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Impact of Disparities in Food Security on Glycemic Control and Health CareUtilization Among Youth and Young Adults with Diabetes

Award Number: R01DK117461
ORGANIZATION: NATIONAL INSTITUTE OF DIABETES & DIGESTIVE & KIDNEY DISEASES
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

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ABSTRACT Food insecurity affected 11% of all US households in 2020, and youth and young adults with type 1 diabetes (T1D) or type 2 diabetes (T2D) experience even higher rates of food insecurity, 18% and 31%, respectively. Moreover, 56% of youth and young adults with T1D and 46% of those with T2D do not achieve optimal glycemic control, with young people from underrepresented racial/ethnic groups experiencing much higher rates of poor glycemic control. We propose a continuation of the NIDDK-funded SEARCH Food Security Cohort Study (SFS 1), which collected data on >1,000 youth and young adults with diabetes and documented the role food insecurity plays in influencing glycemic control and related outcomes. SFS 1 data indicate that compared to those who are food secure: (a) young people with T1D and food insecurity have higher HbA1c (+0.34%, p=0.04) and (b) those with T2D and food insecurity have higher odds of diabetic ketoacidosis (3.1, p=0.02) in fully adjusted models. However, food insecurity varies day-to-day and ranges from intermittent to persistent, and SFS 1 did not capture the day-to-day variation, which is needed for intervention planning. Thus, we propose a research strategy of high scientific rigor that will integrate longitudinal quantitative and qualitative methods, including ecological momentary assessment (EMA) and continuous glucose monitoring (CGM), in an intensive, mixed methods study. This proposal (SFS 2) greatly expands our work in SFS 1 toward identifying the temporal causal cascades and actionable and acceptable interventions for eliminating food insecurity. To achieve these goals, we aim to (1) leverage the ongoing SFS 1 study to enroll a cohort of 360 youth and young adults with diabetes (260 T1D, 100 T2D), 72% with a history of food insecurity, for a repeated-measures, longitudinal mixed methods study over 9 months; (2) evaluate differences in real-time glycemic control between participants with varying levels of food insecurity, assessed by average daily time in range (TIR) via CGM over two 14-day time periods spaced 9 months apart; (3) evaluate the within-participant impact of food insecurity on TIR and intermediate paths using EMA methods, including dynamic structural equation models; (4) use longitudinal, qualitative methods to concurrently and deeply characterize the context of participants’ food insecurity experience and coping process, by conducting a concurrent events study of 30 individuals with T1D and 15 with T2D with a history of food insecurity through in-depth, one-on-one, repeated semi-structured interviews over 9 months. This study will integrate intensive data collection of the primary outcome (TIR by CGM) and the primary exposure (daily food insecurity), as well as measures of physical activity, diet, and mood. These quantitative data will be complemented by longitudinal qualitative interviews, which will allow us to triangulate the quantitative data with participants’ lived experiences. The findings will contribute to future interventions and policies that are designed to interrupt the cycle of food insecurity and poor glycemic control and are effective for and acceptable to young people with diabetes.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2024 ( Subtotal = $0 )
2024	2023	UNIVERSITY OF SOUTH CAROLINA	1600 HAMPTON ST	COLUMBIA	SC	29208	RICHLAND	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	002	6	12/14/2023	COMPETING CONTINUATION	$468,605
2024	2022	UNIVERSITY OF SOUTH CAROLINA	1600 HAMPTON ST	COLUMBIA	SC	29208	RICHLAND	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	001	5	12/14/2023	SUPPLEMENT FOR EXPANSION	-$12,642
2024	2022	UNIVERSITY OF SOUTH CAROLINA	1600 HAMPTON ST	COLUMBIA	SC	29208	RICHLAND	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	000	5	12/14/2023	NON-COMPETING CONTINUATION	-$455,963
														Subtotal = $0

Issue Date FY: 2023 ( Subtotal = $723,619 )
2023	2023	UNIVERSITY OF SOUTH CAROLINA	1600 HAMPTON ST # 414	COLUMBIA	SC	29208	RICHLAND	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	002	6	3/21/2023	COMPETING CONTINUATION	$723,619
2023	2022	UNIVERSITY OF SOUTH CAROLINA	1600 HAMPTON ST # 414	COLUMBIA	SC	29208	RICHLAND	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	001	5	3/11/2023	SUPPLEMENT FOR EXPANSION	$0
2023	2022	UNIVERSITY OF SOUTH CAROLINA	1600 HAMPTON ST # 414	COLUMBIA	SC	29208	RICHLAND	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	000	5	3/10/2023	NON-COMPETING CONTINUATION	$0
														Subtotal = $723,619

Issue Date FY: 2022 ( Subtotal = $655,214 )
2022	2022	UNIVERSITY OF SOUTH CAROLINA	1600 HAMPTON ST # 414	COLUMBIA	SC	29208	RICHLAND	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	000	5	4/1/2022	NON-COMPETING CONTINUATION	$637,538
2022	2022	UNIVERSITY OF SOUTH CAROLINA	1600 HAMPTON ST # 414	COLUMBIA	SC	29208	RICHLAND	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	001	5	4/4/2022	SUPPLEMENT FOR EXPANSION	$17,676
														Subtotal = $655,214

Issue Date FY: 2021 ( Subtotal = $697,513 )
2021	2021	UNIVERSITY OF SOUTH CAROLINA	1600 HAMPTON ST # 414	COLUMBIA	SC	29208	RICHLAND	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	000	4	3/29/2021	NON-COMPETING CONTINUATION	$697,513
														Subtotal = $697,513

Issue Date FY: 2020 ( Subtotal = $696,699 )
2020	2020	UNIVERSITY OF SOUTH CAROLINA	1600 HAMPTON ST # 414	COLUMBIA	SC	29208	RICHLAND	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	001	3	5/21/2020	NON-COMPETING CONTINUATION	$0
2020	2020	UNIVERSITY OF SOUTH CAROLINA	1600 HAMPTON ST # 414	COLUMBIA	SC	29208	RICHLAND	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	000	3	3/30/2020	NON-COMPETING CONTINUATION	$661,347
2020	2020	UNIVERSITY OF SOUTH CAROLINA	1600 HAMPTON ST # 414	COLUMBIA	SC	29208	RICHLAND	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	003	3	9/8/2020	SUPPLEMENT FOR EXPANSION	$35,352
2020	2020	UNIVERSITY OF SOUTH CAROLINA	1600 HAMPTON ST # 414	COLUMBIA	SC	29208	RICHLAND	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	002	3	8/27/2020	NON-COMPETING CONTINUATION	$0
														Subtotal = $696,699

Issue Date FY: 2019 ( Subtotal = $673,690 )
2019	2019	UNIVERSITY OF SOUTH CAROLINA	1600 HAMPTON ST # 414	COLUMBIA	SC	29208	RICHLAND	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	000	2	4/8/2019	NON-COMPETING CONTINUATION	$673,690
														Subtotal = $673,690

Issue Date FY: 2018 ( Subtotal = $730,964 )
2018	2018	UNIVERSITY OF SOUTH CAROLINA	1400 WHEAT ST	COLUMBIA	SC	29210	RICHLAND	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	000	1	3/26/2018	NEW	$730,964
														Subtotal = $730,964

Grand Total All Awards = $4,177,699

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Impact of Disparities in Food Security on Glycemic Control and Health CareUtilization Among Youth and Young Adults with Diabetes

Award Number: R01DK117461

ORGANIZATION: NATIONAL INSTITUTE OF DIABETES & DIGESTIVE & KIDNEY DISEASES

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

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