Food and Resources Expanded to Support Health and Type 2 Diabetes (FRESH-T2D)

扩大食品和资源以支持健康和 2 型糖尿病 (FRESH-T2D)

• 批准号: 10580984
• 负责人: Melanie Daniela Hingle
• 金额: $ 29.46万
• 依托单位: UNIVERSITY OF ARIZONA
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-01-20 至 2025-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10580984
• 关键词: Address; Adherence; Adult; Affect; American; Arizona; Behavior; Belief; Blood Glucose; Body Weight; COVID-19 pandemic; Carbohydrates; Certification; Chronic; Chronic Disease; Collaborations; Communities; Coping Skills; County; Custom; Data; Diabetes Mellitus; Diet; Dietitian; Disease Management; Disparity; Education; Educational Intervention; Ensure; Evaluation; Federally Qualified Health Center; Fiber; Food; Food Assistance Programs; Food Packaging; Future; Glycosylated hemoglobin A; Goals; Health; Health Resources; Healthy Eating; Home; Household; Human Resources; Incidence; Individual; Intake; Intervention; Life Style; Low Income Population; Low income; Medical; Methods; Modeling; Monitor; Morbidity - disease rate; National Institute of Diabetes and Digestive and Kidney Diseases; Neighborhood Health Center; Non-Insulin-Dependent Diabetes Mellitus; Nutrient; Nutritional; Nutritionist; Outcome; Participant; Patients; Persons; Pharmaceutical Preparations; Pilot Projects; Problem Solving; Process; Public Health; Randomized; Randomized Controlled Clinical Trials; Recipe; Recommendation; Research; Resources; Risk; Risk Reduction; Security; Self Care; Series; Severities; System; Testing; Underinsured; Uninsured; Visit; Waiting Lists; Work; acceptability and feasibility; blood glucose regulation; care coordination; care seeking; clinically relevant; coping; cost; design; diabetes educator; diabetes self-management; dietary; economic disparity; education resources; evidence base; food insecurity; food resource; food security; fruits and vegetables; glycemic control; health related quality of life; improved; intervention program; mortality; nutrition; patient engagement; patient oriented; personalized medicine; prevent; recruit; response; retention rate; social factors; social health determinants; uptake

In 2020, more than 38.5 million (10.5%) U.S. households were without reliable access to sufficient quantities of affordable, nutritious food due to limited money or other resources. Food insecurity, poor nutrition, and economic disadvantage are critical social determinants of health that contribute to disparities in type 2 diabetes mellitus (T2DM), a serious diet-sensitive chronic disease affecting more than 20% of food insecure adults. Coping strategies favor inexpensive, ultra-processed foods that substantially diminish diet quality and are associated with increased incidence and severity of T2DM, including poorer glycemic control and excess body weight. Given that numerous social factors and systems contribute to and perpetuate food insecurity and poor diabetes outcomes, there is a demonstrable need for multilevel (individual, household, community) food-focused interventions to effectively and sustainably address the diet quality of persons with, or at risk of, T2DM. To our knowledge, no studies have rigorously tested whether intervention programs explicitly designed to improve both food and nutrition security of low-income persons with T2DM are feasibly delivered by personnel at a Federally Qualified Health Center (FQHC), acceptable to patients seeking care in their medical home, or are capable of producing clinically relevant changes in T2DM endpoints. These are questions we will explore in our proposed randomized wait-list controlled pilot study— Food and Resources Expanded to Support Health and Type 2 Diabetes (FRESH-T2DM)— in which our previously developed food and diabetes self-management education (DSME) intervention (FRESH) will be delivered to 50 adult FQHC patients with T2DM and food insecurity twice monthly, for 6 months. The FRESH intervention consists of bimonthly food provision; a series of recipes that feature FRESH foods; diabetes self-management education (DSME) resources; and four, 30-minute visits with an FQHC Registered Dietitian Nutritionist and Certified Diabetes Educator who will help participants utilize FRESH resources to meet personalized treatment goals. We will build upon our prior work and existing collaborations with colleagues at El Rio Community Health Center, a Federally Qualified Health Center serving >110,000 underinsured, uninsured patients and the Community Food Bank of Southern Arizona, a regional food bank serving 180,000 Arizonans across 5 counties to: (Specific Aim 1) Assess the feasibility, acceptability, and participant uptake of our FRESH intervention, delivered to 50 food insecure adults with T2DM at their medical home, El Rio Community Health Center, and (Specific Aim 2) Explore changes in blood glucose control, diet quality, food security, diabetes self-care behaviors, and health-related quality of life among participants at 3 and 6 months. Completion of our pilot study —submitted in response to NIDDK PAS-20-160 —will produce data to inform the rationale and design of a future definitive randomized controlled clinical trial, including recruitment, retention, adherence, and cost data. Our long-term goal is to produce a tested, efficacious model of coordinated care capable of replication and scaling across other FQHCs and food bank networks.

2020年，美国家庭超过3850万（10.5％）的家庭无法获得足够数量 由于资金有限或其他资源，负担得起的营养食品。粮食不安全，营养不良和经济 缺点是健康的关键社会决定者，导致2型糖尿病的差异 （T2DM），一种严重的饮食敏感慢性疾病，影响20％以上的不安全成年人。应对 策略有利于廉价，超级加工的食物，这些食物是降低饮食质量并相关的饮食质量 随着T2DM的发病率和严重程度增加，包括血糖控制较差并超过体重。给出 众多的社会因素和系统导致粮食不安全和糖尿病不良 结果，对以食品为中心的多层次（个人，家庭，社区）的需求明显 干预措施有效，可持续地解决具有T2DM或有风险的人的饮食质量。向我们 知识，没有严格测试干预计划是否明确设计以改善两者 T2DM低收入人员的食物和营养安全是由联邦政府的人员提供的 合格的健康中心（FQHC），在其医疗家中寻求护理的患者可以接受或能够接受 在T2DM端点中产生临床相关的变化。这些是我们将在提议中探讨的问题 随机等待名单受控的试点研究 - 粮食和资源扩大以支持健康和类型 2种糖尿病（Fresh-T2DM） - 我们先前开发的食物和糖尿病仅仅是管理教育 （DSME）干预（新鲜）将交付给50名T2DM和粮食不安全的成人FQHC患者 每月两次，持续6个月。新的干预措施包括两次粮食供应；一系列食谱 那是新鲜食品；糖尿病自我管理教育（DSME）资源；和四个30分钟的访问 与FQHC注册的营养学营养学家和认证的糖尿病教育者一起，他们将帮助参与者使用 实现个性化治疗目标的新资源。我们将基于我们先前的工作和现有 与联邦合格的健康中心的El Rio社区健康中心的大学合作 > 110,000名未保险的患者和亚利桑那州南部社区食品银行 食品银行为5个县的180,000个亚利桑那人服务：（具体目标1）评估可行性，可接受性， 并参与我们的新干预措施，在其医疗中送给了50名没有T2DM的食品不安全的成年人 主页，El Rio社区健康中心和（特定目标2）探索血糖控制的变化，饮食 3岁和 6个月。完成我们的试点研究 - 响应NIDDK PAS-20-160的提议 - 将产生数据 告知未来确定的随机对照临床试验的理由和设计，包括招聘， 保留，依从性和成本数据。我们的长期目标是生产经过协调的测试，高效的模型 能够在其他FQHC和食品银行网络之间进行复制和扩展。