Linking education, produce provision, and community referrals to improve diabetes care (LINK)

将教育、农产品供应和社区转诊联系起来，以改善糖尿病护理 (LINK)

• 批准号: 10599979
• 负责人: Joshua J Joseph
• 金额: $ 67.73万
• 依托单位: OHIO STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-04-01 至 2027-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10599979
• 关键词: Academic Medical Centers; Address; Adult; Caring; Clinic; Clinical Research; Communities; Community Health Aides; Community Health Education; Control Groups; Cost Analysis; Data; Diabetes Mellitus; Dose; Education; Educational Intervention; Educational Status; Effectiveness; Employment; Equity; Evaluation; Face; Focus Groups; Food; Food Access; Glucose; Glycosylated hemoglobin A; Group Interviews; Health; Health system; Healthcare; Healthcare Systems; Housing; Incidence; Individual; Intervention; Link; Medical center; Methods; National Health and Nutrition Examination Survey; National Institute of Diabetes and Digestive and Kidney Diseases; Non-Insulin-Dependent Diabetes Mellitus; Occupations; Ohio; Outcome; Participant; Pathway interactions; Patients; Pattern; Persons; Population; Prevalence; Protocols documentation; Provider; Randomized; Randomized, Controlled Trials; Schedule; Secure; Testing; Transportation; Universities; Wait Time; Work; blood glucose regulation; combat; community engaged research; community organizations; comparison control; contextual factors; cooking; cost effectiveness; cost-effectiveness ratio; design; diabetes control; diabetes education; diabetes self-management; ethnic diversity; ethnic minority population; experience; food insecurity; food preparation; food resource; glycemic control; health equity; housing instability; improved; incremental cost-effectiveness; innovation; interest; long-term sequelae; low socioeconomic status; member; microcosting; mortality; peer; process evaluation; programs; racial diversity; racial minority population; racial population; response; screening; social; social stigma; success; uptake

Project Summary The combined impacts of type 2 diabetes mellitus (T2D) and food insecurity can be devastating. According to recent NHANES data, 19% of adults with T2D are food-insecure, and T2D prevalence is higher among those with food insecurity. Individuals with T2D and food insecurity have worse diabetes self-management and glycemic control compared to food-secure peers. While addressing food insecurity is important in T2D care, individuals with food insecurity may also have other non-medical, health-related social needs (e.g., transportation barriers, housing instability, job insecurity) that may decrease their ability to attain glucose targets and impact other diabetes-related health outcomes. Partnerships between healthcare systems and community-based organizations have emerged as a promising approach to improve diabetes control in food- insecure populations. Given the design limitations of prior studies, there remains a critical need for randomized controlled trials (RCTs) to test the combined impact of diabetes education, food provision, and addressing unmet social needs on glycemic control in people with T2D experiencing food insecurity. Leveraging existing programs and relationships, we propose to test the combined effects of a food referral program, social needs screening and referral, and diabetes education intervention on hemoglobin A1c in a population of racially/ethnically diverse participants with food insecurity and T2D with A1c ≥7.5% identified at OSUWMC. We plan to use a community-engaged research approach with community members and stakeholders informing the design and focus of the interventions. Aim 1: Using a pragmatic randomized controlled trial (pRCT), to test the effect of produce provision, diabetes education, and community referrals on A1c levels in individuals with T2D experiencing food insecurity. Aim 2: To assess the cost-effectiveness of each of the interventions that comprise the pRCT. Aim 3: To utilize a process evaluation to understand the contextual factors that impact the uptake, effectiveness, and sustainability of the interventions. Impact: Our proposed study aligns with the NIDDK’s interest in clinical studies addressing T2D treatment, complications, and health equity, as our project directly examines health system-based approaches to address non-medical, health-related social needs to improve health outcomes. Innovative solutions are warranted to combat the long-term sequelae of uncontrolled T2D combined with food insecurity that contribute to the two-fold higher all-cause mortality in T2D that disproportionality impacts lower socio-economic status and racial/ethnic minority populations. Food insecurity, unmet social needs, and diabetes education are critical issues that must be addressed to improve T2D treatment, care, and equity. Our study will provide essential evidence that will support both scalable and sustainable partnerships to address these conditions.

项目概要 2 型糖尿病 (T2D) 和粮食不安全的综合影响可能是毁灭性的。 最近的 NHANES 数据显示，19% 患有 T2D 的成年人粮食不安全，并且其中 T2D 患病率更高 患有 T2D 和粮食不安全的个体的糖尿病自我管理能力较差，并且 与食品安全同行相比，血糖控制虽然解决食品不安全问题对于 T2D 护理很重要， 粮食不安全的个人还可能有其他非医疗、与健康相关的社会需求（例如， 交通、住房不稳定、工作不稳定）可能会降低他们获得葡萄糖的能力 目标并影响医疗保健系统和其他与糖尿病相关的健康结果。 以社区为基础的组织已成为改善食品领域糖尿病控制的一种有前景的方法。 鉴于先前研究的设计局限性，仍然迫切需要随机化。 对照试验 (RCT) 测试糖尿病教育、食品供应和解决问题的综合影响 利用现有粮食不安全的 T2D 患者对血糖控制的社会需求未得到满足。 计划和关系，我们建议测试食品推荐计划、社会需求的综合影响 人群中血红蛋白 A1c 的筛查和转诊以及糖尿病教育干预 我们在 OSUWMC 发现了患有粮食不安全和 A1c ≥7.5% 的 T2D 的种族/族裔多样化参与者。 计划使用社区参与的研究方法，由社区成员和利益相关者提供信息 干预措施的设计和重点 目标 1：使用实用的随机对照试验 (pRCT) 进行测试。 农产品供应、糖尿病教育和社区转诊对患有糖尿病的个体 A1c 水平的影响 经历粮食不安全的 T2D 目标 2：评估每项干预措施的成本效益。 目标 3：利用过程评估来了解影响结果的背景因素。 干预措施的采用、有效性和可持续性：我们提出的研究与 NIDDK 对解决 T2D 治疗、并发症和健康公平问题的临床研究感兴趣，作为我们的项目 直接审查基于卫生系统的方法来满足非医疗、与健康相关的社会需求 改善健康结果需要创新的解决方案来对抗不受控制的长期后遗症。 T2D 与粮食不安全相结合，导致 T2D 的全因死亡率高出两倍， 不成比例影响较低的社会经济地位和少数种族/族裔人口的粮食不安全， 未满足的社会需求和糖尿病教育是改善 T2D 必须解决的关键问题 我们的研究将提供支持可扩展和公平的重要证据。 可持续的伙伴关系来解决这些问题。