Community-Based Lifestyle Interventions to Prevent Type 2 Diabetes

Abstract

FRANK VINICOR, MD, MPH 1OBJECTIVE -To conduct a literature review of community-based interventions intended to prevent or delay type 2 diabetes.RESEARCH DESIGN AND METHODS -Recently published findings about the potential to prevent or delay type 2 diabetes with intensive lifestyle interventions prompted a literature search for community-based diabetes prevention interventions. The literature review design was a search of databases for publications in 1990 -2001 that identified reports on community-based interventions designed to prevent or modify risk factors for type 2 diabetes.RESULTS -The search revealed 16 published interventions, 8 of which were conducted in the U.S. and involved populations disproportionately burdened by diabetes (e.g., American Indians, Native Hawaiians, Mexican Americans, and African Americans). Of the studies reporting results among youth, there were posttest improvements in intervention groups in knowledge, preventive behaviors, and self-esteem. Among studies reporting results among adults, most reported improvements in intervention groups in knowledge or adoption of regular physical activity. Several investigators offered important reflections about the process of engaging communities and sharing decision making in participatory research approaches, as well as insights about the expectations and limitations of community-based diabetes prevention research. Many of the studies reported limitations in their design, including the lack of control or comparison groups, low response rates or lack of information on nonresponders, or brief intervention periods.CONCLUSIONS -There is a critical need to conduct and publish reports on well-designed community-based diabetes prevention research and share information on the process, results, and lessons learned. Armed with recent positive findings about diabetes prevention and literature documenting community-based efforts, advocates at local, state, and national levels can collaborate to stem the rising tide of diabetes in communities. Diabetes Care 26:2643-2652, 2003I n a decade's time (1990 -2001), the prevalence of self-reported (diagnosed) diabetes increased 61% in the U.S. (1), including a startling 76% increase from 1990 to 1998 among people in their 30s (2). Accounting for roughly 95% of all diabetes, type 2 diabetes is associated with obesity and weight gain (3), which also increased over the same time period. One projection is that the 11 million U.S. residents with diagnosed diabetes will increase to 29 million in 2050 (4). The escalating prevalence of type 2 diabetes portends serious consequences for the quality of life of those affected and their families and communities.To stem the rising tide of diabetes, public health policies need to move upstream toward prevention or at least a delay in the onset of type 2 diabetes. A number of recent studies offer scientific evidence and new hope for curtailing the epidemic of type 2 diabetes with support for intensive lifestyle modification and modest weight loss as effective interventions among a...

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