Research Description
Healthy nutrition habits are key to managing type 2 diabetes (T2D). However, American Indian and Alaska Natives (AI/ANs) often lack access to culturally relevant nutrition education and they disproportionately experience food insecurity. Food insecurity, defined as lack of consistent access to enough food for an active, healthy life, negatively impacts one’s ability to engage in diabetes self-management and care. The purpose of this study is to evaluate if diabetes nutrition education and an added food security resource, such as farmers market vouchers for fruits and vegetables, can improve diabetes self-management for AI/ANs with T2D. Researchers will work with collaborators at the Oklahoma City Indian Clinic in Oklahoma City, OK, and an American Indian community advisory board (CAB) throughout the study to ensure the nutrition education and food security resources are designed to meet the needs of the community and clinic. With the guidance of the CAB, researchers will recruit adults with T2D to participate in a 3-month intervention. Participants will be randomized into one of 3 groups. Some people will have diabetes nutrition education and the food security resource, some will have only the diabetes nutrition education, and some will receive only the food security resource. Outcomes such as food security status and clinical diabetes health indicators will be measured at 5 timepoints. This intervention is significant to diabetes because AI/ANs experience diabetes health disparities and the combination of diabetes nutrition education plus an added food security resource could help decrease T2D complications and improve quality of life for AI/ANs.Research Profile
What area of diabetes research does your project cover? What role will this particular project play in preventing, treating and/or curing diabetes?My project will broadly cover multi-level efforts to improve nutrition for American Indian adults living with T2D. Multi-level includes individual and group-based diabetes nutrition education as well as improving access to healthful foods through a food security resource. This food security resource will provide supplemental healthy foods (e.g., fresh produce) to American Indian adults living with T2D who have difficulty with healthy eating because of limited access to healthy foods. Diabetes nutrition education is one way to support people living with T2D, but offering them increased access to healthful foods is a second ‘level’ of support that may impact diabetes self management and care. By addressing healthy food access, other people in the family (household) will also benefit from improved access to healthy food and this could assist not only in preventing nutrition-related diabetes complications for the individual with T2D, but can help prevent T2D in other family members of the same household.
If a person with diabetes were to ask you how your project will help them in the future, how would you respond?We want to understand how to best support people living with T2D, especially those for whom have limited income. People living with T2D have to make decisions on how they spend their money, and sometimes it comes down to deciding between healthful food or medication co-pay, or transportation, for example. In this project, we are hoping to alleviate some of the challenges to accessing healthful food, by offering a food security resource in conjunction with diabetes nutrition education. Together, we hope that diabetes nutrition education plus the food security resource can show positive impacts on diabetes self management and care. If we can show these programs work synergistically together to improve the lives of people living with T2D, we can provide evidence to organizations that pay for these types of programs that these programs work, they improve the lives of people living with T2D, and that the programs are worthy of sustained funding.
Why important for you, personally, to become involved in diabetes research? What role will this award play?I worked as a clinical RDN and CDCES for almost 15 years before I went back to school to earn my PhD in nutrition. As a clinician, I saw first-hand how nutrition education for adults living with T2D can support diabetes self management and care, however, for people who also experienced food insecurity, it was always hard to end a nutrition education appointment by only being able to offer them directions to the nearest food bank/pantry. As an RDN, I knew that food banks/pantries are important resources but often they’re filled with food that is not healthy for people living with T2D. With this project, we hope to see how providing healthful foods for people living with T2D can improve their lives and decrease diabetes health disparities. For my own research efforts, this ADA grant is augmenting my NIH K01 (NIDDK) grant. This NIH K01 grant provides funding to support my salary and a small amount for research, but the ADA grant will now allow me to more robustly evaluate the diabetes nutrition education and food security intervention – and importantly provide funding to support an American Indian community advisory board who can help guide the intervention, including advice on recruitment, sustainability and program evaluation.
In what direction do you see the future of diabetes research going?I hope that socio-behavioral diabetes research continues to reach across sectors and invite/include non-clinical representation in these efforts. For example, food retailers, city planners, urban transit authorities, and schools – as to not only provide direct nutrition education but also help change the environment of where people spend their time (e.g., where they eat, work, learn, play, and pray) – to help make healthy choices more accessible to all. I hope there is more research on the Food as Medicine movement, which includes things like produce prescription programs, medically tailored meals, and medically tailored groceries – to help support people living with T2D who also experience food insecurity. I see the mental health effects of providing healthy food access resources for people living with T2D also an important area for continued research and exploration, as well as the whole-family benefits of such programs. Finally, I hope diabetes research continues to become more equitable and inclusive – and that resources/power/decision making regarding future directions, community needs, ways to evaluate program success are diversified and broadened – informed by the desires of members of the priority audience.