# Identifying and Reducing Disparities in Outcomes Among Economically Vulnerable and Minority Young Adults with Type 1 Diabetes

> **NIH NIH K23** · ALBERT EINSTEIN COLLEGE OF MEDICINE · 2021 · $197,640

## Abstract

There is a critical need to further understand disparities in care and improve outcomes in young adults (YA)
with type 1 diabetes (T1D) of low socioeconomic (SES) and minority status. Only 13% of YA (ages 18-30) with
T1D nationally achieve the American Diabetes Association-recommended HbA1c target of <7.0%, substantially
increasing long-term risk exposure and mortality later in life. Young adults have unique challenges, including
the developmental transition to adulthood and healthcare transition to adult care, making it a critical period to
intervene early. Compared to their white peers, YA with T1D of low SES and minority race/ethnicity are at
disproportionately higher risk for adverse outcomes, including worse glycemic control and increased rates of
recurrent diabetic ketaoacidosis and psychiatric comorbidity. This may be in part due to unrecognized and
unaddressed social determinants of health. Despite these stark discrepancies and poor overall outcomes in
YA, very little research has focused on these high-risk YA with T1D. Thus, the overall objectives of this
proposal are to 1) identify social determinants of health that contribute to poor outcomes in high-risk YA with
T1D and 2) develop and implement innovative tailored solutions to address disparities that extend beyond the
traditional healthcare environment. Shivani Agarwal, M.D., M.P.H. is an adult endocrinologist and early
diabetes and health services researcher who has previously developed a successful adult-based healthcare
transition intervention for YA with T1D, which will be enhanced to address high-risk YA needs based on
information gleaned from this proposal. In Specific Aim 1, data from YA in the national T1D Exchange Clinic
Network will be used to identify social determinants that impact glycemic control in low SES and minority
compared to higher SES non-minority YA with T1D. In Specific Aim 2, qualitative interviews will be conducted
locally to determine care-related needs and challenges for high-risk YA with T1D, and solicit potential
solutions. In Specific Aim 3, based upon an improved understanding of how social determinants affect care
engagement, care processes, and glycemic control in high-risk YA with T1D, Dr. Agarwal will use a
multidisciplinary multiple stakeholder advisory panel to enhance her transition intervention model to address
disparities. She will also test the enhanced intervention’s efficacy on retention in adult care in a pilot
randomized controlled trial. When complete, these studies will offer new insight on meaningful, addressable
determinants of health in high-risk YA with T1D, to inform a new model for healthcare transition to address
disparities. This work will form the basis for an R01 application of a multi-site randomized controlled trial testing
the efficacy of a comprehensive diabetes transition program against usual care. Dr. Agarwal seeks to acquire
important skills in disparities and diabetes investigation in addition to quantitative, qualita...

## Key facts

- **NIH application ID:** 10242732
- **Project number:** 5K23DK115896-05
- **Recipient organization:** ALBERT EINSTEIN COLLEGE OF MEDICINE
- **Principal Investigator:** Shivani Agarwal
- **Activity code:** K23 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $197,640
- **Award type:** 5
- **Project period:** 2018-09-01 → 2023-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10242732

## Citation

> US National Institutes of Health, RePORTER application 10242732, Identifying and Reducing Disparities in Outcomes Among Economically Vulnerable and Minority Young Adults with Type 1 Diabetes (5K23DK115896-05). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10242732. Licensed CC0.

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