Type 1 diabetes mellitus (T1D) is the second-most common serious childhood disease in the United States, while the incidence of type 2 diabetes mellitus (T2D) has increased markedly among adolescents, with racial/ethnic minority populations at particularly high risk. Maintaining control of diabetes is particularly difficult whn these adolescents enter young adulthood. Young adults with T1D have mortality rates 3-6 times higher than those without diabetes, and are at elevated risk for mental health disorders, substance abuse, and diabetic complications. Less is known about health outcomes for young adults with T2D, although preliminary studies suggest an aggressive disease course, with more rapid onset of complications, and greater diabetes- related stress and negative life events, than their peers with T1D or older people with T2D. The reasons for poor health among young adults with diabetes are complex and interrelated, including psychosocial issues, diabetes "burnout," risk-taking behavior, competing priorities, and the challenge of transitioning from pediatric to adult healthcare settings. Studies evaluating interventions to improve diabetes self-care in young adults have, overall, shown success in reducing loss to medical follow-up, but not in improving glycemic control or psychosocial outcomes. The proposed program of research and career development targets the needs of urban minority young adults with poorly controlled diabetes - a group at particularly high risk for poor health outcomes. Given existing interventions'modest effects, the significant barriers to self-care encountered by this group, and the likelihood of their incurring high healthcare costs, we posit that an intensive, multifaceted intervention may be warranted to improve health in this population. This three-year mentored career development award for Dr. Elizabeth Pyatak aims to address these issues by pilot-testing an innovative diabetes self-management intervention, Resilient, Empowered, Active Living with Diabetes (REAL). The REAL intervention was developed using the principles of an activity-based intervention, Lifestyle Redesign, which has been shown to cost-effectively improve long-term physical and mental health outcomes, and to be feasible and accessible to implement for a range of chronic conditions in diverse populations. The proposed career development program positions Dr. Pyatak within a network of successful mentors from diverse disciplinary backgrounds who have collective expertise in the clinical management of diabetes in ethnically diverse young adults, health behavior and psychological interventions for minority youth, and randomized trials of diabetes self-management interventions. The career development plan includes training in clinical trial management, statistical analysis, and process and evaluation of complex behavioral interventions. The highly supportive mentoring team and institutional environment aim to equip Dr. Pyatak with the skills necessary to conduct large-scale RCTs of complex interventions addressing the health and psychosocial needs of underserved populations.
Diabetes is a growing health concern among young adults in the United States;low-SES and minority young adults in medically underserved communities are at particularly high risk for poor health outcomes. This project incorporates an experienced mentoring team and highly supportive research environment in developing the expertise of a promising behavioral researcher to address the health and psychosocial needs of this population. The project will provide preliminary evidence regarding the efficacy of an evidence-based, activity- based intervention designed to improve diabetes self-care and glycemic control among low-SES minority young adults.