- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02266576
A Patient-Centered Strategy for Improving Diabetes Prevention in Urban American Indians
December 9, 2019 updated by: Randall Stafford, Stanford University
The goal of the proposed research is to identify effective patient-centered strategies to prevent diabetes in high-risk populations in real world settings.
The investigators will accomplish this by conducting a randomized controlled trial comparing an enhanced Diabetes Prevention Program addressing psychosocial stressors to a standard version in a high-risk population of urban American Indian and Alaska Native people within a primary care setting.
Study Overview
Status
Completed
Intervention / Treatment
Detailed Description
The goal of the proposed research is to identify effective patient-centered strategies to prevent diabetes in high-risk populations in real world settings.
The investigators will accomplish this by conducting a randomized controlled trial comparing an enhanced Diabetes Prevention Program addressing psychosocial stressors to a standard version in a high-risk population of urban American Indian and Alaska Native peoples within a primary care setting.
Diabetes is disproportionately prevalent among low-socioeconomic status and racial/ethnic minority populations in the US.
The high prevalence of psychosocial stressors such as depression, discrimination, and exposure to trauma among these populations contributes to the high prevalence of diabetes and interferes with successful completion of lifestyle interventions.
The investigators hypothesize that a DPP that directly addresses these psychosocial stressors will be superior to the standard DPP in addressing this disparity in diabetes.
Study Type
Interventional
Enrollment (Actual)
207
Phase
- Not Applicable
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Locations
-
-
California
-
San Jose, California, United States, 95128
- Timpany Center of San Jose State University
-
Stanford, California, United States, 94305
- Stanford University School of Medicine
-
-
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
21 years and older (Adult, Older Adult)
Accepts Healthy Volunteers
Yes
Genders Eligible for Study
All
Description
Inclusion Criteria:
- Urban of Indigenous Ancestry from the Americas (North, Central and South America)
- Men and women
- BMI Between 30-55
- Not diagnosed with Type II Diabetes
At least one of the following criterion
- Triglycerides: 150mg/dL or higher
- Reduced HDL: <40mg/dL (men); <50mg/dL (women)
- Blood pressure: >130/80 or current treatment with antihypertensives
- Fasting glucose: >100mg/dL
Exclusion Criteria:
- Significant medical comorbidities, including uncontrolled metabolic disorders (e.g., thyroid, diabetes, renal, liver), unstable heart disease, heart failure, and ongoing substance abuse;
- On greater than 10 prescription medications.
- Psychiatric disorders requiring atypical antipsychotics or multiple medications;
- Inappropriate for moderate exercise according to the Revised Physical Activity Readiness Questionnaire;
- Pregnant, planning to become pregnant, or lactating;
- Family household member already enrolled in the study;
- Already enrolled or planning to enroll in a clinical trial that would limit full participation in the study;
- Resident of a long term care facility;
- Lack of spoken English by patient or a household member > 18 y who can serve as interpreter;
- Plans to move during the study period (9 months post-randomization);
- Investigator discretion for clinical safety or adherence reasons (e.g., unstable housing, chronic pain).
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Prevention
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Standard Diabetes Prevention Program (DPP)
Participants receive Standard DPP over the course of 20 weeks.
|
The Standard Diabetes Prevention Program (DPP) delivered by the San Jose State Timpany Center is the Group Lifestyle Balance™ DPP, which has previously been tailored for urban American Indians and Alaska Natives by the Indian Health Service.
Standard DPP components consist of 16 group classes, 4 visits with a lifestyle coach and access to a therapeutic swimming pool and gym.
|
Experimental: Enhanced DPP
Participants receive Standard DPP plus Enhanced DPP over the course of 20 weeks.
|
The Standard Diabetes Prevention Program (DPP) delivered by the San Jose State Timpany Center is the Group Lifestyle Balance™ DPP, which has previously been tailored for urban American Indians and Alaska Natives by the Indian Health Service.
Standard DPP components consist of 16 group classes, 4 visits with a lifestyle coach and access to a therapeutic swimming pool and gym.
Enhanced DPP components consist of access to a mental health counselor, active referrals to mental health services, and traditional healing workshops such as the use of talking circles, a modified photo voice and digital storytelling to address specific psychosocial issues that are a result of historical trauma, stress, and grief.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change From Baseline in Body Mass Index (BMI) Through Month 12
Time Frame: Change through month 12, with assessments at baseline, 6 months, and 12 months
|
BMI is measured as weight in kg divided by the square of height in meters.
|
Change through month 12, with assessments at baseline, 6 months, and 12 months
|
Change From Baseline in the Quality of Life Short Form Survey (SF-12)
Time Frame: Change through month 12, with assessments at baseline, 6 months, and 12 months
|
SF-12 scale is a generic, multipurpose short-form survey with 12 questions selected from the SF-36 Health Survey to evaluate overall health-related quality of life.
Answers are combined, scored and weighted into mental and physical functioning component scales.
The scores for each scale range from 0 to 100.
A higher value indicates a better quality of life of the patient.
|
Change through month 12, with assessments at baseline, 6 months, and 12 months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change From Baseline in Food Frequency Questionnaire (FFQ) Score as a Measure of Healthy and Unhealthy Diet Choices
Time Frame: Change through month 12, with assessments at baseline, 6 months, and 12 months
|
The FFQ modified to incorporate culturally-relevant food choices (e.g. corn tortillas and frybread) was used.
Food items were scored on a scale of 1 to 6 (6 corresponding to the greatest frequency of consumption), and categorized as "healthy," "unhealthy," and "undetermined" based on classifications previously determined by Teuful-Shone et al. "Healthy" foods were those recommended for increased intake (e.g.
green leafy salad).
"Unhealthy" foods were recommended for decreased intake (e.g.
soft drinks), and all remaining foods were "undetermined."
Healthy and unhealthy food scores (but not undetermined) were collected for this outcome measure.
Scores were summed for a total score.
Healthy food choices (6 questions) score range 3-36 (higher scores mean healthier diet).
Unhealthy food choices (13 questions) score range: 13-78 (lower scores mean healthier diet).
|
Change through month 12, with assessments at baseline, 6 months, and 12 months
|
Change From Baseline in Physical Activity Measured in Metabolic Equivalents (MET) Per Week
Time Frame: Change through month 12, with assessments at baseline, 6 months, and 12 months
|
MET is a term used to represent the intensity of exercise. A MET is the ratio of the rate of energy expended during an activity to the rate of energy expended at rest. At least 1000 MET minutes per week are needed to lower the risk of disease.
|
Change through month 12, with assessments at baseline, 6 months, and 12 months
|
Change From Baseline in the Center for Epidemiologic Studies - Depression Scale (CES-D) as a Measure of Mental Health Symptoms
Time Frame: Change through month 12, with assessments at baseline, 6 months, and 12 months
|
The CES-D (Radloff, 1977) is a 20-item, self-report scale designed to assess the presence and severity of depressive symptoms over the past week.
The total range is 0-80, with higher scores reflecting more severe depression symptoms.
|
Change through month 12, with assessments at baseline, 6 months, and 12 months
|
Change in From Baseline in Empowerment
Time Frame: Change through month 12, with assessments at baseline, 6 months, and 12 months
|
The Growth and Empowerment Measure (GEM) was developed to measure change in dimensions of empowerment as defined and described by Aboriginal Australians who participated in the Family Well Being programme.
The GEM has two components.
The 14-item Emotional Empowerment Scale has a range of 12-60, with higher scores corresponding to more ability to feel and show the signs of empowerment .
The 12-item Scenarios scale has a range of 12-84, with higher scores corresponding to better emotional empowerment in different scenarios.
|
Change through month 12, with assessments at baseline, 6 months, and 12 months
|
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Systolic Blood Pressure
Time Frame: Baseline, 6 months and 12 months
|
Blood pressure readings are expressed in millimeters of mercury.
This unit is abbreviated as mm Hg.
A normal reading would be any blood pressure below 120/80 mm Hg and above 90/60 mm Hg in an adult.
|
Baseline, 6 months and 12 months
|
Diastolic Blood Pressure
Time Frame: Baseline, 6 months and 12 months
|
Blood pressure readings are expressed in millimeters of mercury (mmHg).
A normal reading would be any blood pressure below 120/80 mm Hg and above 90/60 mm Hg in an adult.
|
Baseline, 6 months and 12 months
|
Fasting Blood Glucose
Time Frame: Baseline, 6 months and 12 months
|
Performed via fasting participant finger stick with Alere Cholestech LDX POS device.
|
Baseline, 6 months and 12 months
|
Symptoms of Historical Trauma
Time Frame: Baseline, 6 months and 12 months
|
By patient report using a modified version of the Indigenous People's Survey
|
Baseline, 6 months and 12 months
|
Waist Circumference
Time Frame: Baseline, 6 months and 12 months
|
In centimeters, measured by trained assessor using standard protocol
|
Baseline, 6 months and 12 months
|
Lipid Bioassays
Time Frame: Baseline, 6 months and 12 months
|
LDL-cholesterol, HDL-cholesterol, and Triglycerides; performed via fasting participant finger stick with Alere Cholestech LDX POS device
|
Baseline, 6 months and 12 months
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Investigators
- Principal Investigator: Randall S Stafford, MD, PhD, Stanford University
Publications and helpful links
The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.
General Publications
- Rosas LG, Vasquez JJ, Naderi R, Jeffery N, Hedlin H, Qin F, LaFromboise T, Megginson N, Pasqua C, Flores O, McClinton-Brown R, Evans J, Stafford RS. Development and evaluation of an enhanced diabetes prevention program with psychosocial support for urban American Indians and Alaska natives: A randomized controlled trial. Contemp Clin Trials. 2016 Sep;50:28-36. doi: 10.1016/j.cct.2016.06.015. Epub 2016 Jul 2.
- Rosas LG, Vasquez JJ, Hedlin HK, Qin FF, Lv N, Xiao L, Kendrick A, Atencio D, Stafford RS. Comparing enhanced versus standard Diabetes Prevention Program among indigenous adults in an urban setting: a randomized controlled trial. BMC Public Health. 2020 Jan 30;20(1):139. doi: 10.1186/s12889-020-8250-7.
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
June 1, 2015
Primary Completion (Actual)
August 30, 2017
Study Completion (Actual)
August 30, 2017
Study Registration Dates
First Submitted
October 13, 2014
First Submitted That Met QC Criteria
October 16, 2014
First Posted (Estimate)
October 17, 2014
Study Record Updates
Last Update Posted (Actual)
January 2, 2020
Last Update Submitted That Met QC Criteria
December 9, 2019
Last Verified
December 1, 2019
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- SU-30015
- PCORI-PCORIAD-1306-02172 (Other Grant/Funding Number: Patient-Centered Outcomes Research Institute)
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
No
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Diabetes Mellitus, Type 2
-
SanofiCompletedType 1 Diabetes Mellitus-Type 2 Diabetes MellitusHungary, Russian Federation, Germany, Poland, Japan, United States, Finland
-
Mannkind CorporationTerminatedType 2 Diabetes Mellitus | Type 1 Diabetes MellitusUnited States
-
RWTH Aachen UniversityBoehringer IngelheimCompletedDiabetes Mellitus Type 2 (T2DM)Germany
-
Griffin HospitalCalifornia Walnut CommissionCompletedDIABETES MELLITUS TYPE 2United States
-
University Hospital Inselspital, BerneCompletedType 2 Diabetes MellitusSwitzerland
-
India Diabetes Research Foundation & Dr. A. Ramachandran...CompletedTYpe 2 Diabetes MellitusIndia
-
Scripps Whittier Diabetes InstituteSan Diego State UniversityCompletedType 2 Diabetes Mellitus (T2DM)United States
-
AstraZenecaRecruiting
-
Daewoong Pharmaceutical Co. LTD.Not yet recruitingT2DM (Type 2 Diabetes Mellitus)
-
Zhongda HospitalRecruitingType 2 Diabetes Mellitus (T2DM)China
Clinical Trials on Standard DPP
-
Lovoria WilliamsNational Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)Recruiting
-
Baylor Research InstituteActive, not recruitingHypertension | Risk Reduction Behavior | African Americans | Diet, Carbohydrate-RestrictedUnited States
-
Kaiser PermanenteActive, not recruitingPreDiabetes | Type 2 DiabetesUnited States
-
Johns Hopkins Bloomberg School of Public HealthNational Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)CompletedPre-diabetesUnited States
-
Kaiser PermanenteCompleted
-
The University of Texas Medical Branch, GalvestonWithdrawnHypertension | Prediabetic State | Overweight or Obesity | Gestational Weight Gain
-
Albert Einstein College of MedicineNew York Presbyterian Hospital; Chinese American Independent Practice Association... and other collaboratorsCompleted
-
Vanderbilt University Medical CenterNational Heart, Lung, and Blood Institute (NHLBI)Not yet recruitingType2 Diabetes | Gestational DiabetesUnited States
-
Johns Hopkins UniversityNational Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)CompletedPreDiabetes | Type 2 Diabetes | Obesity, Childhood | Overweight and Obesity | Lifestyle, Healthy | Overweight, ChildhoodUnited States
-
Noom Inc.Stony Brook UniversityCompleted