Neighborhood characteristics and lifestyle intervention outcomes: Results from the Special Diabetes Program for Indians

Abstract

Growing evidence reveals various neighborhood conditions are associated with the risk of developing type 2 diabetes. It is unknown, however, whether the effectiveness of diabetes prevention interventions is also influenced by neighborhood characteristics. The purpose of the current study is to examine the impact of neighborhood characteristics on the outcomes of a lifestyle intervention to prevent diabetes in American Indians and Alaska Natives (AI/ANs). Year 2000 US Census Tract data were linked with those from the Special Diabetes Program for Indians Diabetes Prevention Program (SDPI-DP), an evidence-based lifestyle intervention implemented in 36 AI/AN grantee sites across the US. A total of 3394 participants started the intervention between 01/01/2006 and 07/31/2009 and were followed by 07/31/2016. In 2016-2017, data analyses were conducted to evaluate the relationships of neighborhood characteristics with intervention outcomes, controlling for individual level socioeconomic status. AI/ANs from sites located in neighborhoods with higher median household income had 38% lower risk of developing diabetes than those from sites with lower neighborhood income (adjusted hazard ratio = 0.65, 95% CI: 0.47-0.90). Further, those from sites with higher neighborhood concentrations of AI/ANs achieved less BMI reduction and physical activity increase. Meanwhile, participants from sites with higher neighborhood level of vehicle occupancy made more improvement in BMI and diet. Lifestyle intervention effectiveness was not optimal when the intervention was implemented at sites with disadvantaged neighborhood characteristics. Meaningful improvements in socioeconomic and other neighborhood disadvantages of vulnerable populations could be important in stemming the global epidemic of diabetes.

Longitudinal Changes in Allostatic Load during a Randomized Church-based, Lifestyle Intervention in African American Women

“…27 Though neighborhood disadvantage was not statistically significant in our study, its direction is similar to previous literature of other minority groups, which found that the DPP for American Indians and Alaska Natives had suboptimal outcomes in disadvantaged neighborhoods. 28 Other longitudinal studies also observed greater increases in allostatic load among African American youth who lived in neighborhoods with higher concentrations of neighborhood poverty if youth did not receive high levels of emotional support. 29 Another study found that adults who experienced low SES in childhood and had lower allostatic load in adulthood were more likely to maintain "shift and persist" resiliency, characterized by adaptation to stressors and focus on the future.…”

Using community-based participatory research to improve care for American Indians/Alaska Natives with type 2 diabetes mellitus

“…Further analysis of the SDPI-DP data revealed local characteristics that were barriers to lifestyle interventions 11. Higher diabetes incidence was associated with neighborhoods with lower median income.…”

“…4 For comparison, the incidence of diabetes in AI/ANs in the placebo group of the DPP was 12.9% per year. 11 The participants in the SDPI-DP lost approximately 9.6 lb or 4.4% of their average baseline weight and exercised more after the program. The researchers concluded that DPP was applicable to AI/ANs.…”

“…Locales with higher populations of AI/ANs (such as reservations) had less weight reduction and less increase in exercise. In contrast, AI/ANs from neighborhoods with a higher median income had a 35% lower risk of developing T2DM, and areas with higher vehicle ownership also had better weight reduction possibly through better access to healthy food 11. Consequently, NPs need to be aware of the neighborhood and personal economic characteristics of their AI/AN patients and make healthcare suggestions accordingly.…”

The Effectiveness of Social Support Management of Diabetes on Glucose Control of Type 2 Diabetes Mellitus Patients: Quasi-Experiments

“…The total was 5.7% in 2007, 6.9% in 2013, and in 2018 it increased to 8.5% [3]. International Diabetes Federation (IDF) has estimated that the number of Indonesian diabetic patients was 11.3% in 2020 and it was ranked on 7 in the world [4] DM will become a severe problem if the patient has an unhealthy lifestyle [5], [6], [7]. However, it can be prevented and controlled by controlling risk factors [8].…”