Biopsychosocial Pathways to Type 2 Diabetes

University Of Wisconsin-Madison, Madison WI

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Abstract

DESCRIPTION (provided by applicant): This application will support the research and training of Dr. Tsenkova, a health psychologist committed to developing a career in aging-related morbidities such as type 2 diabetes and cardiovascular disease. Using a national longitudinal study of aging adults (MIDUS, Midlife in the U.S.), the proposed aims will investigate the extent to which sociodemographic and psychosocial factors modulate the impact of traditional risk factors (e.g., obesity) on preclinical glucose metabolism. A didactic plan includes development of: 1) a strong grounding in geriatric endocrinology and metabolism, and 2) expertise in epidemiology and statistical methodology. Training objectives will be accomplished through multidisciplinary mentorship, along with targeted coursework in epidemiology, nutritional sciences, and aging. The research plan will focus initially on data from MIDUS I and II (9- 10 years) to create cumulative profiles of SES advantage or disadvantage as well as cumulative profiles of psychosocial resources and vulnerabilities to test their combined influence on glucose metabolism and subsequent morbidity. Cumulative SES disadvantage and minority status are hypothesized to amplify the effects of traditional risk factors, resulting in por glycemic control. Similarly, cumulative psychosocial vulnerabilities are hypothesized to exacerbate the effects of traditional risk factors, resulting in poor glycemic control. Alternativey, persistent SES advantage and persistent psychosocial resources are predicted to buffer the effects of traditional risk factors on glycemic control. In the final years of this CDA, data from MIDUS III (9- 10 years post MIDUS II) will be used to predict morbidity (type 2 diabetes and cardiovascular disease) and mortality two decades after post-baseline assessments, using combinations of traditional risk factors, cumulative SES and psychosocial measures, and glucose metabolism as the mediating mechanism. A key question is whether the combined presence of risk factors from multiple areas translates to accelerated aging (i.e., compromised glycemic control earlier in the adult life course). Glucose metabolism will be indexed with multiple indicators known to operate on different timelines and reflect related yet distinct physiological processes. The central significance of the proposed research is the focus on integrative biopsychosocial pathways (some illustrating vulnerability, others illustrating resilience) to explicit health outcomes, assessed over a 20-year period. Findings from the above aims have implications for prevention of type 2 diabetes, a public health epidemic of striking proportions, particularly among older adults.