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

识别并减少患有 1 型糖尿病的经济弱势群体和少数民族年轻人的结局差异

• 批准号: 10242732
• 负责人: Shivani Agarwal
• 金额: $ 19.76万
• 依托单位: ALBERT EINSTEIN COLLEGE OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-01 至 2023-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10242732
• 关键词: Achievement; Acute; Address; Adult; Affect; Age; American; Caring; Childhood; Clinic; Complement; Control Groups; Data; Development; Diabetes Mellitus; Diabetic Ketoacidosis; Doctor of Medicine; Elements; Endocrinologist; Environment; Ethnic Origin; Face; Foundations; Future; Glean; Glycosylated hemoglobin A; Goals; Health; Health Services; Healthcare; Hispanics; Individual; Insulin-Dependent Diabetes Mellitus; Intervention; Interview; Investigation; K-Series Research Career Programs; Life; Master of Public Health; Mediating; Medical; Mental disorders; Mentors; Methods; Minority; Modeling; Monitor; Not Hispanic or Latino; Outcome; Participant; Patients; Population; Process; Race; Randomized Controlled Trials; Recurrence; Research; Research Personnel; Risk; Sampling; Site; Social Work; Socioeconomic Status; Suggestion; Testing; Time; Training; Treatment Efficacy; Update; Visit; Work; adverse outcome; base; care coordination; care outcomes; career development; comorbidity; critical period; design; diabetes education; diabetic; disorder control; disparity reduction; efficacy evaluation; efficacy testing; experience; follow-up; glycemic control; group intervention; health care disparity; health care model; high risk; improved; improved outcome; innovation; insight; low socioeconomic status; mortality; multidisciplinary; novel; patient oriented; peer; programs; skills; social determinants; social health determinants; social inclusion; socioeconomics; treatment as usual; trend; young adult

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.

迫切需要了解护理方面的进一步差异并改善年轻人 (YA) 的结果 只有 13% 的青少年（18-30 岁）患有低社会经济 (SES) 和少数民族身份的 1 型糖尿病 (T1D)。 全国范围内的 T1D 大大实现了美国糖尿病协会建议的 HbA1c 目标 <7.0% 长期风险暴露和日后死亡率的增加 年轻人面临着独特的挑战，包括 向成年期的发展过渡以及向成人护理的医疗保健过渡，使其成为一个关键时期 与白人同龄人相比，低社会经济地位和少数族裔/族裔的 1 型糖尿病青少年处于早期干预状态。 不良后果的风险不成比例地较高，包括血糖控制较差和糖尿病发生率增加 复发性糖尿病酮症酸中毒和精神合并症的部分原因可能是未被认识和认识。 尽管存在这些明显的差异并且总体结果不佳，但健康问题的社会决定因素尚未得到解决。 YA，很少有研究关注这些高风险的 T1D YA。因此，本研究的总体目标。 建议 1) 确定导致高风险青少年不良结果的健康社会决定因素 T1D 和 2) 开发和实施创新的定制解决方案，以解决超出范围的差异 Shivani Agarwal，医学博士，公共卫生硕士，是一位成年内分泌学家和早期医生。 以前开发过成功的成人医疗保健的糖尿病和健康服务研究人员 针对 T1D 青少年的过渡干预，将根据以下情况加强解决高风险青少年的需求： 从该提案中收集的信息 在具体目标 1 中，来自国家 T1D 交流诊所的 YA 的数据。 网络将用于识别影响低社会经济地位和少数族裔血糖控制的社会决定因素 与患有 T1D 的社会经济地位较高的非少数民族青少年相比，在具体目标 2 中，将进行定性访谈。 当地确定患有 T1D 的高风险青少年的护理相关需求和挑战，并征求潜力 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。 Agarwal 博士将使用 多学科、多利益相关者咨询小组加强她的过渡干预模式，以解决 她还将在试点项目中测试强化干预措施对成人护理保留率的效果。 随机对照试验完成后，这些研究将为有意义的、可解决的问题提供新的见解。 患有 T1D 的高危青少年的健康决定因素，为医疗保健转型提供新模式以解决 这项工作将构成多地点随机对照试验测试 R01 应用的基础。 阿加瓦尔博士寻求获得全面的糖尿病过渡计划相对于常规护理的功效。 除了定量、定性和干预之外，差异和糖尿病调查的重要技能 通过提出职业发展奖的方法，她的最终目标是成为一名独立的人。 差异和卫生服务调查人员的重点是改善年轻成人糖尿病人群的健康状况。