Prevention of type 2 diabetes in urban American Indian/Alaskan Native communities: The Life in BALANCE pilot study

Abstract

Objective: The Life in BALANCE (LIB) study is a pilot translational study modeling the Diabetes Prevention Program (DPP) intensive lifestyle coaching intervention among an underserved, high-risk population: American Indians/Alaska Natives (AI/ANs) living in a large urban setting (Las Vegas, Nevada). Research Design and Methods: A total of 22 overweight/obese AI/ANs (age, 39.6 ± 10.4 years; BMI, 34.1 ± 6.3 kg/m2) at increased risk for developing type 2 diabetes (HbA1c > 5.4 (36 mmol/mol) < 6.4 percent (46 mmol/mol) participated in the program between April and December, 2011. Study participants completed a 16 week intensive lifestyle coaching intervention. In addition to obtaining qualitative data regarding opportunities and challenges of applying the lifestyle intervention for AI/AN participants in an urban setting, clinical data, including BMI, waist circumference, blood pressure, fasting blood glucose, and blood lipids (HDL, LDL and Triglycerides), were collected. Results: Only 12 of the 22 participants remained in the LIB program at the final post-program follow-up. Participants demonstrated significant decreased waist circumference and elevated HDL cholesterol. Triglycerides manifested the highest percentage change without statistical significance. No significant change was observed in blood pressure or fasting blood glucose. Conclusions: LIB participants’ improvements in BMI, waist circumference, HDL cholesterol and triglycerides suggests type 2 diabetes prevention programs aimed at urban AI/ANs show significant potential for reducing the risk of developing type 2 diabetes among this underserved and high risk community. Qualitative data suggest the main challenge for type 2 diabetes prevention specific to this population is a need for improved community outreach strategies.

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Benyshek, D. , Chino, M. , Dodge-Francis, C. , Begay, T. , Jin, H. and Giordano, C. (2013) Prevention of type 2 diabetes in urban American Indian/Alaskan Native communities: The Life in BALANCE pilot study. Journal of Diabetes Mellitus, 3, 184-191. doi: 10.4236/jdm.2013.34028.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] Caprio, S., et al. (2008) Influence of race, ethnicity, and culture on childhood obesity: Implications for prevention and treatment a consensus statement of shaping America’s health and the obesity society. Diabetes Care, 31, 2211-2221. http://dx.doi.org/10.2337/dc08-9024
[2] Mokdad, A.H., Bowman, B.A., Engelgau, M.M. and Vinicor, F. (2001) Diabetes trends among American Indians and Alaska natives: 1990-1998. Diabetes Care, 24, 1508-1509. http://dx.doi.org/10.2337/ diacare.24.8.1508-a
[3] CDC (2003) Diabetes prevalence among American Indians and Alaska Natives and the overall population— United States, 1994-2002. Morbidity and Mortality Weekly Report, 52, 702-704.
[4] Benyshek, D.C. (2007) The developmental origins of obesity and related health disorders: Prenatal and perinatal factors. Collegium Antropologicum, 31, 11-17.
[5] Norris, T., Vines, P. and Hoeffel, E. (2012) The American Indian and Alaska Native population: 2010. United States Bureau of the Census. http://www.census.gov/prod/cen2010/briefs/c2010br-10.pdf
[6] Grossman, D.C., Krieger, J.W., Sugarman, J.R. and Forquera, R.A. (1994) Health status of urban American Indians and Alaska Natives: A population-based study. JAMA, 271, 845-850.
http://dx.doi.org/10.1001/jama.1994.03510350055037
[7] Hodge, F.S., Weinmann, S. and Roubideaux, Y. (2000) Recruitment of American Indians and Alaska Natives into clinical trials. Annals of Epidemiology, 10, S41-S48. http://dx.doi.org/10.1016/S1047-2797(00)00196-4
[8] Kramer, B. (1992) Health and aging of urban American Indians. Western Journal of Medicine, 157, 281-285.
[9] Schulze, M.B., et al. (2006) Comparison of anthropometric characteristics in predicting the incidence of type 2 diabetes in the EPIC-Potsdam study. Diabetes Care, 29, 1921-1923. http://dx.doi.org/ 10.2337/dc06-0895
[10] Feller, S., Boeing, H. and Pischon, T. (2010) Body mass index, waist circumference, and the risk of type 2 diabetes mellitus: Implications for routine clinical practice. Deutsches Arzteblatt international, 107, 470-476. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2905837
[11] Christ, M., Iannello, C., Iannello, P.G. and Grimm, W. (2004) Effects of a weight reduction program with and without aerobic exercise in the metabolic syndrome. International Journal of Cardiology, 97, 115-122. http://dx.doi.org/10.1016/j.ijcard.2004.01.034
[12] Muzio, F., Mondazzi, L., Harris, W.S., Sommariva, D. and Branchi, A. (2007) Effects of moderate variations in the macronutrient content of the diet on cardiovascular disease risk factors in obese patients with the metabolic syndrome. American Journal of Clinical Nutrition, 86, 946-951.
[13] Rector, R.S., et al. (2007) Exercise and diet induced weight loss improves measures of oxidative stress and insulin sensitivity in adults with characteristics of the metabolic syndrome. American Journal of Physiology, Endocrinology and Metabolism, 293, E500-E506. http://dx.doi.org/ 10.1152/ajpendo.00116.2007
[14] Meckling, K.A. and Sherfey, R. (2007) A randomized trial of a hypocaloric high-protein diet, with and without exercise, on weight loss, fitness, and markers of the Metabolic Syndrome in overweight and obese women. Applied Physiology, Nutrition, and Metabolism, 32, 743-752. http://dx.doi.org/ 10.1139/H07-059
[15] Reaven, G.M. (2005) The insulin resistance syndrome: Definition and dietary approaches to treatment. Annual Review of Nutrition, 25, 391-406. http://dx.doi.org/10.1146/annurev. nutr.24.012003.132155
[16] Baker, M.K., Simpson, K., Lloyd, B., Bauman, A.E. and Singh, M.A.F. (2011) Behavioral strategies in diabetes prevention programs: A systematic review of randomized controlled trials. Diabetes Research and Clinical Practice, 91, 1-12. http://dx.doi.org/10.1016/j.diabres.2010.06.030
[17] Brown, S.A. (1990) Studies of educational interventions and outcomes in diabetic adults: A meta-analysis revisited. Patient Education and Counseling, 16, 189-215. http://dx.doi.org/10.1016/0738-3991(90)90070-2
[18] Roter, D.L., et al. (1998) Effectiveness of interventions to improve patient compliance: A meta-analysis. Medical Care, 36, 1138-1161. http://dx.doi.org/10.1097/00005650-199808000-00004
[19] Topol, E.J. (2012) The creative destruction of medicine: How the digital revolution will create better health care. Basic Books, New York.

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