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: 10078549
• 负责人: Leonard E. Egede
• 金额: $ 76.29万
• 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 2023-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10078549
• 关键词: Address; Adult; Affect; African American; 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.

糖尿病影响着 9.4% 的美国人口，与非洲裔美国人 (AA) 相比，糖尿病的影响尤为严重 在患有糖尿病的人中，AA 和生活在联邦贫困线以下的人更穷。 与白人和生活在白人中的人相比，代谢控制更高，并发症发生率更高，死亡率更高 最高收入水平。粮食不安全（即无法或限制获得营养充足的食物） 比收入更好地预测慢性病，凸显了其作为可改变因素的重要性，占近 28%。 美国糖尿病患者报告粮食不安全，相比之下，非糖尿病患者的这一比例为 12%，并且 AA 食品不安全的糖尿病患者的情况比白人高出 3 倍。 与那些患有糖尿病的人相比，血糖控制较差，饮食质量较低，遵循健康饮食也更困难 目前，解决粮食不安全问题的策略包括补充食品。 形式： 1) 支付食品费用的代金券； 2) 只能在农贸市场使用的代金券/优惠券； 3) 将预包装食品（库存盒）运送到参与者家中 然而，重要的问题尚未得到答复。 糖尿病患者的问题包括： 1) 在食品补充剂选项中，是否有邮寄的库存盒 就实现血糖控制而言，是否优于食品券？ 2) 邮寄库存盒的组合是否有效？ 和食品券优于单独的食品补充剂选项 3) 提供糖尿病教育吗？ 与单独的教育相比，与食品补充剂相结合可以改善临床结果吗？ 为了解决文献中的这一空白，我们提出了一项随机对照试验来测试单独和联合的功效 每月向农贸市场发放食品券，每月根据糖尿病情况邮寄食品库存盒 针对低收入、粮食不安全、患有 2 型糖尿病 (T2DM) 的 AA 患者进行改善血糖控制的教育 2x2 因子设计。