Translating the Diabetes Prevention Program Into American Indian and Alaska Native Communities
Results from the Special Diabetes Program for Indians Diabetes Prevention demonstration project
- Luohua Jiang, PHD1⇑,
- Spero M. Manson, PHD2,
- Janette Beals, PHD2,
- William G. Henderson, PHD3,
- Haixiao Huang, MPH2,
- Kelly J. Acton, MD, MPH4,
- Yvette Roubideaux, MD, MPH5,
- the Special Diabetes Program for Indians Diabetes Prevention Demonstration Project
- 1Department of Epidemiology and Biostatistics, School of Rural Public Health, Texas A&M Health Science Center, College Station, Texas
- 2Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- 3Colorado Health Outcomes Program, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- 4Office of the Assistant Secretary of Health, U.S. Department of Health and Human Services, San Francisco, California
- 5Office of the Director, Indian Health Service Rockville, Maryland.
- Corresponding author: Luohua Jiang, .
OBJECTIVE The landmark Diabetes Prevention Program (DPP) showed that lifestyle intervention can prevent or delay the onset of diabetes for those at risk. We evaluated a translational implementation of this intervention in a diverse set of American Indian and Alaska Native (AI/AN) communities.
RESEARCH DESIGN AND METHODS The Special Diabetes Program for Indians Diabetes Prevention (SDPI-DP) demonstration project implemented the DPP lifestyle intervention among 36 health care programs serving 80 tribes. A total of 2,553 participants with prediabetes were recruited and started intervention by 31 July 2008. They were offered the 16-session Lifestyle Balance Curriculum and underwent a thorough clinical assessment for evaluation of their diabetes status and risk at baseline, soon after completing the curriculum (postcurriculum), and annually for up to 3 years. Diabetes incidence was estimated. Weight loss, changes in blood pressure and lipid levels, and lifestyle changes after intervention were also evaluated.
RESULTS The completion rates of SDPI-DP were 74, 59, 42, and 33% for the postcurriculum and year 1, 2, and 3 assessments, respectively. The crude incidence of diabetes among SDPI-DP participants was 4.0% per year. Significant improvements in weight, blood pressure, and lipid levels were observed immediately after the intervention and annually thereafter for 3 years. Class attendance strongly correlated with diabetes incidence rate, weight loss, and change in systolic blood pressure.
CONCLUSIONS Our findings demonstrate the feasibility and potential of translating the lifestyle intervention in diverse AI/AN communities. They have important implications for future dissemination and institutionalization of the intervention throughout the Native American health system.
This article contains Supplementary Data online at http://care.diabetesjournals.org/lookup/suppl/doi:10.2337/dc12-1250/-/DC1.
See accompanying commentary, p. 1820.
- Received June 27, 2012.
- Accepted November 13, 2012.
- © 2013 by the American Diabetes Association.
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