Effective Translation of an Intensive Lifestyle Intervention for Hispanic Women With Prediabetes in a Community Health Center Setting

Abstract

OBJECTIVEThe Diabetes Prevention Program (DPP) demonstrated that weight loss from intensive lifestyle intervention (ILI) in adults with prediabetes could decrease progression to type 2 diabetes. Inner-city, low-income Hispanic women are at high risk for developing type 2 diabetes; however, this type of intervention is not well established in this group. We hypothesized that a DPP intervention modified for a community health center (CHC) setting would decrease weight and improve metabolic measures in Hispanic women with prediabetes.RESEARCH DESIGN AND METHODSWomen diagnosed with prediabetes on a screening oral glucose tolerance test were recruited from a CHC. Participants (90% of whom were Hispanic) were randomized to either usual care (age 43 ± 9.7 years, BMI 35.2 ± 7.3 kg/m2) or ILI (age 43.8 ± 10.8 years, BMI 35.4 ± 8.5 kg/m2), structured as 14 weeks of group sessions focused on food choices, behavior change, physical activity, and weight loss. One year after enrollment, 122 women repeated baseline measures.RESULTSGroups had similar baseline weight, BMI, and fasting and 2-h glucose. One year later, the ILI group had lost 3.8 kg (4.4%), while the usual care group had gained 1.4 kg (1.6%, P < 0.0001). Two-hour glucose excursion decreased 15 mg/dL (0.85 mmol/L) in the ILI and 1 mg/dL (0.07 mmol/L) in the usual care group (P = 0.03). Significant decreases favoring the ILI group were noted in BMI, percent body fat, waist circumference, and fasting insulin.CONCLUSIONSA 14-week ILI program based on the DPP can effectively be translated into a predominantly Hispanic CHC setting, resulting in decreased weight, improved fasting insulin, and smaller glucose excursions 1 year after enrolling in the program.

Clinical impact of lifestyle interventions for the prevention of diabetes: an overview of systematic reviews

“…We have not systematically searched for more recent primary studies not included in the reviews considered here. However, the latest update from the DPP is in keeping with the results reviewed,43 as are the results of additional recent trials,44 45 including trials based in routine practice, where clinical benefits were found to be modest 4647 We excluded non-English language publications that we were unable to access (see figure 1).…”

Diabetes Prevention in U.S. Hispanic Adults: A Systematic Review of Culturally Tailored Interventions

“…Studies varied widely in sample size (N=20–312). Four studies recruited female participants only, 16–19 and four others were composed of largely (≥70%) female samples. 20–23 Participant mean age ranged from 27.8 to 52 years, participants were largely of Mexican descent, and the majority were overweight or obese (BMI >25).…”

“…20–23 Participant mean age ranged from 27.8 to 52 years, participants were largely of Mexican descent, and the majority were overweight or obese (BMI >25). Six studies used participant BMI >24 or 25 as an inclusion criterion, 16,17,22–25 and three studies used elevated HbA1c 20,22 or prediabetes diagnosis via oral glucose tolerance test 19 as inclusion criteria.…”

“…Strategies reported for each intervention are listed in Table 2. Some interventions included minimal changes to previously evaluated interventions (e.g., adapting the Diabetes Prevention Program to a community setting in Spanish, with literacy modifications 19 ), whereas other research groups engaged in a formalized community-based participatory research approach to developing intervention content, and solicited local knowledge and input regarding tailoring strategies. Aggregating across studies, the most common domains of tailoring/adaptation were language (delivery in Spanish, all studies), setting (community locations, all studies), delivery (e.g., peer educator or community health worker versus a nurse or other non–peer health professional, 11 studies).…”

“…Several studies also incorporated modifications for literacy (nine studies), Hispanic foods and recipes (seven studies), and structured community input (into curriculum content/design, eight studies). Innovative strategies used less commonly in interventions included group trips to a supermarket or garden to practice healthy food selection and purchasing, 19,24 creation of a telenovela (a type of soap opera) video to teach diabetes content, 24 social marketing campaign to promote community-level diabetes awareness, 22 recruitment of parent–child and mother–adult daughter dyads, 15,16 and participant-led community walking groups. 23 …”