GEISINGER AND JOHNS HOPKINS BLOOMBERG SCHOOL OF PUBLIC HEALTH AND SCHOOL OF MEDICINE

Geisinger and Johns Hopkins University Bloomberg School of Public Health and School of Medicine are working together to study type 2 diabetes onset and control in rural and urban communities across central and northeastern Pennsylvania. The study is informed by prior research by the joint Geisinger-Johns Hopkins Bloomberg School of Public Health Environmental Health Institute regarding contextual influences on health, including obesity and type 2 diabetes. Our past research has highlighted four community domains that may impact the development of diabetes in our region, as well as management of the disease:

1. Social environment, particularly the level of community socioeconomic deprivation
2. Food environment, in terms of food outlets present in a community
3. Physical activity environment, including walkability and the fitness and recreational environment
4. Chronic environmental contamination, including the presence of abandoned coal mine lands, unconventional natural gas development, and industrial food animal production

Our first study includes 17 years of electronic health record data on more than 130,000 patients with type 2 diabetes, combined with secondary data on characteristics of Pennsylvania communities. In a second study, we are enriching electronic health record data with questionnaire, morphometric, and biomarker data on a subset of 1000 patients with diabetes. This primary data will allow us to evaluate the pathways by which the four community domains influence type 2 diabetes, whether through stress, sleep quality, mental health, or physical activity and dietary behaviors. Through this work, we aim to identify modifiable contextual factors with the greatest influence on type 2 diabetes in Pennsylvania to inform targeted disease prevention and management strategies.