Research Description
People at risk for type 2 diabetes can reduce that risk by eating more produce and unprocessed foods and achieving moderate physical activity and weight loss. Participating in Diabetes Prevention Programs (DPPs) and in peer support calls with other DPP participants can help achieve those goals. Yet, even when DPPs reduce barriers (e.g., providing transportation and virtual options), it can be hard to engage. And barriers like the cost of fruits and vegetables further make it difficult for low-income adults to adopt healthier diets. Offering financial incentives can help increase engagement in programs. But, safety net health systems would not be able to offer these. With the growth of food voucher programs able to partner with health systems, food voucher incentives could be sustainable alternatives to financial incentives and would directly help motivate eating healthy food. This study would test if providing food voucher incentives for meeting weekly engagement targets to participants in a Community Health Worker (CHW)-led DPP in which participants are paired to help each other meet that week's goals in weekly telephone calls would help these participants achieve weight loss and other outcomes better than participants who are offered only a CHW-led DPP. The study also seeks to increase teamwork and accountability between paired participants by giving food vouchers to each participant who attends that week's DPP session and an additional food voucher to both members of a peer pair if both attend the DPP session and talk together at least once by phone that week.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?Low-income adults who receive care at safety net health systems face a disproportionate burden of prediabetes exacerbated by adverse social determinants of health like poor access to fresh produce that is more costly than highly processed foods. Engagement in group Diabetes Prevention Programs (DPPs) and ongoing support for healthy behaviors can help prevent or delay progression to type 2 diabetes (T2D). Yet, rates of uptake and engagement in such programs--especially among low-income adults of color--are often very low. It is crucial to test novel approaches to increase uptake of and engagement in behaviors that decrease progression to T2D among adults with prediabetes who receive care at safety net health systems such as Federally Qualified Health Centers (FQHC). To address this need, we propose to conduct a clinical trial of the INSPIRA (INSPIRing Action to Prevent Diabetes) intervention among adults with prediabetes who receive care at Community Health and Social Services Center, Inc. (CHASS), an FQHC that serves a predominantly Latina/o and Black community in Detroit.
If a person with diabetes were to ask you how your project will help them in the future, how would you respond?This project supports my research group's overarching aim to help people who are at risk of developing type 2 diabetes (T2D) or already are living with T2D to have access to very accessible programs that help them initiate and sustain healthy behaviors such as weight loss, physical activity, healthy diet, that can help prevent T2D and improve health among those who have T2D. The strategies that we will test in this intervention (INSPIRA) are person-centered and scalable approaches that will support adult patients at high risk for T2D to adopt and maintain dietary and other evidence-based diabetes prevention behaviors. If we find these strategies effective, the aim would be to work to sustain this novel program and disseminate it to other health care centers and communities. While we are testing this program for diabetes prevention, we hypothesize that these strategies might also help adults with diabetes self-management to improve diabetes outcomes.
Why important for you, personally, to become involved in diabetes research? What role will this award play?As a physician and member of a family in which many members have T2D, I deeply believe that a key challenge for improving health care and outcomes for people at risk of and with T2D is extending ongoing support and care beyond face-to-face clinic visits. While I strive as a physician to be sure my patients receive necessary screenings, information they need, and appropriate medications, most of good health depends on the quality of food we eat, our physical activity, weight management and other health behaviors such as stress management, sleep, and maintaining supportive connections with others. Thus, I became involved in diabetes research to develop and test innovative ways to better support people in all their daily self-management tasks. I am especially excited about the project this ADA award will fund as it is the first time my team and I are explicitly trying to increase access to healthy food like fruits and vegetables while also increasing uptake and engagement in evidence-based diabetes prevention programs further supplemented with peer support, which we have found very effective among those who engage in improving diabetes self-management and outcomes.
In what direction do you see the future of diabetes research going?I think this project that ADA has funded reflects the direction diabetes research needs to go: We need to be developing, evaluating, and scaling up effective integrated approaches that address ongoing clinical/medical, behavioral, and social needs. In partnership with health systems, community organizations, and social service organizations such as the food voucher programs in Detroit we are partnering with, we have to seek to address the multiple barriers people face in taking the necessary steps to initiate and then sustain all the complicated daily behaviors required to prevent T2D and T2D-related complications.