Objective: To test the efficacy of a hybrid model of the self-help intervention program (hSHIP), which combines a mobile version of SHIP (mSHIP) and personal coaching, to address unique cultural and motivational factors for optimal self-management of type 2 diabetes and prediabetes among Korean Americans (KAs). Methods: A single-group feasibility study design was used. The hSHIP utilizes texts and motivational counseling based on well-tested intervention content for KAs. To facilitate the dissemination of hSHIP, we developed a web application adopting the principles of persuasive technology to motivate behavior changes. Results: Feasibility assessment found that hSHIP was well accepted by both participants and community health workers who delivered the intervention. An average of 1.3% A1C reduction (from 7.8% to 6.5%) was achieved by KAs with diabetes (n = 165), 51.5% of whom lowered their A1C below 6.5% in 6-months. No one with prediabetes (n = 50) progressed to diabetes. Other clinical outcomes (e.g., weight, depression, and blood pressure) also improved significantly; 41.2% were able to reduce or discontinue antidiabetic drugs. Conclusion: The feasibility and initial efficacy of hSHIP were demonstrated. Practice implication: This hybrid diabetes self-management model is a viable tool for traditionally underserved groups with diabetes or prediabetes.

BackgroundComorbid depression and diabetes mellitus (DM) compound challenges to disease management such as low health literacy, insufficient access to care, and social or linguistic isolation. Korean Americans (KAs), predominantly first-generation immigrants, suffer from a high prevalence of type 2 DM and depression. Limited research on KAs has prevented the development of effective interventions.ObjectivesTo compare the prevalence of depression in KAs with DM and all Americans with/without DM, and to explore correlates of comorbid DM and depression and strategies to address KAs' DM and depression.MethodsKAs' data were from a clinical trial of a community-based self-help intervention to improve KAs' DM and mental health outcomes. National Health and Nutrition Examination Survey data sets enabled comparison. Clinical indicators included hemoglobin A1C, lipid panel, and body mass index. Psychobehavioral indicators included self-efficacy for DM management, quality of life, and depression (Patient Health Questionnaire-9 (PHQ-9)).ResultsMore KAs with DM had depression (44.2%) than did all Americans with DM (28.7%) or without DM (20.1%). Significantly more KAs with DM had mild (29.3%) or clinical (14.9%) depression than did Americans with DM (mild, 17.2%; clinical, 11.5%) or without (mild, 13.8%; clinical, 6.3%). One of six KAs with DM (16.9%) thought of suicide or self-harm (Americans with/without =5.0%, 2.8%). The self-help intervention reduced the mean PHQ-9 from 5.4 at baseline to 4.1 at 12 months.LimitationsExternal validity might be limited; KAs' data were from one study site.ConclusionsThe prevalence of depression and DM among KAs warrants the development of efficacious interventions.Trial registration numberNCT01264796.

Obesity, a pandemic in the U.S. [1], is continuing to worsen. In 2013-2014, more than a third of American adults (37.7%) were obese, with a body mass index (BMI) of ≥30. That figure represents an increase of 7.2% from the years 1999-2000, roughly equivalent to 16 million people. During the same period in the U.S., the prevalence of the morbidly obese (BMI ≥40) increased from 4.7% to 7.7% in 2013-2014, representing 6.7 million. Perhaps not surprisingly, bariatric surgery grew from 158,000 cases in 2011 to 216,000 in 2016 [2].Obesity, the accumulation of excess body fat, is linked to many chronic conditions or diseases as a cause of comorbidities, which include asthma [3], type 2 diabetes [4,5], rheumatoid arthritis [6], cardiovascular diseases [7,8], cancer [9], depression [10,11], and dementia [12,13]. On average, an obese person incurred $3,429 more healthcare costs (in 2013 dollars) from 2006 to 2013 than did a non-obese person [14]. Beyond that, the social costs of obesity are incalculable.Despite enormous efforts to curtail the rising trend in obesity, the war against obesity is losing its footing, with no clear strategy to overcome this challenge in sight [15]. This is not because the causes of obesity are unknown; the WHO's International Statistical Classification of Diseases and Related Health Problems version 10 (ICD-10) identified excess calories and drugs as obesity's most important causes. But homocentric theories of obesity at both macro and micro levels seem to have prevailed and misguided the practice of obesity control. At the macro level, for example, the homeostatic theory of obesity has suggested "a circle of discontent" linking weight gain, body dissatisfaction, negative affect, and overconsumption, resulting in strategies to overcome the obesity epidemic such as putting a stop to victim-blaming, stigma, and discrimination and revalorizing the thin ideal, among others [16]. At the micro level, extensive studies of genetic and biochemical mechanisms have linked excess nutrients to obesity as a byproduct of metabolism, but the linking mechanisms are still poorly

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