Randomized Trial of a Lifestyle Intervention for Urban Low-Income African Americans with Type 2 Diabetes

• Published in: Journal of general internal medicine : JGIM 2019-07, Vol.34 (7), p.1174-1183
• Main Authors: Lynch, Elizabeth B., Mack, Laurin, Avery, Elizabeth, Wang, Yamin, Dawar, Rebecca, Richardson, DeJuran, Keim, Kathryn, Ventrelle, Jennifer, Appelhans, Bradley M., Tahsin, Bettina, Fogelfeld, Leon
• Format: Article
• Language: English
• Subjects: African Americans; Control methods; Diabetes; Diabetes mellitus; Diabetes mellitus (non-insulin dependent); Diet; Drugs; Hemoglobin; Income; Internal Medicine; Intervention; Low income groups; Medicine; Medicine & Public Health; Minority & ethnic groups; Nutrition; Original Research; Physical activity; Research design
• ISSN: 0884-8734; 1525-1497
• DOI: 10.1007/s11606-019-04894-y

Background African Americans suffer more than non-Hispanic whites from type 2 diabetes, but diabetes self-management education (DSME) has been less effective at improving glycemic control for African Americans. Our objective was to determine whether a novel, culturally tailored DSME intervention would result in sustained improvements in glycemic control in low-income African-American patients of public hospital clinics. Research Design and Methods This randomized controlled trial ( n  = 211) compared changes in hemoglobin A1c (A1c) at 6, 12, and 18 months between two arms: (1) Lifestyle Improvement through Food and Exercise (LIFE), a culturally tailored, 28-session community-based intervention, focused on diet and physical activity, and (2) a standard of care comparison group receiving two group DSME classes. Cluster-adjusted ANCOVA modeling was used to assess A1c changes from baseline to 6, 12, and 18 months, respectively, between arms. Results At 6 months, A1c decreased significantly more in the intervention group than the control group (− 0.76 vs − 0.21%, p  = 0.03). However, by 12 and 18 months, the difference was no longer significant (12 months − 0.63 intervention vs − 0.45 control, p  = 0.52). There was a decrease in A1c over 18 months in both the intervention ( β  = − 0.026, p  = 0.003) and the comparison arm ( β  = − 0.018, p  = 0.048) but no difference in trend ( p  = 0.472) between arms. The intervention group had greater improvements in nutrition knowledge (11.1 vs 6.0 point change, p  = 0.002) and diet quality (4.0 vs − 0.5 point change, p  = 0.018) while the comparison group had more participants with improved medication adherence (24% vs 10%, p