Personal and social-built environmental factors of glucose variability among multi ethnic groups of adults with type 2 diabetes

多种族成人 2 型糖尿病患者血糖变异性的个人和社会环境因素

• 批准号: 10418218
• 负责人: Soohyun Nam
• 金额: $ 43.71万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-01 至 2026-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10418218
• 关键词: Address; Adult; Affect; Affective; Alcohol consumption; Behavior; Blinded; Blood Glucose; Body mass index; Cardiovascular Diseases; Characteristics; Clinical; Complications of Diabetes Mellitus; Data; Data Collection; Development; Diabetes Mellitus; Diet; Eating; Ecological momentary assessment; Elderly; Environment; Environmental Risk Factor; Ethnic Origin; Ethnic group; Exercise; Fasting; Frequencies; Future; Glucose; Glycosylated Hemoglobin; Goals; Health Personnel; Hemoglobin concentration result; High Prevalence; Hour; Hyperglycemia; Income; Individual; Insulin-Dependent Diabetes Mellitus; Intake; Intervention; Knowledge; Life Style; Link; Measures; Mediating; Neighborhoods; Non-Insulin-Dependent Diabetes Mellitus; Nutrient; Outcome; Participant; Patients; Persons; Pharmaceutical Preparations; Physical activity; Pilot Projects; Play; Protocols documentation; Provider; Public Health; Publishing; Quality of life; Questionnaires; Race; Research; Risk; Risk Factors; Role; Sleep; Smoking; Social support; Stress; Teenagers; Time; Well in self; actigraphy; adherence rate; base; blood glucose regulation; built environment; clinical application; clinical decision-making; clinical practice; comorbidity; demographics; diabetes distress; diabetes risk; diabetes self-management; dietary; effective therapy; epidemiology study; ethnic minority; experience; food insecurity; glucose metabolism; glucose monitor; glycemic control; high risk; hypothalamic-pituitary-adrenal axis; improved; insight; lifestyle data; lifestyle factors; macrovascular disease; middle age; mortality; multi-ethnic; personalized intervention; prospective; racial and ethnic; racial discrimination; randomized trial; response; sedentary; sex; sleep quality; social; social cohesion; time interval

PROJECT SUMMARY The pivotal goals of diabetes treatment are to minimize diabetes complications and improve quality of life for individuals with diabetes. In-depth analyses from large scale, randomized trials and epidemiological studies have indicated that glycated hemoglobin (HbA1c), the primary metric for assessing glycemic control, alone may not sufficiently predict the risk of diabetes complications. Near-normal HbA1c level did not consistently improve diabetes complications. People with similar HbA1c values can have markedly different glucose profiles with varying frequencies and amplitudes of hypo- and hyper-glycemia. Glucose variability (GV) refers to fluctuations in blood glucose levels throughout the day (intra-day GV) or over days (inter-day GV) and is an emerging predictor of diabetes complications. GV can be measured in real-time through continuous glucose monitoring (CGM). Considerable research in CGM to understand GV has led to the growing use of CGM in clinical practice among individuals with type 1 diabetes. However, few studies address factors that affect GV in type 2 diabetes (T2D), leaving large gaps in knowledge about how to mitigate GV and improve diabetes outcomes in T2D. Roles of individuals’ lifestyle behaviors, emotional well-being and social-built environments in glucose control have been well documented. Also, real-time data on lifestyle such as day-to-day sleep, physical activity and diet are being generated. However, how these factors are associated with GV has yet to be examined. This study will be one of the first to prospectively examine the temporal relationships among sleep, physical activity, diet, emotional well-being, and GV, incorporating between-person associations and within-person variability among adults of diverse race/ethnicity with T2D. We will use a real-time, data capture strategy, ecological momentary assessment to measure lifestyle factors and emotional well-being. Three 24-hr dietary recalls will be conducted to collect nutrient-level data. We will also use actigraphy as objective measures of sleep and physical activity paired with CGM, a real-time, unobtrusive glucose measure that will be blinded from participants during a study period of 14 days. The specific aims of the study are to: (1) identify risk factors associated with high GV among diverse adults with T2D by examining between-person associations among demographics, clinical factors, lifestyle (sleep, physical activity, diet) factors, the variability of each lifestyle factor, emotional well-being, social-built environmental factors and inter-day GV, (2) identify ‘within- person predictors’ of GV to inform the development of personalized diabetes interventions by examining within- person associations among sleep, physical activity, diet, emotional well-being and intra-day GV, and (3) examine which lifestyle factors either mediate or moderate the relationship between emotional well-being and GV among diverse adults with T2D. The findings from the proposed study will guide clinical decision-making for healthcare providers to facilitate effective treatment using CGM and inform the development of personalized interventions to mitigate GV and improve diabetes outcomes.

项目摘要 糖尿病治疗的关键目标是最大程度地减少糖尿病并发症并改善生活质量 大规模，随机试验和流行病学研究的深入分析 已经表明糖化血红蛋白（HBA1C）是评估血糖控制的主要度量 可能无法充分预测糖尿病并发症的风险。接近正常的HBA1C水平并非一致 改善糖尿病并发症。具有相似HBA1C值的人可能具有明显不同的葡萄糖曲线 低血糖和高血糖的频率和放大器变化。葡萄糖变异性（GV）是指 全天（日内GV）或几天（中间GV）的血糖水平波动，是一个 糖尿病并发症的新兴预测指标。可以通过连续葡萄糖实时测量GV 监视（CGM）。在CGM中进行大量研究以了解GV导致CGM在 1型糖尿病患者的临床实践。但是，很少有研究解决影响GV的因素 2型糖尿病（T2D），在有关如何减轻GV和改善糖尿病的知识中留下了巨大的差距 T2D的结果。个人的生活方式行为，情感幸福和社交环境的角色 在葡萄糖控制中，已经有充分的文献记录。此外，关于生活方式的实时数据，例如日常睡眠， 体育锻炼和饮食正在产生。但是，这些因素与GV如何相关 被检查。这项研究将是第一个前瞻性研究临时关系的研究之一 睡眠，体育锻炼，饮食，情感健康和GV，结合了人际关系和 T2D的成年人种族/民族成年人之间的人体内变异性。我们将使用实时的数据捕获 策略，生态瞬时评估，以衡量生活方式因素和情感幸福感。三个24小时 饮食召回将进行收集营养水平的数据。我们还将以行为摄影为目标 与CGM配对的睡眠和体育锻炼的测量，这是一种实时的，不引人注目的葡萄糖测量 在14天的研究期间对参与者视而不见。该研究的具体目的是：（1）确定风险 通过检查人际关系的关联，与T2D不同的成年人中与高GV相关的因素 在人口统计学，临床因素，生活方式（睡眠，体育锻炼，饮食）因素中，每种因素的可变性 生活方式因素，情感福祉，社会建立的环境因素和日期GV，（2）确定“内部” GV的人预测因素，以检查个性化糖尿病干预措施的发展 睡眠，体育锻炼，饮食，情绪健康和日内GV之间的人交往，以及（3） 检查哪些生活方式因情感幸福感与情感幸福与之间的关系调节 T2D成年人的GV。拟议研究的发现将指导临床决策 让医疗保健提供者使用CGM促进有效治疗，并告知个性化的开发 减轻GV并改善糖尿病结果的干预措施。