PROJECT SUMMARY/ABSTRACT Rural areas, where ~60 million Americans live, have a higher burden of type 2 diabetes mellitus (T2DM) compared to urban areas, yet, there is sparse information on T2DM risk factors and interventions that improve T2DM primary prevention. Dr. Dugani, an academic hospitalist and early-stage investigator, is committed to improving the primary prevention of T2DM in rural areas. His long-term goal as an independent clinical investigator is to reduce health disparities for T2DM in rural populations by developing patient-centered interventions for better T2DM primary prevention. The short-term goals of this proposal are to acquire proficiency in data science, qualitative/mixed methods, health disparities research, and clinical trial study design through a Master of Public Health degree; mentorship; and, leadership skills to build and lead an independent research program to advance T2DM care. This research will be conducted at Mayo Clinic, which has robust infrastructure and facilities for patient-oriented research. Dr. Dugani will leverage data from the Centers for Disease Control and Prevention (Aim 1) and Mayo Clinic Biobank (Aims 2 and 3) to advance the research aims and also rely on a dedicated team of mentors and advisors with expertise in T2DM, epidemiology, health disparities research, and health services research. Dr. Dugani will accomplish his short-term goals through the novel Rural Patient Risks and Exposures for Diabetes ConTrol (Rural PREDICT) study, which he developed to investigate the higher burden of T2DM in Midwest rural compared to urban populations. At present, there is sparse information on risk factors for T2DM in Midwest rural populations and no T2DM risk prediction score for Midwest rural populations. Through Rural PREDICT, Dr. Dugani will address these knowledge gaps. Specifically, in Aim 1, he will characterize the incidence rate and temporal trend of diabetes in the rural Midwest. In Aim 2, he will evaluate the associations of traditional risk factors (e.g., lifestyle, socioeconomic status) and novel rural- enriched risk factors (e.g., organic chemicals, pesticides) with incident T2DM in the rural Midwest. He will directly engage rural patients to explore their perspectives regarding the high burden of risk factors. In Aim 3, he will develop a non-invasive (i.e., non-laboratory) 5-year T2DM risk prediction score for rural populations and obviate the need for laboratory testing, which may be a barrier for rural populations. He will engage patients to develop a meaningful, non-stigmatizing questionnaire for the risk score and explore barriers to the use of this risk score. These studies will form the basis for an NIH R01 (years 4-5) application to advance T2DM primary prevention in Midwest rural populations. His research goals align with NIMHD's priority to reduce health disparities in minority groups, including rural communities.

PROJECT NARRATIVE In the United States (US), the higher prevalence and mortality of type 2 diabetes mellitus (T2DM) in rural compared to urban populations represents a major public health problem. The proposed research focuses on the rural Midwest and leverages institutional resources and a multidisciplinary team of mentors and advisors to (1) characterize diabetes epidemiology; (2) evaluate the associations of traditional and novel rural-enriched risk factors with incident T2DM; and (3) develop a rural-specific self-administered T2DM risk score through patient engagement. This study has the potential to support efforts to prevent T2DM, improve T2DM care, and reduce T2DM health disparities for Midwest rural populations.