In 2002, a multicenter study called the Diabetes Prevention Program (DPP) reported that diet and exercise were more protective than preventive drug therapy in helping people with pre-diabetes delay or avoid the disease. The participants who followed a lifestyle intervention arm attended healthy eating classes, lowered the fat content in their diet, and exercised moderately for 150 minutes each week. They lost seven percent of their body weight and maintained the weight loss. Further, research shows that non-Hispanic blacks are nearly twice as likely to have diabetes as non-Hispanic whites and are more likely to die of the disease’s complications than either whites or Hispanics. Practical ways to apply lifestyle interventions could help lower their risk.
In this core project, schools, churches, and health centers in New Haven and Bridgeport, Connecticut, are delivering community-based peer support, mentoring, and education by using community health advisors (CHAs). The study occurs in three phases; in each phase, participants will be randomized to an intervention site or a control group. The school portion is first, followed by the church and health center portions. In phase three, the control group members will participate (delayed intervention).
In the participating schools, researchers will help children in fourth and fifth grade lower their standardized body mass index, make healthy food choices, and improve their level of physical fitness. Children in the intervention group will learn to read food labels and recognize how unhealthy foods are marketed to them. They also will participate in a school fitness program, which introduces several brief episodes of activity into classrooms throughout the day.
In the participating churches, CHAs provide information about diabetes prevention. The CHAs receive training in teaching DPP lifestyle changes through a faith-based curriculum first developed for the PREDICT project, which used church events, walking groups, workshops, and other church-oriented events to help teach participants about avoiding diabetes.
In the health centers, providers at participating clinics learn time-efficient ways to teach patients about adopting healthy habits. Patients also attend group meetings with certified diabetes educators and CHAs.
Before and after the intervention, researchers use the following criteria to compare participants and control-group members: eating habits, measured with the Alternative Healthy Eating Index (a measure of diet quality based on guidelines from the Department of Health and Human Services and Department of Agriculture); physical activity, based on guidelines from CDC and the American College of Sports Medicine (five days each week, 30 minutes per exercise session); and overall weight loss. Researchers also will assess results of medical tests, such as fasting glucose level, lipid count, and blood pressure.