就在几代人之后, type 2 diabetes has gone from being a relatively rare disease to America’s seventh leading cause of death. 今天, 超过十分之一的美国人患有这种疾病, 而至少还有1亿人处于糖尿病前期. 为了应对这场危机, public health officials have often tried to help prediabetics with a one-size-fits-all approach, but the intervention that effectively helps one community may not meet the needs of another. 结果是, 许多美国最脆弱的人群实际上被剥夺了获得救生护理的机会.
Tam H. 阮, 康奈尔学院的副教授, believes that one way to expand access is to tailor treatment programs to the unique culture and circumstances of each community. 她最新的太阳城官网项目, 哪一个是由三年期资助的, $450,000 Betty Irene Moore Fellowship for Nurse Leaders and Innovators from the nursing school at UC Davis and the Gordon and Betty Moore Foundation, 旨在确定这样做的最有效的方法.
与…合作 昆西亚洲资源有限公司. (手中), a nonprofit focused on promoting the welfare of immigrant communities in New York and Boston, 阮 will be designing and evaluating prediabetic interventions tailored to Vietnamese American communities of varying 收入 levels and proficiency in English.
这项太阳城官网已刻不容缓, since diabetes rates are rising faster among Asian Americans than among any other racial group. “One in two Asian Americans will become diabetic or prediabetic in their lifetime,阮说. “Supporting the health and well-being of the community is important to me not just because I am Vietnamese American but because this community is extremely under-researched and underserved.
所面临的挑战
糖尿病的流行是许多复杂原因相互作用的结果, 但阮特别指出了几个罪犯.
“Asian Americans, like all Americans, live in an environment that promotes obesity,她解释道. “我们已经有计划地将体育活动从日常生活中剔除, 我们的工作往往是久坐不动的. 对于亚裔美国人, 然而, 使情况更具挑战性的是，糖尿病的流行在很大程度上是沉默的.”
谭洪副教授. 阮
亚裔美国人的肥胖程度往往低于一般人群, 阮解释, 因此，他们不太可能被视为高风险或接受筛查, 这意味着糖尿病经常不被发现. The problem is exacerbated by widespread ignorance about consequential physical differences between Asian American populations and others.
“问题在于亚裔美国人, 他们的脂肪大部分集中在腹部, 哪一种代谢最活跃,”她说。. “That creates a situation where there’s a greater likelihood of chronic illnesses such as diabetes and cardiovascular disease at a lower BMI than you would see in other racial groups.”
The fast-rising rates among Asian Americans also result from earlier well-intentioned but ill-conceived outreach efforts from health officials. 这些努力被证明是不够的, 阮说, 因为他们倾向于把他们试图帮助的社区简单化.
“What the health services research world has done over the last 30 years is take an existing medical intervention, 把它翻译, 调整一些细节, 说所有越南裔美国人现在都可以参加这个项目了,”她说。. “这种做法的问题是，即使在越南裔美国人社区内, 对于一个放之四海而皆准的项目来说，多样性太大了.”
通过数字
9.2%
患有糖尿病的亚裔美国人
50%
会在一生中患上糖尿病或前驱糖尿病的亚裔美国人
80%
患有前驱糖尿病的美国人不知道自己患有这种疾病
这是因为治疗前驱糖尿病的主流模式是 糖尿病预防计划(DPP)——很简单，但很难付诸实践. The DPP is an evidence-based self-management and lifestyle intervention that focuses on helping patients lose 5–7% of their body weight through dietary changes and increased physical activity. 当后, 这个项目 has been shown to reduce the incidence of type 2 diabetes by more than 50 percent—but following 这个项目 requires a certain level of privilege and stability.
“The DPP works really well for someone who has the resources to engage in 这个项目 and buy the groceries to change their diet,阮说。. “但并不是每个人都有财力购买新鲜水果和蔬菜, 或者控制他们的生活，要求他们在六个月的时间里每周参加一次培训.“这些人, 她解释说, are not going to be well served by an intervention that puts the onus on the individual to make and sustain different choices.
太阳城官网项目
One of the primary goals of 阮’s research project will be to determine the psychosocial phenotypes that inform how effective a 给n prediabetes treatment is for a 给n person. Psychosocial phenotyping is the method by which researchers identify patterns of measurable behaviors, 心理特征, and social factors that help explain the variation in people’s ability to self-manage chronic conditions.
“例如, if somebody doesn’t have the capacity or resources to fully engage in certain parts of the DPP, 这种情况可能与某些结果有关,阮说. “Identifying phenotypes like that could help us determine if a particular person should start medication, 这个项目, 或两个.”
接触到不同的越南裔美国人, 阮将与QARI合作, 哪个与当地社区关系密切. “我们会帮助博士. 阮管理着. community outreach and identify the Vietnamese American groups in several states who can take part in the research project,Philip Chong说, QARI的总裁兼首席执行官. “We’ll help her find the focus groups and get her the right data to eventually create a pilot that is culturally sensitive, 有创意的, 和改变生活.”
QARI will also help 阮 by offering study participants essential social services—workforce development, 精神卫生保健, 补充营养——这可能会使糖尿病前期患者更有可能对治疗反应良好. 对他来说, Chong believes the project could help fill a crucial gap in the services QARI already offers.
“当博士. 阮找我谈这笔拨款的事, 我很高兴看到对如此重要的问题有一个更具有文化敏感性的方法,Chong说. “We know that offering people rewards for changing their lifestyle that week is unlikely to motivate long-term change. 我们需要的是更有力的方法和更多的成功案例.”
因为不确定哪些干预措施会被证明是有效的, 阮将进行一项适应性太阳城官网. That means she will be able to make changes to the trial design based on emerging evidence without jeopardizing the validity of the final results.
“我们认为, Why not take a look at a particular decision point to see if it’s working for people or not?她解释道. “如果不是的话, 我们如何利用额外的资源, 支持, 或者社会服务，以获得更好的结果?”
While 阮 hopes that this project will provide the 支持 some Vietnamese Americans with prediabetes need to change their lifestyles, 她强调，要解决糖尿病危机，系统性的改变也是必要的.
“因为健康的生活需要一个村庄, 我们必须处理健康的社会决定因素,”她说。. “在大流行期间, 许多越南裔美国人由于种种原因失去了获得新鲜食物的机会, 心理健康问题激增. These are not separate concerns: mental health and stress have a negative effect on diabetes and cardiovascular disease.”
Although this project is based around treating the unique needs of different Vietnamese American communities, 阮认为，这项太阳城官网可以帮助改善对所有糖尿病前期患者的护理.
“如果我们做好功课，把事情做好, the principles informing our culturally specific care can be applied to other populations as well,”她说。. “This project is one way to think about how to restructure the system to make it easier for people to make healthy changes. 而不是仅仅要求人们改变他们的行为, 然而, 我们总是需要从听取每个社区的意见开始.” ▪
缩小差距
阮的合作者团队中有她23岁的顾问May Tadano, 一位来自新泽西的护理专业学生. “我对公共卫生护理很感兴趣，”Tadano说，“所以当Dr. 阮获得了资助，我帮她做了一个现有文献的概述.”
她最重要的发现? 太阳城官网中的深刻差距. “几乎没有一项针对亚裔美国人的太阳城官网包括基于年龄的亚分析, 性别, 收入, 教育水平, 以及文化适应状况,”她说。. “这就是我想说的. 阮的项目旨在解决这个问题.”
Tadano说她很幸运能参与这个项目. “和Tam一起工作真的是一次很棒的经历. 我很感激护理学校将太阳城官网纳入课程.”