Diabetes is the leading cause of chronic kidney disease (CKD) and end stage renal disease (ESRD). Thirty- seven percent of adults with diagnosed diabetes have CKD, defined as the presence of elevated urine albumin- to-creatinine ratio, impaired glomerular filtration rate or both. Diabetes disproportionately affects African Americans, with a total prevalence of 16.4% among African Americans compared to 11.9% among Non-Hispanic Whites. African Americans with diabetes have a 22% higher risk of developing CKD and are 3 times more likely to progress to ESRD compared with Non-Hispanic Whites with diabetes. Multidimensional adversity or disadvantage is a phenomenon that describes the variety of factors related to poverty, such as having both socioeconomic and neighborhood disadvantage. In this proposal, multidimensional adversity refers to the coexistence of food insecurity, and a variety of other adverse circumstances including housing instability, adverse childhood experiences, transportation needs, utility needs and interpersonal safety. There is growing evidence that having a single adversity such as food insecurity, adverse childhood experiences, or financial hardship negatively impacts disease outcomes in individuals with diabetes or kidney disease; however, there is limited understanding on the cumulative impact of these adversities (i.e. multidimensional adversity) on health outcomes. Also, there is limited information on the lived experience of African American adults living with diabetes and CKD who are also food insecure. This study will address a number of gaps in our current knowledge in food insecure African Americans with type 2 diabetes by 1) evaluating the incremental effect of multidimensional adversity on clinical outcomes (glycemic control, blood pressure, and cholesterol) and whether it differs by CKD status, 2) evaluating the incremental effect of multidimensional adversity on self-care behaviors (diet, physical activity, and medication adherence), and whether it differs by CKD status, and 3) conducting focus groups to identify essential components of an intervention to address multidimensional adversity in a population of food insecure African Americans with type 2 diabetes and CKD. For this diversity supplement, blood for basic metabolic panel and eGFR estimation and urine for microalbumin/proteinuria will be added to baseline data collection for the parent R01 and will be used to classify participants as having CKD. Then, using baseline data from the parent study and additional focus groups from enrolled participants in the parent R01, this mixed methods study will examine the relationship between multidimensional adversity and chronic kidney disease (CKD) in food insecure African American adults with diabetes and CKD. This supplement will provide preliminary data for a future culturally tailored intervention focused on African Americans with diabetes and CKD experiencing multidimensional adversity. The supplement will also provide the candidate training in implementation of randomized controlled trials, incorporating social determinants of health into behavioral interventions, and conducting mixed methods research.
The overarching goal of the supplement study complements and extends the goals of the parent grant by evaluating the incremental effect of food insecurity and other adversities (multidimensional adversity) on clinical outcomes and self-care behaviors, and investigating the differential effect of CKD on clinical outcomes and self-care behaviors in food insecure African American adults with type 2 diabetes. This diversity supplement will utilize baseline data from the parent grant, combined with additional baseline blood and urine samples for determination of whether participants have CKD. The findings from the proposed study will serve as preliminary data for an NIH R01 application to test a culturally tailored intervention to address multidimensional adversity in African Americans with diagnosed type 2 diabetes and CKD by the end of Year 2.
