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Randomized Trial of a Lifestyle Intervention for Urban Low-Income African Americans with Type 2 Diabetes
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 wou...
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| Published in: | Journal of general internal medicine : JGIM 2019-07, Vol.34 (7), p.1174-1183 |
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| container_title | Journal of general internal medicine : JGIM |
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| creator | Lynch, Elizabeth B. Mack, Laurin Avery, Elizabeth Wang, Yamin Dawar, Rebecca Richardson, DeJuran Keim, Kathryn Ventrelle, Jennifer Appelhans, Bradley M. Tahsin, Bettina Fogelfeld, Leon |
| description | 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
|
| doi_str_mv | 10.1007/s11606-019-04894-y |
| format | article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6614233</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2206228223</sourcerecordid><originalsourceid>FETCH-LOGICAL-c474t-cdf9445eaaa6df7ae4d37021039ebc4fc85c8c13908fb3f90c837c27e7a3e2b13</originalsourceid><addsrcrecordid>eNp9kUtr3DAUhUVpaKZp_0AXRdBNN2r1si1vCkP6GhgIlMlayPJVRsGWppInwfn10WTS9LHoSkL3u0f3noPQG0Y_MEqbj5mxmtaEspZQqVpJ5mdowSpeESbb5jlaUKUkUY2Qp-hlzteUMsG5eoFOBW1rISVdoO0PE_o4-jvo8SZ5M-DosMFr7yBP8wB4FSZINxAmHwN2MeHL1JmA1_GWrIKNI-ClS96Wp-UID5eMb_20xZt5B5jjz950MEF-hU6cGTK8fjzP0OXXL5vz72R98W11vlwTKxs5Edu7VsoKjDF17xoDshcN5YyKFjornVWVVZaJlirXCddSq0RjeQONEcA7Js7Qp6Pubt-N0NsyeTKD3iU_mjTraLz-uxL8Vl_FG13XTHIhisD7R4EUf-6LC3r02cIwmABxnzXntC4ucn5A3_2DXsd9CmW9A1UVkyWVheJHyqaYcwL3NAyj-hCkPgapS5D6IUg9l6a3f67x1PIruQKII5BLKVxB-v33f2TvAUDYqso</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2205096404</pqid></control><display><type>article</type><title>Randomized Trial of a Lifestyle Intervention for Urban Low-Income African Americans with Type 2 Diabetes</title><source>Open Access: PubMed Central</source><source>Springer Link</source><creator>Lynch, Elizabeth B. ; Mack, Laurin ; Avery, Elizabeth ; Wang, Yamin ; Dawar, Rebecca ; Richardson, DeJuran ; Keim, Kathryn ; Ventrelle, Jennifer ; Appelhans, Bradley M. ; Tahsin, Bettina ; Fogelfeld, Leon</creator><creatorcontrib>Lynch, Elizabeth B. ; Mack, Laurin ; Avery, Elizabeth ; Wang, Yamin ; Dawar, Rebecca ; Richardson, DeJuran ; Keim, Kathryn ; Ventrelle, Jennifer ; Appelhans, Bradley M. ; Tahsin, Bettina ; Fogelfeld, Leon</creatorcontrib><description>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
< 0.05) at 12 months.
Conclusions
The LIFE intervention resulted in improved nutrition knowledge and diet quality and the comparison intervention resulted in improved medication adherence. LIFE participants showed greater A1c reduction than standard of care at 6 months but the difference between groups was no longer significant at 12 and 18 months.
NIH Trial Registry Number
NCT01901952</description><identifier>ISSN: 0884-8734</identifier><identifier>EISSN: 1525-1497</identifier><identifier>DOI: 10.1007/s11606-019-04894-y</identifier><identifier>PMID: 30963440</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>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</subject><ispartof>Journal of general internal medicine : JGIM, 2019-07, Vol.34 (7), p.1174-1183</ispartof><rights>Society of General Internal Medicine 2019</rights><rights>Journal of General Internal Medicine is a copyright of Springer, (2019). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c474t-cdf9445eaaa6df7ae4d37021039ebc4fc85c8c13908fb3f90c837c27e7a3e2b13</citedby><cites>FETCH-LOGICAL-c474t-cdf9445eaaa6df7ae4d37021039ebc4fc85c8c13908fb3f90c837c27e7a3e2b13</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6614233/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6614233/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,727,780,784,885,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30963440$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lynch, Elizabeth B.</creatorcontrib><creatorcontrib>Mack, Laurin</creatorcontrib><creatorcontrib>Avery, Elizabeth</creatorcontrib><creatorcontrib>Wang, Yamin</creatorcontrib><creatorcontrib>Dawar, Rebecca</creatorcontrib><creatorcontrib>Richardson, DeJuran</creatorcontrib><creatorcontrib>Keim, Kathryn</creatorcontrib><creatorcontrib>Ventrelle, Jennifer</creatorcontrib><creatorcontrib>Appelhans, Bradley M.</creatorcontrib><creatorcontrib>Tahsin, Bettina</creatorcontrib><creatorcontrib>Fogelfeld, Leon</creatorcontrib><title>Randomized Trial of a Lifestyle Intervention for Urban Low-Income African Americans with Type 2 Diabetes</title><title>Journal of general internal medicine : JGIM</title><addtitle>J GEN INTERN MED</addtitle><addtitle>J Gen Intern Med</addtitle><description>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
< 0.05) at 12 months.
Conclusions
The LIFE intervention resulted in improved nutrition knowledge and diet quality and the comparison intervention resulted in improved medication adherence. LIFE participants showed greater A1c reduction than standard of care at 6 months but the difference between groups was no longer significant at 12 and 18 months.
NIH Trial Registry Number
NCT01901952</description><subject>African Americans</subject><subject>Control methods</subject><subject>Diabetes</subject><subject>Diabetes mellitus</subject><subject>Diabetes mellitus (non-insulin dependent)</subject><subject>Diet</subject><subject>Drugs</subject><subject>Hemoglobin</subject><subject>Income</subject><subject>Internal Medicine</subject><subject>Intervention</subject><subject>Low income groups</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Minority & ethnic groups</subject><subject>Nutrition</subject><subject>Original Research</subject><subject>Physical activity</subject><subject>Research design</subject><issn>0884-8734</issn><issn>1525-1497</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><recordid>eNp9kUtr3DAUhUVpaKZp_0AXRdBNN2r1si1vCkP6GhgIlMlayPJVRsGWppInwfn10WTS9LHoSkL3u0f3noPQG0Y_MEqbj5mxmtaEspZQqVpJ5mdowSpeESbb5jlaUKUkUY2Qp-hlzteUMsG5eoFOBW1rISVdoO0PE_o4-jvo8SZ5M-DosMFr7yBP8wB4FSZINxAmHwN2MeHL1JmA1_GWrIKNI-ClS96Wp-UID5eMb_20xZt5B5jjz950MEF-hU6cGTK8fjzP0OXXL5vz72R98W11vlwTKxs5Edu7VsoKjDF17xoDshcN5YyKFjornVWVVZaJlirXCddSq0RjeQONEcA7Js7Qp6Pubt-N0NsyeTKD3iU_mjTraLz-uxL8Vl_FG13XTHIhisD7R4EUf-6LC3r02cIwmABxnzXntC4ucn5A3_2DXsd9CmW9A1UVkyWVheJHyqaYcwL3NAyj-hCkPgapS5D6IUg9l6a3f67x1PIruQKII5BLKVxB-v33f2TvAUDYqso</recordid><startdate>20190701</startdate><enddate>20190701</enddate><creator>Lynch, Elizabeth B.</creator><creator>Mack, Laurin</creator><creator>Avery, Elizabeth</creator><creator>Wang, Yamin</creator><creator>Dawar, Rebecca</creator><creator>Richardson, DeJuran</creator><creator>Keim, Kathryn</creator><creator>Ventrelle, Jennifer</creator><creator>Appelhans, Bradley M.</creator><creator>Tahsin, Bettina</creator><creator>Fogelfeld, Leon</creator><general>Springer US</general><general>Springer Nature 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Low-Income African Americans with Type 2 Diabetes</title><author>Lynch, Elizabeth B. ; Mack, Laurin ; Avery, Elizabeth ; Wang, Yamin ; Dawar, Rebecca ; Richardson, DeJuran ; Keim, Kathryn ; Ventrelle, Jennifer ; Appelhans, Bradley M. ; Tahsin, Bettina ; Fogelfeld, Leon</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c474t-cdf9445eaaa6df7ae4d37021039ebc4fc85c8c13908fb3f90c837c27e7a3e2b13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>African Americans</topic><topic>Control methods</topic><topic>Diabetes</topic><topic>Diabetes mellitus</topic><topic>Diabetes mellitus (non-insulin dependent)</topic><topic>Diet</topic><topic>Drugs</topic><topic>Hemoglobin</topic><topic>Income</topic><topic>Internal Medicine</topic><topic>Intervention</topic><topic>Low income groups</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Minority & ethnic groups</topic><topic>Nutrition</topic><topic>Original Research</topic><topic>Physical activity</topic><topic>Research design</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lynch, Elizabeth B.</creatorcontrib><creatorcontrib>Mack, Laurin</creatorcontrib><creatorcontrib>Avery, Elizabeth</creatorcontrib><creatorcontrib>Wang, Yamin</creatorcontrib><creatorcontrib>Dawar, Rebecca</creatorcontrib><creatorcontrib>Richardson, DeJuran</creatorcontrib><creatorcontrib>Keim, Kathryn</creatorcontrib><creatorcontrib>Ventrelle, Jennifer</creatorcontrib><creatorcontrib>Appelhans, Bradley M.</creatorcontrib><creatorcontrib>Tahsin, Bettina</creatorcontrib><creatorcontrib>Fogelfeld, Leon</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Nursing & Allied Health Database 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One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of general internal medicine : JGIM</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lynch, Elizabeth B.</au><au>Mack, Laurin</au><au>Avery, Elizabeth</au><au>Wang, Yamin</au><au>Dawar, Rebecca</au><au>Richardson, DeJuran</au><au>Keim, Kathryn</au><au>Ventrelle, Jennifer</au><au>Appelhans, Bradley M.</au><au>Tahsin, Bettina</au><au>Fogelfeld, Leon</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Randomized Trial of a Lifestyle Intervention for Urban Low-Income African Americans with Type 2 Diabetes</atitle><jtitle>Journal of general internal medicine : JGIM</jtitle><stitle>J GEN INTERN MED</stitle><addtitle>J Gen Intern Med</addtitle><date>2019-07-01</date><risdate>2019</risdate><volume>34</volume><issue>7</issue><spage>1174</spage><epage>1183</epage><pages>1174-1183</pages><issn>0884-8734</issn><eissn>1525-1497</eissn><abstract>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
< 0.05) at 12 months.
Conclusions
The LIFE intervention resulted in improved nutrition knowledge and diet quality and the comparison intervention resulted in improved medication adherence. LIFE participants showed greater A1c reduction than standard of care at 6 months but the difference between groups was no longer significant at 12 and 18 months.
NIH Trial Registry Number
NCT01901952</abstract><cop>New York</cop><pub>Springer US</pub><pmid>30963440</pmid><doi>10.1007/s11606-019-04894-y</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0884-8734 |
| ispartof | Journal of general internal medicine : JGIM, 2019-07, Vol.34 (7), p.1174-1183 |
| issn | 0884-8734 1525-1497 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6614233 |
| source | Open Access: PubMed Central; Springer Link |
| 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 |
| title | Randomized Trial of a Lifestyle Intervention for Urban Low-Income African Americans with Type 2 Diabetes |
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