PROJECT SUMMARY
Approximately 40% of individuals with type 2 diabetes (T2DM) have chronic kidney disease (CKD), also
known as diabetic kidney disease (DKD). DKD is the leading cause of end stage renal disease (ESRD), and
ESRD is the most expensive complication of diabetes. African American adults are almost twice as likely to
have DKD and are three times more likely to progress to ESRD. Inner-city populations, made up of
predominantly African Americans, are at high risk for DKD. Challenges of living in the inner-city include
multidimensional adversity, defined as having three or more social adversities such as loss of employment,
housing instability, food insecurity, transportation needs, utility needs, interpersonal safety, and financial strain.
African American adults living in the inner-city disproportionately experience multidimensional adversity, which
impacts the complex self-management of DKD such as self-monitoring and behavior modification. The
compounded risks of being African American, living in the inner-city, having T2DM and multidimensional
adversity likely contribute to the accelerated rate of CKD progression among African American adults and
potentiate existing health disparities. Patient education and self-management behaviors improve patient
outcomes and represent the cornerstone of DKD management. In addition, behavioral intervention studies in
African American adults with T2DM incorporating cultural tailoring, peer-support/coaching, and community
health workers have shown promise in improving short-term clinical outcomes. However, their benefits are not
sustained long-term, and they do not produce long-term effects on lifestyle and behavior changes. Further,
majority of existing studies do not account for the unique challenges of inner-city African American adults
which limits effectiveness of patient education and self-management behaviors in African American adults
living in the inner-city long-term. Similarly, studies in African American adults with T2DM and CKD that
incorporate the challenges of living with multidimensional adversity are scarce, despite growing evidence which
recognizes the negative effects of multidimensional adversity on clinical outcomes in this population.
Therefore, the goal of this proposal is to address these gaps in knowledge using a convergent parallel mixed
methods study design to understand the role and effect of multidimensional adversity in African American
adults with DKD. In addition, this proposal will identify appropriate intervention components which will inform
the development of a culturally tailored intervention that addresses multidimensional adversity to improve
clinical outcomes, quality of life, and self-care behaviors in African American adults with DKD living in the
inner-city. Ultimately, findings from this proposal will serve as a preliminary data for addressing
multidimensional adversity in a large-scale appropriately powered, multicenter, randomized controlled trial
focused on African American adults with DKD.
