Case Study: A Community-Based Survey for Pre-Diabetes
| At a Glance |
Research Question
This study aims to examine the physiologic influences and health conditions that often occur before diabetes is diagnosed, to determine if they are different across race and ethnicity, and if so, what explanatory factors (such as environment, family history, or socioeconomic status) contribute to those differences.
NERI's Role
Employing a multi-level approach, NERI is beginning a large, community-based epidemiologic study to disentangle the relative contributions of these different influences on T2DM disparities.
Results
This study is currently conducting field work. If successful, this project will inform ways in which excess risk of type 2 diabetes observed among vulnerable populations can be reduced.
Funding Institution
This research is funded by a grant from the National Institute of Diabetes and Digestive and Kidney Diseases.
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Diabetes in the U.S. is at epidemic levels. Yet some regions and races suffer more than others. What are the roots of these disparities? NERI has begun a study of type 2 diabetes that examines the influence of the multilevel contributors on the observed disparities in diabetes prevalence.
NERI's Role
NERI has designed and is currently running a random population based survey involving more than 3000 in-home interviews and acquisition of biophysiologic measures (via a blood draw). Study participants will be visited multiple times over the course of the study (bilingual interviewers are used because 1/3 of study participants are expected to be Hispanic).
NERI has extensive expertise in this kind of large, in person survey that involves phlebotomy. One key approach to managing this challenge has been the field efforts prior to conducting a single interview. NERI understands that providing appropriate, and appropriately timed, information for the potential participants goes a long way to helping them understand the importance of the research and how it affects them and their community. By including neighborhood effects and biophysiologic influences such as ancestry markers, this study will enhance understanding of basic disease processes and pathways.
Results
Previous NERI research has shown that socioeconomic status (SES), a potentially modifiable influence, has a much stronger impact on the disparities in type 2 diabetes prevalence than race or ethnicity. This suggests that focusing on race/ethnicity as the primary determinants of these disparities overemphasizes the importance of biomedical factors and diverts efforts from more important and potentially modifiable social determinants.
- Structural (e.g., SES)
- Demographic (e.g., age and gender)
- Environmental (e.g., neighborhood location and accessibility of medical care)
- Behavioral (e.g., nutrition and physical activity)
- Bio-physiologic (e.g., insulin resistance and inflammatory processes)
- Genetic (e.g. family history)
By focusing on risk states preceding the onset of type 2 diabetes, the current study will contribute to the understanding of upstream disparities. In addition, the study results may help prioritize strategies for primary and secondary prevention of type 2 diabetes. The study will facilitate understanding of disease pathways within their social and environmental contexts, aiding clinical providers and policy makers to enhance their ability to prevent and treat type 2 diabetes.