开发更精确和临床上可行的预测，以确定哪些人真正处于危险之中 为了开发YT2D，通过评估代谢和生活方式因素、社会经济因素的综合影响 地位(SES)、社会文化因素和其他SDoH；(2)增加对 (3)为关键方面的深入辅助研究提供平台和辅助基础设施 使用队列数据和银行样本与YT2D相关

ABSTRACT Youth-onset type 2 diabetes (YT2D) has emerged as one of the most important clinical and public health consequences of the current obesity epidemic. Not only have the rates of YT2D been increasing over the years, achieving and maintaining optimal glycemic control in this population poses unique challenges. Furthermore, disease progression in youth is faster than in adults, with a higher risk of developing diabetes complications earlier in the disease process than adults. Importantly, there are profound disparities in the burden of YT2D, with racial/ethnic minorities the most at risk. Despite these facts, the pathophysiology that leads to the development of YT2D is not well understood and even less is known about the social determinants of health (SDOH) associated with YT2D risk. Given that SDOH are major drivers of disease among racial/ethnic minorities, there is a critical need to assess the intersection of SDOH and biological factors in shaping the risk of developing YT2D. In response to RFA-DK-21-002, we propose to establish a cohort of children at risk of YT2D by recruiting from the Children’s Hospital at Montefiore Medical Center (CHAM) pediatric primary care practices (the largest provider of children’s health services in the Bronx). The Bronx is one of the most racially and ethnically diverse counties in the country; children in the Bronx have a high burden of obesity-related metabolic disorders and of social and economic adversities (e.g. food insecurity). Thus, our site is very well positioned to contribute to a better understanding of the factors that lead to inequities in YT2D risk and to inform development of more effective prevention and glycemic control strategies. Our overall objectives are to: (1) Develop more precise and clinically feasible prediction of which individuals are truly at risk for developing YT2D, by assessing the combined impact of metabolic and lifestyle factors, socio-economic status (SES), sociocultural factors, and other SDoH; (2) Increase understanding of the physiologic drivers of YT2D; (3) Provide a platform and supportive infrastructure for in-depth ancillary studies on critical aspects related to YT2D using cohort data and banked specimens