The Implementation of Diabetes Prevention Program at a Community Health Center

Background: Time-trend Hispanic population data spanning 2007-2012 shows a stronger association between obesity trends and a higher prevalence of Type 2 Diabetes Mellitus (T2DM) in Hispanic than non-Hispanic Whites (NHW): 40.1% and 44.4% for male and female Hispanic adults, respectively, and 32.4% and 32.8 % for male and female NHW adults. Patients with T2DM have 2-3-fold higher mortality than unaffected adults, and the disease is strongly correlated with obesity1. Obesity, insulin resistance, and abnormal glucose metabolism are strongly associated with diabetes. Reducing the incidence of T2DM depends upon body weight control. The Center for Disease Control and Prevention (CDC)'s Diabetes Prevention Program (DPP) strategies evidence 58% reduced incidence of T2DM over three years of study2. Objectives: The purpose of this quality improvement (QI) project is to implement a modified Diabetes Prevention Program (DPP) curriculum in the underserved, uninsured Hispanic patient population by imposing health-promoting behaviors through weight loss, diet, and exercise. One of the main objectives of this QI is to demonstrate to clinic leadership the efficacy of this modified DPP curriculum in preventing diabetes so it may be adopted as a standard of care across all prediabetic patients within the clinic's healthcare system. Methods: We modified the DPP curriculum to better reflect the culture and language represented by Spanish-speaking adults with prediabetes and obesity. A fluent Spanish-speaking diabetic educator implemented this QI project at a Federally Qualified Health Center (FQHC) over 13 weekly sessions covering 16 DPP core concepts. Pretests and posttests were administered to 18 participants to measure knowledge before and after the intervention. Bodyweight was measured at the pretest and each weekly session, as well as self-reported minutes of exercise. Waist circumference and point of care HbA1c were evaluated at week 1 and week 13. Each measure was discussed with participants for personal reflection. Results: Of 18 planned, 61% (=11/18) enrolled and completed the program; all the participants were female. Nutritional and diabetes prevention knowledge increased (p<0.003), and waist circumference decreased (p=0.005), but no change in HbA1c, weight loss, or BMI change were noted over the period compared to baseline data. The week 13, HbA1c is inversely associated with an absolute change in waist circumference over the period (p=0.043); however, a low-sample size limited associations of change in HbA1c with either weight loss or BMI trend. Conclusion: Over the relatively short period of 13 weeks, those Hispanic women received linguistically and culturally competent education therapy to change their T2DM-associated behaviors, and the absolute changes in waist circumference were inversely accompanied by lower levels of post-DPP HbA1c. Improving the appeal of DPP to male Hispanics is an important next step. Also, developing a culturally competent follow-on approach to promoting further adherence to evidence-based exercise and dietary recommendations is essential to improving the public’s health. (1) Fryar, C. D., Carroll, M. D., & Ogden, C. L. (2014). Prevalence of Overweight, Obesity, and Extreme Obesity Among Adults: United States, 1960–1962 Through 2011–2012 https://www.cdc.gov/nchs/data/hestat/obesity_adult_11_12/obesity_adult_11_12.pdf (2) La Sala, L., & Pontiroli, A. E. (2020). Prevention of diabetes and cardiovascular disease in obesity. International Journal of Molecular Sciences, 21(21), 1-17. https://doi.org/10.3390/ijms2121817