Lowering the Impact of Food insecurity in African American Adults with Type 2 Diabetes Mellitus (LIFT-DM)

降低粮食不安全对患有 2 型糖尿病的非裔美国成人的影响 (LIFT-DM)

• 批准号: 10408242
• 负责人: Leonard E. Egede
• 金额: $ 1.05万
• 依托单位: MEDICAL COLLEGE OF WISCONSIN
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-05-03 至 2022-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10408242
• 关键词: Address; Adult; Affect; African American; African American population; Behavior; Blood Pressure; Centers for Disease Control and Prevention (U.S.); Chronic Disease; Clinical; Complication; Control Groups; Diabetes Mellitus; Dietary intake; Education; Food; Food Supplementation; Glycosylated hemoglobin A; High Prevalence; Home; Income; Individual; Intervention; Knowledge; Lead; Lipids; Literature; Low income; Low-Density Lipoproteins; Measures; Mediator of activation protein; Metabolic Control; Non-Insulin-Dependent Diabetes Mellitus; Nutritional; Outcome; Participant; Population; Quality of life; Randomized; Randomized Controlled Trials; Reporting; Self Care; Self Efficacy; Ships; Testing; Time; Walkers; blood pressure reduction; cost; cost effective; cost effectiveness; design; diabetes education; dietary; effectiveness testing; empowerment; farmers markets; federal poverty level; food insecurity; glycemic control; good diet; improved; intervention effect; mortality; program costs; voucher

Diabetes affects 9.4% of the US population and disproportionately affects African Americans (AAs) compared to whites. Among individuals with diabetes, AAs and those living below the federal poverty level have poorer metabolic control, higher complication rates and higher mortality compared to Whites and those living at the highest income level. Food insecurity (i.e. an inability to or limitation in accessing nutritionally adequate food) better predicts chronic disease than income, highlighting its importance as a modifiable factor. Almost 28% of the US population with diabetes report food insecurity, compared to 12% of those without diabetes, and AAs are 3 times more likely than whites to be food insecure. Food insecure individuals with diabetes have worse glycemic control, report lower dietary quality and more difficulty following a healthy diet compared to those who are not food insecure. Currently tested strategies to address food insecurity include food supplementation in the form of: 1) vouchers to cover cost of food; 2) vouchers/coupons that can only be used at farmer’s markets; and 3) shipments of pre-packaged food (stock boxes) to participants homes. However, important unanswered questions in individuals with diabetes include: 1) Within food supplementation options, are mailed stock boxes superior to food vouchers in terms of achieving glycemic control? 2) Is the combination of mailed stock boxes and food vouchers superior to either food supplementation option alone? 3) Does providing diabetes education in combination with food supplementation lead to improved clinical outcomes compared to education alone? To address this gap in the literature, we propose an RCT to test the separate and combined efficacy of monthly food vouchers to farmers market and monthly mailed food stock boxes layered upon diabetes education in improving glycemic control in low income, food insecure, AAs with Type 2 Diabetes (T2DM) using a 2x2 factorial design.

糖尿病会影响美国人口的9.4％，并对非洲裔美国人（AAS）影响不成比例 到白人。在患有糖尿病的人中，AAS和生活在联邦贫困层面以下的人较差 与白人相比，代谢控制，较高的并发症率和更高的死亡率 最高收入水平。粮食不安全（即无法或无法限制获得营养充足的食物） 比收入更好地预测慢性疾病，强调其作为可修改因素的重要性。几乎28％ 美国糖尿病人口报告粮食不安全，而没有糖尿病的人中有12％，AAS和AAS 粮食不安全的可能性是白人的3倍。食品不安全的糖尿病患者恶化 血糖控制，报告饮食质量较低，健康饮食后比 不是粮食不安全的。目前已测试的解决粮食不安全的策略包括补充食物 形式：1）支付食物费用的代金券； 2）只能在农贸市场上使用的代金券/优惠券； 3）装满预包装的食物（库存箱）以参与房屋。但是，重要的是没有回答 糖尿病患者的问题包括：1）在食物补充选择中，是邮箱 在获得血糖控制方面，优于食品凭证？ 2）是邮寄的库存箱的组合 和食品券仅优于任何一种补充食品？ 3）确实提供糖尿病教育 与补充食物相比，与仅教育相比，补充食物会改善临床结果吗？ 为了解决文献中的这一差距，我们提出了一个RCT来测试单独和组合的效率 每月向农贸市场的食品凭证和每月邮寄的食品库存盒，分层糖尿病 使用低收入，粮食不安全，具有2型糖尿病（T2DM）的AA的血糖控制的教育 2x2阶乘设计。