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Addressing Social Determinants of Health to Improve Diabetes Prevention Program Outcomes Among Underserved African Americans

Award Number: R01DK124664
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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PROJECT SUMMARY African Americans (AAs) are disproportionately burdened by diabetes mellitus (DM) with rates twice as high as Whites (13% vs 7.5%), and increased rates of DM-related complications and comorbidities (e.g. amputations, cardiovascular disease). A key pre-DM risk factor is overweight/obesity. Nearly 70% of AAs are overweight or obese, with higher rates among AAs with low-income. A critical component of national efforts to reduce growing obesity rates and prevent DM is the Diabetes Prevention Program (DPP), a lifestyle intervention proven to reduce or delay DM onset with diet change, exercise, and modest weight loss (5-7%) in a rigorously evaluated national trial. A group-based version of the DPP has been widely disseminated and numerous community-based trials support its efficacy. In spite of these successes, there are significant health disparities in DPP attendance and outcomes and considerable room exists for improving success rates among AAs, a population that tends to experience half the amount of DPP weight loss compared to Whites. We aim to build on our promising pilot studies by tailoring the DPP via a social determinants (SD) of health lens to achieve optimal DPP attendance and clinically meaningful weight loss with pre-DM AAs. This includes tailoring on cultural and socioeconomic SD mechanisms that are associated with improving health outcomes and align with predisposing needs among AAs who are primarily of low-income and live in low-resource AA communities. We propose a randomized controlled trial of 360 pre-DM AA patients from a safety net hospital (SNH) to test a standard DPP (S-DPP) against a culturally tailored DPP (TC-DPP; e.g., tailoring of language, foods, values, religiosity, norms, values) alone and a culturally tailored DPP enhanced to address access and support related economic barriers (TCE-DPP; hybrid group/online/text DPP; community health worker support to improve access to DPP classes, healthy food, exercise, and other community and health resources; and financial incentives) over 12 months. We will: 1) examine effects of TC-DPP and TCE-DDP on percent weight loss and attendance (primary outcomes) and on secondary outcomes (physical activity, completion of physician follow- up visit, hbA1c, and blood pressure) at 6 and 12 months with SNH AAs, 2) evaluate potential mediators/ moderators related to weight loss and attendance among AA SNH patients at 6 and 12 months to determine modifiable facilitators and barriers, and 3) conduct a process evaluation to examine TCE-DPP acceptability, feasibility, and fidelity, and relationships between delivery dose, exposure, costs, and outcomes to identify and improve essential intervention components. Our multidimensional DPP interventions are guided by our past pilots, and based on components that, all together, were used to help drive clinically important outcomes in the original DPP trial – and are certainly needed to achieve similar outcomes with AA primarily of low-income. To our knowledge this is the first study to test multidimensional tailoring via an SD lens to truly impact DPP attendance and outcomes, and has potential to be a feasible, scalable model to reduce DM disparities among at-risk AA.


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: 2023 ( Subtotal = $661,274 )
2023	2023	UNIVERSITY OF MISSOURI SYSTEM	1011 E 51ST ST	KANSAS CITY	MO	64110	JACKSON	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	002	4	4/17/2023	NON-COMPETING CONTINUATION	$661,274
2023	2022	UNIVERSITY OF MISSOURI SYSTEM	5100 ROCKHILL RD	KANSAS CITY	MO	64110	JACKSON	USA	Trans-NIH Research Support	000	2	1/12/2023	SUPPLEMENT FOR EXPANSION	$0
2023	2021	UNIVERSITY OF MISSOURI SYSTEM	5100 ROCKHILL RD	KANSAS CITY	MO	64110	JACKSON	USA	Trans-NIH Research Support	001	1	2/8/2023	SUPPLEMENT FOR EXPANSION	$0


Issue Date FY: 2022 ( Subtotal = $1,117,911 )
2022	2022	UNIVERSITY OF MISSOURI SYSTEM	5100 ROCKHILL RD	KANSAS CITY	MO	64110	JACKSON	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	001	3	4/5/2022	NON-COMPETING CONTINUATION	$663,387
2022	2022	UNIVERSITY OF MISSOURI SYSTEM	5100 ROCKHILL RD	KANSAS CITY	MO	64110	JACKSON	USA	Trans-NIH Research Support	000	2	1/29/2022	SUPPLEMENT FOR EXPANSION	$454,524
2022	2021	UNIVERSITY OF MISSOURI SYSTEM	5100 ROCKHILL RD	KANSAS CITY	MO	64110	JACKSON	USA	Trans-NIH Research Support	002	1	9/2/2022	SUPPLEMENT FOR EXPANSION	$0


Issue Date FY: 2021 ( Subtotal = $2,110,891 )
2021	2021	UNIVERSITY OF MISSOURI SYSTEM	5100 ROCKHILL RD	KANSAS CITY	MO	64110	JACKSON	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	004	2	8/4/2021	NON-COMPETING CONTINUATION	$0
2021	2021	UNIVERSITY OF MISSOURI SYSTEM	5100 ROCKHILL RD	KANSAS CITY	MO	64110	JACKSON	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	002	2	3/31/2021	NON-COMPETING CONTINUATION	$671,214
2021	2021	UNIVERSITY OF MISSOURI SYSTEM	5100 ROCKHILL RD	KANSAS CITY	MO	64110	JACKSON	USA	Trans-NIH Research Support	000	1	11/17/2020	SUPPLEMENT FOR EXPANSION	$1,439,677
2021	2021	UNIVERSITY OF MISSOURI SYSTEM	5100 ROCKHILL RD	KANSAS CITY	MO	64110	JACKSON	USA	Trans-NIH Research Support	003	1	3/31/2021	SUPPLEMENT FOR EXPANSION	$0
2021	2021	UNIVERSITY OF MISSOURI SYSTEM	5100 ROCKHILL RD	KANSAS CITY	MO	64110	JACKSON	USA	Trans-NIH Research Support	001	1	12/10/2020	SUPPLEMENT FOR EXPANSION	$0


Issue Date FY: 2020 ( Subtotal = $686,578 )
2020	2020	UNIVERSITY OF MISSOURI SYSTEM	5100 ROCKHILL RD	KANSAS CITY	MO	64110	JACKSON	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	000	1	3/17/2020	NEW	$686,578


Grand Total All Awards = $4,576,654

Sum of Action Amount is $4,576,654;

Grand Total = $4,576,654

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Addressing Social Determinants of Health to Improve Diabetes Prevention Program Outcomes Among Underserved African Americans

Award Number: R01DK124664

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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