Julie A. Wagner, Ph.D. - US grants

[unreadable] DESCRIPTION (provided by applicant): African American (AA) women carry a disproportionate burden of T2DM and some of its complications. The stress of exposure to discrimination may contribute to altered blood pressure, glycemia, insulin resistance, and self-care behaviors, thereby increasing risk for complications. Our aims are to: 1) Establish proof of principle that cumulative lifetime exposure to perceived discrimination is related to baseline behavioral and physiological factors that underlie complications in AA women with T2DM; 2) Establish proof of principal that cumulative lifetime exposure to perceived discrimination primes individuals for heightened reactivity to acute stressors. 3) Explore candidate modifiers of the relationship between cumulative lifetime exposure to perceived discrimination and stress reactivity; and 4) Refine and expand plans for a daily process study of these variables with diabetic AA women to support an R01 application. Forty AA women and 40 White women with T2DM will participate. On day 1, participants will perform 24-hour ambulatory blood pressure monitoring. On day 2, participants will complete baseline measures of exposure to discrimination, fasting glucose, insulin resistance, and blood pressure. Then we will expose the participants to a public speaking task in the laboratory to detect metabolic and cardiovascular reactivity to the acute stressor. On day 3, participants will again perform 24-hour ambulatory blood pressure monitoring. Five hypotheses will be tested. Ha1: There will be an effect for race on cumulative lifetime exposure to perceived discrimination. AA women will report greater cumulative lifetime exposure to perceived discrimination than White women. Ha2: There will be an effect for cumulative lifetime exposure to perceived discrimination on resting blood pressure, insulin resistance, and diabetes self- care behaviors. Higher cumulative lifetime exposure to perceived discrimination will be associated with higher resting blood pressure, higher insulin resistance, and lower diabetes self-care behaviors. Ha3: There will be an effect for stressor period on blood pressure and glycemia. Post-stressor blood pressure and glycemia will be higher than baseline levels. Ha4: There will be an effect for cumulative lifetime exposure to perceived discrimination on reactivity to experimental stressor. Higher lifetime exposure to perceived discrimination will predict greater glycemic and blood pressure reactivity to an acute experimental stressor. Ha5: There will be an effect for cumulative lifetime exposure to perceived discrimination on delayed recovery from an experimental stressor. Higher levels of lifetime exposure to perceived discrimination will predict less nighttime blood pressure dipping in response to an acute experimental stressor. Ha6: There will be trends for modifiers of the association between cumulative lifetime exposure to perceived discrimination and stress reactivity. Social support, SES, and coping will be explored. If successful, this R21 will lead to an R01 application for a daily process study with greater ecological validity. Eventually, this line of research will inform interventions to help AA women with T2DM manage racial stress, thereby reducing disparities in diabetes outcomes. African American (AA) women carry a disproportionate burden of T2DM and some of its complications. Exposure to the mental stress of racial discrimination may contribute to altered blood pressure, glycemia, insulin resistance, and self-care behaviors, thereby increasing risk for complications. This study will establish proof of principle that cumulative lifetime exposure to perceived discrimination is related to behavioral and physiological factors that underlie complications in AA women with T2DM. Eventually this line of research may lead to interventions to help AA women with T2DM better manage the stress of racial discrimination, thereby decreasing risk for diabetes complications and attenuating gender and racial disparities in diabetes complications. [unreadable] [unreadable] [unreadable]

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Active Follow-up; Acute; Address; Applications Grants; Brachial Artery; CRISP; Computer Retrieval of Information on Scientific Projects Database; Condition; Daily; Data; Depressed mood; Depression; Diabetes Mellitus; Diabetes Mellitus, Adult-Onset; Diabetes Mellitus, Ketosis-Resistant; Diabetes Mellitus, Non-Insulin-Dependent; Diabetes Mellitus, Noninsulin Dependent; Diabetes Mellitus, Slow-Onset; Diabetes Mellitus, Stable; Diabetes Mellitus, Type 2; Diabetes Mellitus, Type II; Dysfunction; Effectiveness of Interventions; Emotional; Emotional Depression; Emotions; Event; Exercise; Exercise, Physical; Feasibility Studies; Feedback; Functional disorder; Funding; Future; Goals; Grant; Grant Proposals; Grants, Applications; Hand; Health; History; Institution; Intervention; Intervention Strategies; Investigators; MODY; Mails; Maturity-Onset Diabetes Mellitus; Mediating; Medical; Mental Depression; Mental Health; Mental Hygiene; NIDDM; NIH; National Institutes of Health; National Institutes of Health (U.S.); Non-Insulin Dependent Diabetes; Non-Insulin-Dependent Diabetes Mellitus; Outcome; Participant; Physiopathology; Population; Post-Menopause; Post-menopausal Period; Postmenopausal Period; Postmenopause; Protocol; Protocols documentation; Psychological Health; Randomized; Recording of previous events; Recruitment Activity; Relative; Relative (related person); Research; Research Personnel; Research Resources; Researchers; Resources; Rest; Risk; SCHED; Sampling; Schedule; Source; Stress; Structure of brachial artery; Symptoms of depression; T2D; T2DM; Testing; Trauma; Type 2 diabetes; Type II diabetes; United States National Institutes of Health; Week; Woman; Writing; adult onset diabetes; brachial artery; depressed; depressive; depressive symptoms; diabetes; effect of intervention; expressive writing; expressive writing therapy; follow-up; improved; interest; interventional strategy; ketosis resistant diabetes; maturity onset diabetes; pathophysiology; post-menopausal; postmenopausal; randomisation; randomization; randomly assigned; recruit; response; sadness; size; stressor; trend

DESCRIPTION (provided by applicant): The objectives of this study are to assess the impact of a stress reduction intervention among Latinos with Type 2 Diabetes (T2D) served by Hartford Hospital on: a) HbA1c levels, and b) stress reactivity measured through a blood glucose sensor and an automated Interactive Voice Response System (IVR). To obtain 200 study completers, 250 Latinos with T2D will be recruited from the 'Amigos en Salud'clinic. They will be randomly assigned to either: a) the control group that will receive 3 community health worker (CHW) led nutrition educational group sessions, or b) the intervention group that in addition will receive an 8-session stress management intervention delivered by a trained CHW. Intervention will be delivered at the Hispanic Health Council in a group format (12 members per group). The primary outcome of the intervention will be HbA1c measured at baseline, post-intervention (9 weeks post-enrollment) and 6 months. The secondary outcome will be stress reactivity measured through an IVR system that involves inserting a metabolic sensor that participants will carry for 3 days as well as daily reporting, via an automated voice system, of stress related events and coping during the same period of time and 6 month s post-enrollment. A subsample (n=75) will participate in the IVR and metabolic sensor measurements conducted pre/post intervention. All study participants will be applied an e-tablet based survey in their homes to assess mental health, nutrition and basic socio-economic and demographic parameters. Blood samples will be collected by a community phlebotomist in the participants'homes at the same time points. Knowledge gained from this randomized trial could lead to a highly innovative CHW led approach to improving the quality of life among individuals with T2D living in very stressful socio-economic environments. PUBLIC HEALTH RELEVANCE: There are no published studies examining the impact of stress management on metabolic control among Latinos with type 2 diabetes (T2D). Knowledge gained from this randomized trial could lead to a highly innovative community health worker led approach to improving the quality of life among individuals with T2D living under very stressful socio-economic environments.

? DESCRIPTION (provided by applicant): Depression and type 2 diabetes are related pressing public health problems. Depression, antidepressant medications, and the health risk behaviors they are associated with, are all risk factors for type 2 diabetes. The overarching goal of this study is to test the additive effects of two proven health interventions - lifestyle modification ad medication therapy management - on risk for diabetes in persons with depression and functional impairment. Treatments will be delivered through our model designed for patients with mental illness (MI) whose care is challenged by distance, disability, language, and culture. Cambodian Americans are ideally suited for this research question because, compared to the general population and other Asian Americans they have: 1) high rates of diabetes and disability; 2) high rates of MI; 3) high rates of polypharmacy and medication problems; and, 4) a worse profile of the social determinants of health. We will recruit 210 adult Cambodian Americans with major depressive disorder and associated impaired functioning, and who are at high risk for diabetes, from our network of community based organizations in the northeast. Seventy participants each will be assigned to one of three arms. In the lifestyle arm, Community Health Workers (CHWs) will deliver the lifestyle intervention during weekly-to-triweekly tapered group sessions and 5 individual home visits over 18 months. In the combination arm, in addition to lifestyle, a pharmacist will join the patient and CHW during home visits via telemedicine to deliver medication therapy management, during 5 home visits over 18 months. In the enhanced standard care arm, participants will receive their usual healthcare enhanced by supportive services. Participants will be assessed at baseline, 1 year, and 2 years. We hypothesize that 1) compared to enhanced standard care, the lifestyle intervention will produce greater improvements in depressive symptoms, medication adherence, objective physical activity, objective sleep quality, and nutrition; and 2) compared to either intervention alone, the combined treatment will improve insulin sensitivity, HbA1c, c-reactive protein, anthropmetrics, blood pressure, lipids and depressive symptoms. If successful, these approaches may apply to other communities with barriers to care and produce diabetes prevention interventions for patients with MI.