Faculty Bibliography

BACKGROUND:Immigrant populations face numerous barriers to accessing evidence-based diabetes interventions. Mobile health (mHealth) interventions are increasingly being used to support individuals in managing diabetes. This review aims to synthesize the available evidence on mHealth interventions specifically designed for immigrant populations with diabetes. METHODS:An integrative review was conducted following Whittemore and Knafl's methodology. Studies from the inception of PubMed, Web of Science, Cochrane Library, CINAHL Ultimate, Embase, and APA PsycInfo up to July 2024 were searched. The Mixed Methods Appraisal Tool was used to assess the quality of the included studies. A constant comparison strategy was employed for data analysis. RESULTS:A total of seven studies met the inclusion criteria for this review, including five randomized controlled trials (RCTs: two fully powered RCTs and three pilot RCTs) and two pre-post single-arm pilot studies. All studies were conducted in the United States. The mHealth interventions were tailored to Korean, Chinese, Marshallese, Latinx, and South Asian immigrants. The sample sizes varied from 17 to 250. Evidence from the included studies is primarily limited by statistical power due to their pilot designs and small sample sizes. Despite this limitation, all studies demonstrated high feasibility and acceptability of mHealth interventions for diabetes management among these immigrant groups. Participants also reported high levels of satisfaction with mHealth interventions. The included studies consistently reported significant improvements in a range of health, psychosocial, and behavioral outcomes within the intervention groups, including hemoglobin A1C levels, body weight, blood glucose, total cholesterol, triglycerides, low-/high-density lipoprotein levels, and blood pressure; and self-efficacy, mental health status, diabetes knowledge, and quality of life; as well as physical activity, self-management, and dietary behaviors. However, when compared to control groups, the reported effectiveness of mHealth interventions on these outcomes was inconsistent. CONCLUSIONS:This review demonstrates the feasibility and acceptability of mHealth interventions for diabetes management among within immigrant populations. The findings suggest that these interventions may serve as a viable strategy to improve health, psychosocial, and behavioral outcomes. Future RCTs with larger sample sizes are needed to provide more robust evidence of the effectiveness of mHealth interventions. Importantly, this review highlights the scarcity of mHealth-related studies focused on immigrant populations with diabetes and calls for more research to examine how to best support this underserved group.

BACKGROUND:levels. However, it remains unclear whether the CARE program also improves diabetes self-efficacy and psychosocial outcomes in the same study sample. OBJECTIVE:This is a secondary analysis to examine the potential efficacy of the CARE program on secondary outcomes, including diabetes self-efficacy, self-care activities, beliefs in diabetes self-care activities, and diabetes distress among Chinese Americans with T2D. METHODS:level of 7% or higher. Participants were recruited from various health care settings in New York City, including community health centers, private primary care providers, and NYU Langone Health and its affiliates, and were randomly assigned to either the CARE intervention group (n=30) or a waitlist control group (n=30). The intervention consisted of 2 culturally and linguistically tailored educational videos per week for 12 weeks, covering diabetes self-care topics such as healthy eating, physical activity, and medication adherence. These videos were delivered via the WeChat app. In addition, community health workers provided support calls to assist them in setting goals, problem-solving, and addressing social determinants of health barriers every 2 weeks. Secondary outcomes included patient self-reported diabetes self-efficacy, self-care activities, beliefs in diabetes self-care activities, and diabetes distress. Outcomes were assessed at baseline, 3 months, and 6 months. RESULTS:Participants had a mean age of 54.3 (SD 11.5) years and 62% (37/60) were male, 78% (47/60) were married, 58% (35/60) were employed, 70% (42/60) had a high school education or lower, and 88% (53/60) reported limited English proficiency. Intervention participants demonstrated statistically significant improvements in self-efficacy at 3 months (estimated difference in change: 8.47; 95% CI 2.44-14.5; adjusted P=.02), diabetes distress at 6 months (estimated difference in change: -0.43; 95% CI -0.71 to -0.15; adjusted P=.009), and adherence to a healthy diet at both 3 months (estimated difference in change: 1.61; 95% CI 0.46-2.75; adjusted P=.02) and 6 months (estimated difference in change: 1.64; 95% CI 0.48-2.81; adjusted P=.02). CONCLUSIONS:The culturally and linguistically tailored intervention showed promise in improving self-efficacy and diabetes self-care activities among Chinese Americans with T2D, warranting validation through a large-scale randomized controlled trial. TRIAL REGISTRATION/BACKGROUND:ClinicalTrials.gov NCT03557697; https://clinicaltrials.gov/study/NCT03557697.

BACKGROUND:Minoritized populations face many barriers to accessing evidence-based diabetes intervention. OBJECTIVES/OBJECTIVE:To evaluate the feasibility, acceptability, and potential efficacy of a social media-based intervention to improve glycemic control among Chinese Americans with type 2 diabetes. DESIGN/METHODS:A pilot randomized controlled trial (RCT) with 3-month and 6-month follow-ups. PARTICIPANTS/METHODS:Chinese Americans (n = 60, mean age 54.3 years old) with limited education (70.0% with high school or less) and low income (50.0% with annual household income < $25,000), and 88.3% have limited English proficiency. INTERVENTION/METHODS:Culturally and linguistically tailored diabetes videos (two videos/week for 12 weeks) delivered via social media and support calls from community health workers. MAIN MEASURES/METHODS:Primary outcomes include feasibility (video watch rate, biweekly call completion rate, and retention rates), acceptability (patient satisfaction), and HbA1c. Secondary health-related outcomes include body weight, BMI, physical activity, and dietary intake. Video watch rate and biweekly call completion rate were assessed at baseline and 3 months, while others were measured at baseline, 3 months, and 6 months. RESULTS:We observed high feasibility and acceptability of the intervention, with retention rates over 87%, an 89% video watch rate, 80% biweekly phone call completion, and a satisfaction rating of 9 out of 10. The intervention group showed a significantly greater increase in fruit intake compared to the control group (0.15 cups vs. - 0.44 cups, adj_p = 0.023) at 3 months. While no significant differences in other outcomes were observed between the groups, the intervention group showed significant improvements in key outcomes, including reduced HbA1c levels (- 1.08%, adj_p < 0.001), weight loss (- 5.15 lbs, adj_p = 0.004), lower BMI (- 0.83, adj_p = 0.023), and reduced starchy food intake (- 0.33 cups, adj_p = 0.033) at 6 months. CONCLUSIONS:The observed high feasibility and acceptability suggest the intervention's feasibility. However, due to the limited sample size, a larger-scale RCT is warranted to test the efficacy of the intervention. TRIAL REGISTRATION/BACKGROUND:ClinicalTrials.gov NCT03557697; https://clinicaltrials.gov/ct2/show/NCT03557697.

AIMS/OBJECTIVE:To characterize changes in continuous glucose monitoring (CGM)-derived time in tight range (TIR) measures in individuals with prediabetes or non-insulin-treated type 2 diabetes undergoing dietary weight loss intervention and to quantify the association between weight loss and TIR improvement. METHODS:) were analysed. The association between weight change and TIR change adjusted for demographic and clinical covariates was computed using linear regression. RESULTS:. There were no associations between weight loss and change in any overnight TIR measure. CONCLUSION/CONCLUSIONS:in individuals with prediabetes and non-insulin-treated type 2 diabetes undergoing dietary intervention. The daytime time in tight range measures can complement traditional markers like HbA1c, offering a more comprehensive view of glycaemic variations during dietary weight loss programmes for individuals with prediabetes and type 2 diabetes not on insulin.

OBJECTIVE:To examine the associations of deprived neighbourhoods with all-cause mortality and incident cardiovascular disease (CVD) and to investigate whether these associations were independently and concurrently stratified by sex and ethnicity. METHODS:Data came from the UK Biobank, a prospective cohort study of over 500 000 participants aged 22-69 across the UK between 2006 and 2010. The follow-up time was calculated from each participant's enrolment at baseline until the first occurrence of a diagnosis of each death, incident or the censor date (31 December 2020). All-cause mortality, incident total CVD, ischaemic heart disease (IHD) and cerebrovascular disease (CeVD) were the outcomes defined based on the International Classification of Diseases. Deprived neighbourhoods were categorised into four groups: least deprived (referent), somewhat deprived, deprived, and most deprived neighbourhoods. Cox proportional hazards models were used to examine associations of deprived neighbourhoods with each outcome. Analyses were stratified by sex and ethnicity separately and simultaneously. RESULTS:A total of 261 954 participants were included. Participants had a mean follow-up of 14.3 years for all-cause mortality (3 745 307 person-years, 9933 deaths) and 12.7 years for total CVD incidence (3 321 619 person-years, 64 748 events). Those in the most deprived neighbourhoods (compared with the least) had a 31%, 13%, 15% and 34% greater risk of all-cause mortality, incident total CVD, IHD and CeVD, respectively. Patterns of associations were somewhat similar by sex, yet varied by ethnicity. The overall results were consistent with the white cohort but not for the other cohorts. CONCLUSIONS:This study indicated that individuals living in highly deprived neighbourhoods may have an elevated risk of all-cause mortality and incident CVD, particularly among the white cohort but not other cohorts. Future research should focus on efforts to invest in deprived areas to alleviate the burden of all-cause mortality and CVD incidence.

AIMS/OBJECTIVE:This study tested direct and indirect associations between neighborhood social environments and type 2 diabetes (T2D), serially mediated via health-related (physical activity [PA], body mass index [BMI]), psychosocial factors, and inflammation. METHODS:Data came from the Midlife in the United States (MIDUS 3 [2013-2014] and MIDUS 3 Biomarker Project [2017-2022]; n = 518). T2D (yes/no) was based on the American Diabetes Association criteria. Perceived neighborhood social cohesion and safety were assessed separately (higher scores = more favorable neighborhoods). PA, BMI, perceived stress, depression, and c-reactive protein (CRP) were included as mediators in the associations between exposure and the outcome adjusting for covariates. RESULTS:Higher social cohesion was indirectly related to lower likelihood of T2D, serially mediated through PA, BMI, and CRP (odds ratio [OR] = 1.00 [95 % bias-corrected confidence interval [BC CI] = 0.99, 1.00]). Higher social cohesion and safety were indirectly associated with a lower likelihood of T2D, serially mediated via stress, depression, and CRP (Social cohesion: OR = 0.98 [95 % BC CI = 0.96, 1.00]; and safety: OR = 0.98 [95 % BC CI = 0.96, 1.00], all p < 0.05). CONCLUSIONS:This study may be the first to demonstrate underlying potential mechanisms through which socially cohesive and safe neighborhoods lower the risk of T2D. These pathways present potential targets for interventions to reduce the risk.

OBJECTIVE/UNASSIGNED:Despite persistent disparities in diabetes prevalence among racial and ethnic minorities, there remains a significant lack of understanding regarding the intersectionality of racial and ethnic groups and socioeconomic status (SES) with diabetes. METHODS/UNASSIGNED: = 30,754, mean age = 47.4) using cross-sectional survey cycles from 2007 to 2008 through 2017-2020. Diabetes status was self-reported by physician diagnosis. Sociodemographic factors included racial and ethnic groups and SES. Weighted Poisson models were used to examine the association of racial and ethnic groups and SES with diabetes, stratified by age groups (20-44, 45-64, 65-79), sex, and racial and ethnic groups for SES, separately. RESULTS/UNASSIGNED:Non-Hispanic Black, Hispanic, and other adults had a 47 %, 31 %, and 76 % higher prevalence of diabetes than non-Hispanic White adults, while adults from low and middle SES compared to high SES had a 37 % and 22 % higher prevalence of diabetes. Non-Hispanic Black, Hispanic, and other adults aged 45-64 years had a 45 %, 34 %, and 78 % higher prevalence of diabetes, and low and middle SES had a 57 % and 32 % higher prevalence of diabetes. Similar patterns were observed for adults aged 65-79. Males among non-Hispanic Black, Hispanic, and other adults and females from low and middle-SES families had a higher prevalence of diabetes. CONCLUSION/UNASSIGNED:Minority groups, middle and older-aged adults, males from minority groups, and females from low SES had a greater prevalence of diabetes. Effective interventions should prioritize tailoring efforts to specific minoritized and low SES groups to address diabetes disparities.

PURPOSE/UNASSIGNED:Chinese Americans face disproportionately higher rates of Type 2 Diabetes (T2D) and co-occurring mental health challenges. Little is known about how they perceive mental health care during their journey with diabetes. This study aimed to provide an in-depth exploration of mental health care perceptions in this population. PATIENTS AND METHODS/UNASSIGNED:Two focus group discussions involving 12 participants were conducted in Mandarin. Participants were purposively sampled from a previous survey of Chinese immigrants with T2D who reported co-occurring mental health challenges and were recruited through referrals from primary care practices and community-based organizations in New York City. Data were analyzed using inductive content analysis. RESULTS/UNASSIGNED:The participants in this study ranged in age from 45 to 67 years. Most were female, married, and had low educational attainment (less than a college education) and low annual household incomes (less than USD $25,000). All participants were first-generation Chinese immigrants with limited English proficiency and had health insurance. HbA1c levels ranged from 6.5% to 12.6%. Depressive symptoms and elevated stress were the most commonly reported mental health issues in this sample. Data analysis revealed five categories related to participants' perceptions of mental health care: 1) interactions between mental health and T2D, 2) barriers to accessing mental health care, 3) facilitators of accessing mental health care, 4) coping strategies for mental health challenges, and 5) preferences for mental health services. CONCLUSION/UNASSIGNED:This study suggests the complex interactions between T2D and mental health issues among Chinese Americans. The findings indicate that seeking professional mental health services is uncommon among many individuals in this population and highlight several barriers and facilitators to access. The findings also suggest directions for future interventions to support mental health among Chinese Americans with T2D. Addressing mental health needs through effective interventions is essential for providing comprehensive care to this underserved population. Future research should explore the role of stigma in mental health-seeking behaviors, as well as design and assess the effectiveness of mental health interventions for Chinese Americans with T2D.

BACKGROUND:Type 2 diabetes (T2D) contributes to significant morbidity and mortality for Chinese immigrants in the United States, exacerbated by social determinants of health (SDOH) barriers such as language barriers, limited access to healthy foods, and low health literacy. OBJECTIVE:The goal of the Integrating Cultural Aspects into Diabetes Education (INCLUDE) study is to test a social media-based intervention adapting the Diabetes Prevention Program (DPP) for Chinese immigrants alongside a culturally adapted, community-supported agriculture program. Here, we report the protocol for the INCLUDE study. METHODS:INCLUDE is a 3-year randomized controlled trial (n=150). Participants with prediabetes or at risk for T2D are enrolled and randomized into either the control or intervention group (n=75 each). Participants from the intervention group receive 2-3 culturally tailored, in-language DPP videos weekly for 12 weeks, as well as biweekly phone calls from bilingual study staff to review video content, support goal setting, and assess and address SDOH-related barriers such as food insecurity. Intervention participants will also be given produce for 10 weeks as part of the community-supported agriculture program. Weight (primary outcome), self-efficacy, diet, physical activity, and food insecurity (secondary outcomes) are measured at baseline, 3-month, and 6-month intervals. Splined linear mixed models will be used to examine group differences in longitudinal weight and other secondary outcomes. The INCLUDE study was approved by the Institutional Review Board at the NYU Grossman School of Medicine. RESULTS:Recruitment started in May 2023, with the first cohort of 75 participants enrolled and randomized into 2 groups in July 2023. The 3-month and 6-month assessment of the first-year cohort has been completed. We have recruited 75 participants for the second cohort as of July 2024. CONCLUSIONS:The INCLUDE study will serve as an innovative model for culturally adapted, multilevel interventions for underserved communities previously unable to access evidence-based diabetes prevention initiatives. Aligning with several national calls for multilevel interventions, the INCLUDE intervention will provide critical data that will inform how researchers and public health professionals address SDOH barriers faced by underserved populations and prevent diabetes. TRIAL REGISTRATION/BACKGROUND:ClinicalTrials.gov NCT05492916; https://clinicaltrials.gov/study/NCT05492916. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)/UNASSIGNED:DERR1-10.2196/65455.