Diabetes prevention in Hispanics: report from a randomized controlled trial

Catherine Duggan, Elizabeth Carosso, Norma Mariscal, Ilda Islas, Genoveva Ibarra, Sarah Holte, Wade Copeland, Sandra Linde, Beti Thompson, Catherine Duggan, Elizabeth Carosso, Norma Mariscal, Ilda Islas, Genoveva Ibarra, Sarah Holte, Wade Copeland, Sandra Linde, Beti Thompson

Abstract

Introduction: Hispanics are at increased risk of developing type 2 diabetes. Lifestyle interventions are effective in preventing diabetes and restoring glucose regulation.

Methods: We recruited Hispanic men and women (N = 320) who were residents of the Lower Yakima Valley, Washington, aged 18 years or older with hemoglobin A1c (HbA1c) levels higher than 6% to a parallel 2-arm randomized-controlled trial conducted from 2008 through 2012. The trial compared participants in the intervention arm, who received an immediate educational curriculum (n = 166), to participants in the control arm, who received a delayed educational curriculum (n = 154). The home-based curriculum consisted of 5 sessions led by community health workers and was designed to inform participants about diabetes, diabetes treatment, and healthy dietary and physical activity behaviors. Participants were randomly assigned to the intervention and control arms, and analysts were blinded as to participant arm. We evaluated intervention effects on HbA1c levels; frequency (times per week) of fruit and vegetable consumption; and frequency (times per week) of mild, moderate, and strenuous leisure-time physical activity. At baseline, 3 months, and 6 months after randomization, participants completed a questionnaire and provided a blood sample. Analysts were blinded to intervention arm.

Results: The immediate intervention group (-0.64% [standard error (SE) 0.10]) showed a significant improvement in HbA1c scores (-37.5%, P = .04) compared with the delayed intervention group (-0.44%, P = .14). No significant changes were seen for dietary end points or changes in physical activity. We did observe a trend of greater increases in frequency of moderate and vigorous physical activity and a smaller increase in mild physical activity in the immediate intervention group than in the delayed intervention group.

Conclusion: This home-based intervention delivered by CHWs was associated with a clinically and statistically significant reduction in HbA1c levels in Hispanic adults with HbA1c levels higher than 6%.

Trial registration: ClinicalTrials.gov NCT01564797.

Figures

Figure 1
Figure 1
Overview of the process for the randomized-controlled prevention trial of the Partnership for a Hispanic Diabetes Prevention Program.
Figure 2
Figure 2
Timing of intervention and HbA1c measurements. Abbreviation: HbA1c, hemoglobin A1c.

References

    1. International Expert Committee. International Expert Committee report on the role of the A1C assay in the diagnosis of diabetes. Diabetes Care 2009;32(7):1327–34. 10.2337/dc09-9033
    1. Carter JS, Pugh JA, Monterrosa A. Non-insulin-dependent diabetes mellitus in minorities in the United States. Ann Intern Med 1996;125(3):221–32. 10.7326/0003-4819-125-3-199608010-00011
    1. Chen R, Corona E, Sikora M, Dudley JT, Morgan AA, Moreno-Estrada A, et al. Type 2 diabetes risk alleles demonstrate extreme directional differentiation among human populations, compared to other diseases. PLoS Genet 2012;8(4):e1002621. 10.1371/journal.pgen.1002621
    1. Eamranond PP, Legedza AT, Diez-Roux AV, Kandula NR, Palmas W, Siscovick DS, et al. Association between language and risk factor levels among Hispanic adults with hypertension, hypercholesterolemia, or diabetes. Am Heart J 2009;157(1):53–9. 10.1016/j.ahj.2008.08.015
    1. Haiman CA, Fesinmeyer MD, Spencer KL, Buzková P, Voruganti VS, Wan P, et al. Consistent directions of effect for established type 2 diabetes risk variants across populations: the Population Architecture using Genomics and Epidemiology (PAGE) Consortium. Diabetes 2012;61(6):1642–7. 10.2337/db11-1296
    1. Centers for Disease Control and Prevention. National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States, 2011. Atlanta (GA): 2011. . Accessed January 29, 2013.
    1. Benjamin SM, Valdez R, Geiss LS, Rolka DB, Narayan KM. Estimated number of adults with prediabetes in the US in 2000: opportunities for prevention. Diabetes Care 2003;26(3):645–9. 10.2337/diacare.26.3.645
    1. Harris MI, Eastman RC, Cowie CC, Flegal KM, Eberhardt MS. Racial and ethnic differences in glycemic control of adults with type 2 diabetes. Diabetes Care 1999;22(3):403–8. 10.2337/diacare.22.3.403
    1. Osborn CY, de Groot M, Wagner JA. Racial and ethnic disparities in diabetes complications in the northeastern United States: the role of socioeconomic status. J Natl Med Assoc 2013;105(1):51–8.
    1. Haffner SM, Hazuda HP, Stern MP, Patterson JK, Van Heuven WA, Fong D. Effects of socioeconomic status on hyperglycemia and retinopathy levels in Mexican Americans with NIDDM. Diabetes Care 1989;12(2):128–34. 10.2337/diacare.12.2.128
    1. Harris MI, Klein R, Cowie CC, Rowland M, Byrd-Holt DD. Is the risk of diabetic retinopathy greater in non-Hispanic blacks and Mexican Americans than in non-Hispanic whites with type 2 diabetes? A U.S. population study. Diabetes Care 1998;21(8):1230–5. 10.2337/diacare.21.8.1230
    1. Diabetes Prevention Program (DPP) Research Group. The Diabetes Prevention Program (DPP): description of lifestyle intervention. Diabetes Care 2002;25(12):2165–71. 10.2337/diacare.25.12.2165
    1. Katula JA, Blackwell CS, Rosenberger EL, Goff DC Jr; Healthy Living Partnerships to Prevent Diabetes Research Team. Translating diabetes prevention programs: implications for dissemination and policy. 2011;72 405-8.
    1. Solis JM, Marks G, Garcia M, Shelton D. Acculturation, access to care, and use of preventive services by Hispanics: findings from HHANES 1982-84. Am J Public Health 1990;80(Suppl):11–9. 10.2105/AJPH.80.Suppl.11
    1. Perez Siwik V, Kutob RM, Ritenbaugh C, Aickin M, Gordon JS. Families United/Familias Unidas: development and implementation of a family-based group office visit model for the primary prevention of type 2 diabetes. Diabetes Educ 2012;38(6):811–21. 10.1177/0145721712461533
    1. Ceballos RM, Coronado GD, Thompson B. Having a diagnosis of diabetes is not associated with general diabetes knowledge in rural Hispanics. J Rural Health 2010;26(4):342–51. 10.1111/j.1748-0361.2010.00299.x
    1. U.S. Census Bureau. 2008-2012 American Community Survey. . Accessed January 29, 2013.
    1. Livaudais JC, Thompson B, Islas I, Ibarra G, Godina R, Coronado GD. Type 2 diabetes among rural Hispanics in Washington State: perspectives from community stakeholders. Health Promot Pract 2010;11(4):589–99. 10.1177/1524839909354458
    1. Subar AF, Heimendinger J, Patterson BH, Krebs-Smith SM, Pivonka E, Kessler R. Fruit and vegetable intake in the United States: the baseline survey of the Five A Day for Better Health Program. Am J Health Promot 1995;9(5):352–60. 10.4278/0890-1171-9.5.352
    1. Subar AS, Heimendinger J, Krebs-Smith SM, Patterson BH, Kessler R, Pivonka E. 5 A Day for Better Health: a baseline study of Americans’ fruit and vegetable consumption. Bethesda (MD): National Cancer Institute, National Institutes of Health, 1992.
    1. Ainsworth BE, Haskell WL, Whitt MC, Irwin ML, Swartz AM, Strath SJ, et al. Compendium of physical activities: an update of activity codes and MET intensities. Med Sci Sports Exerc 2000;32(9, Suppl):S498–504. 10.1097/00005768-200009001-00009
    1. Hawthorne K, Robles Y, Cannings-John R, Edwards AG. Culturally appropriate health education for type 2 diabetes in ethnic minority groups: a systematic and narrative review of randomized controlled trials. Diabet Med 2010;27(6):613–23. 10.1111/j.1464-5491.2010.02954.x
    1. Ockene IS, Tellez TL, Rosal MC, Reed GW, Mordes J, Merriam PA, et al. Outcomes of a Latino community-based intervention for the prevention of diabetes: the Lawrence Latino Diabetes Prevention Project. Am J Public Health 2012;102(2):336–42. 10.2105/AJPH.2011.300357
    1. Brown SA, Garcia AA, Kouzekanani K, Hanis CL. Culturally competent diabetes self-management education for Mexican Americans: the Starr County border health initiative. Diabetes Care 2002;25(2):259–68. 10.2337/diacare.25.2.259
    1. Two Feathers J, Kieffer EC, Palmisano G, Anderson M, Sinco B, Janz N, et al. Racial and Ethnic Approaches to Community Health (REACH) Detroit partnership: improving diabetes-related outcomes among African American and Latino adults. Am J Public Health 2005;95(9):1552–60. 10.2105/AJPH.2005.066134
    1. Lujan J, Ostwald SK, Ortiz M. Promotora diabetes intervention for Mexican Americans. Diabetes Educ 2007;33(4):660–70. 10.1177/0145721707304080
    1. Babamoto KS, Sey KA, Camilleri AJ, Karlan VJ, Catalasan J, Morisky DE. Improving diabetes care and health measures among Hispanics using community health workers: results from a randomized controlled trial. Health Educ Behav 2009;36(1):113–26. 10.1177/1090198108325911
    1. Martin MY. Community health advisors effectively promote cancer screening. Ethn Dis 2005;15(2, Suppl 2):S14–6.
    1. Teufel-Shone NI, Drummond R, Rawiel U. Developing and adapting a family-based diabetes program at the U.S.–Mexico border. Prev Chronic Dis 2005;2(1):A20.

Source: PubMed

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