Diabetes disparities in Latino subpopulations: linking biology to social epidemiology

Abstract The overall goal for this application for an NIDDK Mentored Research Scientist Development Award (K01) is to provide the candidate, Sandra Albrecht, PhD, MPH, with indispensable training and protected time to build an independent, transdisciplinary research program at the interface of the biomedical and socio-ecological domains to provide a more complete understanding of the factors underlying progression to and from type 2 diabetes (T2D) in Latino subpopulations. Responding to the staggering burden of T2D and poor glucose control in U.S. Latinos, to unanswered questions regarding variation in disease risk and burden within this broad population, and to the dearth of longitudinal studies in this area, the research aims are to 1) Characterize patterns of glucose dysregulation over time in non-diabetic Latino ethnic subgroups, and evaluate the role of social, environmental, and clinical factors in driving that variation; (2) Characterize patterns of T2D progression over time in diabetic Latino ethnic subgroups, and evaluate the role of social, environmental, and clinical factors in driving that variation; and (3) Characterize the effectiveness of a key social determinant ? healthcare utilization - for successful T2D management within a specific Latino subpopulation, and evaluate how other social, environmental, and clinical factors modify that effectiveness. Data for Aims 1 and 2 will come from a large national longitudinal population-based study with oversamples of Latino subgroups: the Hispanic Community Health Study/Study of Latinos. Data for Aim 3 will come from electronic health record data from a large healthcare system in North Carolina, a region with a fast growing Latino population. As part of this aim, Latino diabetic subjects will be recruited for a pilot study evaluating self-reported barriers to achieving control of glucose as part of a long-term effort to integrate social factors into the clinical management of T2D. To match the scope of the proposed scientific work, the candidate will seek to integrate her expertise in the social epidemiology of obesity and diabetes with the following career development and training areas: 1) training in the physiology of glucose dysregulation; 2) understanding of clinical issues relevant to T2D prevention and treatment; and 3) use of electronic health records data and health informatics. This training will be augmented with career-building activities to acquire essential tools for leadership and professional growth, as well as dissemination and translation of findings. Experts have emphasized the need for a more complete understanding of subgroup-specific T2D physiology and of subgroup-specific risk factors underlying progression to and from T2D. This K01 project will impact public health by improving characterization of T2D outcomes in Latino subpopulations to inform tailored prevention and treatment strategies. The project builds upon exceptional resources and mentoring at the candidate's institution (University of North Carolina at Chapel Hill), to train her in key new areas, bolster applications for competitive funding, disseminate findings among researchers and the wider community, augment faculty diversity, and attain research independence.