African American (AA) women carry a disproportionate burden of T2DM and some of its complications. The stress of exposure to discrimination may contribute to altered blood pressure, glycemia, insulin resistance, and self-care behaviors, thereby increasing risk for complications.
Our aims are to: 1) Establish proof of principle that cumulative lifetime exposure to perceived discrimination is related to baseline behavioral and physiological factors that underlie complications in AA women with T2DM; 2) Establish proof of principal that cumulative lifetime exposure to perceived discrimination primes individuals for heightened reactivity to acute stressors. 3) Explore candidate modifiers of the relationship between cumulative lifetime exposure to perceived discrimination and stress reactivity; and 4) Refine and expand plans for a daily process study of these variables with diabetic AA women to support an R01 application. Forty AA women and 40 White women with T2DM will participate. On day 1, participants will perform 24-hour ambulatory blood pressure monitoring. On day 2, participants will complete baseline measures of exposure to discrimination, fasting glucose, insulin resistance, and blood pressure. Then we will expose the participants to a public speaking task in the laboratory to detect metabolic and cardiovascular reactivity to the acute stressor. On day 3, participants will again perform 24-hour ambulatory blood pressure monitoring. Five hypotheses will be tested. Ha1: There will be an effect for race on cumulative lifetime exposure to perceived discrimination. AA women will report greater cumulative lifetime exposure to perceived discrimination than White women. Ha2: There will be an effect for cumulative lifetime exposure to perceived discrimination on resting blood pressure, insulin resistance, and diabetes self- care behaviors. Higher cumulative lifetime exposure to perceived discrimination will be associated with higher resting blood pressure, higher insulin resistance, and lower diabetes self-care behaviors. Ha3: There will be an effect for stressor period on blood pressure and glycemia. Post-stressor blood pressure and glycemia will be higher than baseline levels. Ha4: There will be an effect for cumulative lifetime exposure to perceived discrimination on reactivity to experimental stressor. Higher lifetime exposure to perceived discrimination will predict greater glycemic and blood pressure reactivity to an acute experimental stressor. Ha5: There will be an effect for cumulative lifetime exposure to perceived discrimination on delayed recovery from an experimental stressor. Higher levels of lifetime exposure to perceived discrimination will predict less nighttime blood pressure dipping in response to an acute experimental stressor. Ha6: There will be trends for modifiers of the association between cumulative lifetime exposure to perceived discrimination and stress reactivity. Social support, SES, and coping will be explored. If successful, this R21 will lead to an R01 application for a daily process study with greater ecological validity. Eventually, this line of research will inform interventions to help AA women with T2DM manage racial stress, thereby reducing disparities in diabetes outcomes. African American (AA) women carry a disproportionate burden of T2DM and some of its complications. Exposure to the mental stress of racial discrimination may contribute to altered blood pressure, glycemia, insulin resistance, and self-care behaviors, thereby increasing risk for complications. This study will establish proof of principle that cumulative lifetime exposure to perceived discrimination is related to behavioral and physiological factors that underlie complications in AA women with T2DM. Eventually this line of research may lead to interventions to help AA women with T2DM better manage the stress of racial discrimination, thereby decreasing risk for diabetes complications and attenuating gender and racial disparities in diabetes complications. ? ? ?
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