Grantees

DREAMS-CDTR grantees are promising early-stage investigators supported by the Center’s Pilot and Feasibility Program, which funds pilot projects in areas diabetes translational research.

Current Pilot Award Investigators

Abigail Aarons, MD

University of California San Francisco

Project: Designing a Novel Diabetes Prevention Intervention for Older Adolescents and Young Adults: Youth and Service Provider Perspectives.

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Project Description: Prediabetes affects nearly a quarter of older adolescents and young adults (“Older AYA” ages 18-26), with higher rates in Black and Latino/a/x youth. With these ages representing an important developmental window of plasticity across behavioral, social, and physiologic dimensions, upstream prevention efforts targeted to older AYAs are a key opportunity to reduce diabetes disparities. However, evidence for effective diabetes prevention interventions, particularly intensive lifestyle interventions, in this age group remains limited. Both youth input and service provider input are essential to designing tailored interventions for older AYA that encourage participation and support youth in overcoming structural barriers to lifestyle change at both the individual and youth-serving institutional levels, in a practical and feasible way. In this project, we will use a qualitative design (semi-structured interviews) to understand youth and service provider perspectives on needs, best practices, barriers, and feasibility for a multi-level diabetes prevention intervention for older AYA in underserved communities. This study will include the completion of an ongoing youth interview process with 18-26 year old patients with prediabetes at Zuckerberg San Francisco General and UCSF Health (MediCal patients only), and interviews with five types of community-based and clinical service providers with an interest in diabetes prevention and health promotion in this age group. Interviews will be based on a COM-B behavior change framework, with a goal of informing an overarching theory of intervention. Findings from this work will serve as the basis for a future career development award application including a human centered design process to refine an intervention prototype and pilot multi-level intervention to prevent diabetes among older AYAs from underserved communities.

Jennie Davis, PhD, RDN

University of California Davis

Project: Added-sugar labels for type 2 diabetes prevention and health equity

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Project Description: Nearly two-thirds of US adults consume added sugar in excess of the daily recommended limit, increasing risk for type 2 diabetes (T2D). Consumers face multiple barriers to reduce added-sugar intake, including lack of time and/or ability to read nutrition facts labels, misleading claims and imagery on food packaging, and lack of restaurant menu added-sugar information. These barriers are more pronounced among socioeconomically disadvantaged and racialized populations at higher T2D risk. A promising translational approach to equitably reduce added-sugar intake is a policy mandating interpretive added-sugar labels on the front-of-packages and restaurant menus. Interpretive labels (e.g., warning or traffic-light labels) hold the greatest promise because they do not require high numeracy, high cognitive effort, or ample time to use. The goal of this study is to analyze the contents of added-sugar labeling policies to date, including if and how efficacy and equity are prioritized, and to assess public support for such policies among key stakeholders, including those diagnosed with pre-diabetes and T2D, or at higher risk for T2D, including racially and ethnically minoritized adults. We will conduct secondary data analyses from two studies led by the PI and faculty mentor. First, we will analyze the contents of all proposed and enacted U.S. labeling policies related to added sugar (n=44). Second, we will analyze cross-sectional data from a national survey (N=15,496) to measure support for a sugar menu labeling policy overall and in key stakeholders with or at higher T2D risk. Results could promote the dissemination of added-sugar labeling policies designed for efficacy and equity. Such policies could reduce added-sugar intake and thereby T2D risk by helping consumers make healthier choices and encouraging industry reformulation.


Aaron Tierney, PhD

Kaiser Permanente Northern California

Project: Assessing physician and patient experiences with ambient artificial intelligence scribes to ensure efficient and equitable diabetes care delivery

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Project Description: Diabetes care delivery gaps emerge when patients experience lower-quality communication with their physicians. Patients of underrepresented backgrounds are more likely to have lower-quality communication with their physicians resulting in worse diabetes care outcomes. Ambient artificial intelligence (AI) scribes implemented in Kaiser Permanente Northern California (KPNC) demonstrated early promising results of positive impacts on physician-patient communication by freeing up the physician’s focus, allowing them to be more attentive to patients. AI scribes can potentially improve T2D care by reducing the high level of documentation burden and improving communication between patients and physicians. While AI scribes may offer great promise, it is also vital to evaluate their impact on health equity. We aim to explore if AI scribes can facilitate progress toward improved, equitable Type II Diabetes (T2D) care delivery.

Chi Chu, MD MAS

University of California San Francisco

Project: Patient perspectives on data use for population health interventions

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Project Description: Diabetes mellitus (DM) and its associated comorbidities are a major public health concern and a leading contributor to morbidity and mortality worldwide. Population health interventions have been recognized as important tools for improving diabetes care delivery and often involve secondary use of patient health information. Patient acceptance of these interventions is key for success, however, patient perspectives on the secondary use of their health data for these purposes are understudied, especially in the context of historically marginalized populations. This proposal aims to conduct qualitative studies with patients from diverse and marginalized backgrounds to explore perspectives on health systems' secondary use of individual patient data for population health interventions. In the subsequent aim, we will conduct focus groups to define patient-driven best practices for a specific type of intervention (proactive econsults) for improving care delivery and equity.


Andrea Pedroza Tobias, MSc, PhD

Stanford University

Project: Designing Sustainable and Effective Interventions to Reduce Ultra-Processed Foods in School-Age Children.

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Project Description: School meal programs provide 30 million low-income children with 2/3 of the calories needed per day, providing a powerful tool to reduce racial/ethnic and socioeconomic disparities in food insecurity and obesity-related disease, including diabetes.. Although school meals have nutrition standards that limit the amount of sodium, calories, and saturated fat, in our team’s prior studies, parents have expressed concern about the high amount of ultra-processed foods provided in school meals. This proposal aims to build the evidence for interventions and policies to reduce children’s consumption of ultra-processed foods (UPF, foods made using industrial processing methods with added ingredients such as sugar, salt, fat, and food additives) to impact their health and development. First, we will conduct focus groups with parents of schoolaged children from low-income and minority backgrounds to understand knowledge and perceptions of UPF, their associated health and behavioral impacts, and contributors to UPF availability and consumption in children, both in and out-of-school. Second, we will interview food service directors to better understand the barriers and facilitators of providing less UPF and more fresh and unprocessed food in school meals. We will meet with an advisory group of policy advocates, school and food service directors, community organizations, USDA officials, and parents to guide us in interpreting the results and identifying and designing school-based interventions and policies to reduce ultra-processed food consumption.