Addressing the epidemic of uncontrolled type 2 diabetes mellitus in the United States (US) is a top public health priority. More than 25.6 million adults have type 2 diabetes, and 45% of patients have inadequate glycemic control. Every year, poorly controlled diabetes is responsible for $58 billion in medical expenditures. Vulnerable populations including racial and ethnic minorities and individuals living in poverty typically have the highest rates of inadequate glycemic control, often resulting in avoidable and costly healthcare utilization. As such, the US healthcare system urgently needs to improve diabetes management, particularly for vulnerable populations. Diabetes self-management education is known to improve the self-care behaviors of individuals. Increasingly, individuals with diabetes have access to diabetes self-management education in primary care settings, group classes, and over the internet and telephone, yet disparities persist. To date, it is unknown whether vulnerable populations in the US have equal access to diabetes self-management education compared to other less vulnerable adults with type 2 diabetes. In addition, it is unclear whether vulnerable populations with access to diabetes self-management education have similar diabetic outcomes, healthcare utilization, and/or medical expenditures to other less vulnerable adults with type 2 diabetes. Therefore in a nationally representative, population based study the specific aim of this research are: 1) To describe receipt of diabetes self-management education in racial and ethnic minorities and individuals living in poverty with type 2 diabetes, compared to other adults with type 2 diabetes; 2) To determine the extent to which receipt of diabetes self-management education mediates or moderates race/ethnicity and income-related disparities in hemoglobin A1c, blood pressure, and cholesterol; 3) To determine the extent to which receipt of diabetes self-management education mediates or moderates race/ethnicity- and income-related disparities in diabetes-related health care utilization and medical expenditures. This study is directly in line with the mission of National Institute of Diabetes and Digestive Kidney Disease to support research on diabetes to improve people's health and quality of life. Ultimately, this research will identify important points of intervention for the delivery and effectiveness of diabetes self-management education. This research will be carried out as part of a broader training program characterized by (a) a highly motivated MD-PhD applicant who has demonstrated excellence in the pursuit of a degree in the academically rigorous, multidisciplinary field of Population Health Sciences (b) exceptional research training and mentoring by Co-Sponsors Dr. Elizabeth Jacobs and Dr. John Mullahy (c) a world-class institutional environment including a MD/PhD program with a distinguished track record of successfully training clinician-investigators (d) outstanding opportunities for clinical experience in internal medicine (e) well-thought out program of learning, research, and clinical experiences that will serve train the applicant to be an independent and productive physician-scientist.
A large proportion of adults with type 2 diabetes do not have adequate control of their condition. This can have devastating consequences for the individual and on the US health care system. This proposal aims to understand the use of diabetes self-management education in vulnerable adults with type 2 diabetes and associated diabetic outcomes (health, cost and use of health services).
