Type 2 diabetes is a growing public health challenge and gestational diabetes predicts this preventable chronic disease at an early age. Half of all women with gestational diabetes will go on to develop type 2 diabetes without intervention. There are clear opportunities to intercede during and after pregnancy to prevent type 2 diabetes; however, it is difficult to operationalize these interventions in low resource settings and traditional healthcare models. The purpose of this Mentored Patient-Oriented Research Career Development Award is to empower the candidate to develop a research program that uses innovative approaches to care delivery to maximize diabetes prevention in vulnerable populations. To achieve this goal, mentorship and training in this award are proposed to support: 1) additional training in methods of community-engaged research, intervention development for pregnant and postpartum women, tailoring education materials for low health literacy, implementation science, and pragmatic trial design; 2) protected time to conduct the planned patient-oriented research; and 3) the collection and publication of preliminary data to facilitate the next steps in the research program. The research plan in this award is supported by the career development plan and interdisciplinary team of mentors, advisors and collaborators. The proposed work seeks to 1) develop and refine a diabetes self-management education and medical nutrition therapy curriculum for low-income women with gestational diabetes that can be delivered by clinic staff and community health workers; and 2) conduct a pilot trial of this curriculum to assess reach, preliminary effectiveness, adoption, implementation fidelity, and maintenance. The anticipated outcome of this study is high-quality pilot data that will provide the foundation for an R01 application to conduct a larger pragmatic randomized controlled trial to assess effectiveness, cost-effectiveness, and sustainability of the intervention. We hypothesize that a community-engaged intervention delivered by community health workers and clinic staff through the prenatal to postpartum transition of care will decrease diabetes-related distress, increase diabetes knowledge and self-efficacy, and improve diabetes attitudes and risk perception for the development of type 2 diabetes among women, ultimately enhancing post-partum screening and follow-up care. If true, this care model could have a significant positive impact on care delivery for populations in resource-limited settings. The training and research activities delineated in this proposal complement the candidate?s background in clinical endocrinology and population health and will position her to make substantial contributions to health care delivery systems change. Ultimately, this work will lead to new models to improve care transitions and care coordination for diabetes prevention and care in our highest risk populations.
The central goal of this project is to develop and test a community-engaged intervention for diabetes self- management education and medical nutrition therapy that can be implemented in Federally Qualified Health Centers. The goal of the intervention is to improve education, care coordination, and type 2 diabetes prevention for high-risk women with gestational diabetes. This project will generate preliminary data for further study of the community-engaged intervention.
