Tailoring lifestyle programmes for diabetes prevention for US South Asians

A systematic review of the mechanisms influencing engagement in diabetes prevention programmes for people with pre-diabetes

AIMS

To identify barriers and enablers that influence engagement in and acceptability of diabetes prevention programmes for people with pre-diabetes. The results will provide insights for developing strategies and recommendations to improve design and delivery of diabetes prevention programmes with enhanced engagement and acceptability for people with pre-diabetes.

METHODS

This review used a critical realist approach to examine context and mechanisms of diabetes prevention programmes. Medline, Embase, PsycInfo, Cinahl, Web of Science, Scopus and Pre-Medline were searched for English language studies published between 2000 and 2023. A quality assessment was conducted using Joanna Briggs Institute critical appraisal tools.

RESULTS

A total of 90 papers met inclusion criteria. The included studies used a variety of quantitative and qualitative methodologies. Data extracted focused on barriers and enablers to engagement in and acceptability of diabetes prevention programmes, with seven key mechanisms identified. These included financial, environmental, personal, healthcare, social and cultural, demographic and programme mechanisms. Findings highlighted diverse factors that influenced engagement in preventive programmes and the importance of considering these factors when planning, developing and implementing future diabetes prevention programmes.

CONCLUSIONS

Mechanisms identified in this review can inform design and development of diabetes prevention programmes for people with pre-diabetes and provide guidance for healthcare professionals and policymakers. This will facilitate increased participation and engagement in preventive programmes, potentially reducing progression and/or incidence of pre-diabetes to type 2 diabetes and improving health outcomes.

Smartphone-Based Cancer and Obesity Prevention Education Program for Chinese Women (SCOPE): A Pilot RCT

Breast cancer prevalence has increased globally, with 12.2% of breast cancer cases identified in China. Obesity and unhealthy lifestyles are major risk factors for breast cancer. We conducted a randomized control trial to assess the feasibility and evaluate the preliminary effect of the Smartphone-Based Cancer and Obesity Prevention Education (SCOPE) program among adult biological women with a waist circumference greater than 80 cm. The SCOPE program includes tailored and culturally appropriate educational information for obesity and breast cancer prevention delivered by the research team via WeChat. The control group received non-tailored general health information via WeChat. A total of 102 women (52 intervention, 50 control) participated, and 87 (85%) completed 6-month follow-up assessments. For the primary study outcome at 6 months, women using SCOPE significantly reduced waist circumference (Cohen's d = -0.39, p < 0.001). For secondary outcomes at 6 months, women using SCOPE significantly reduced BMI (d = -0.18, p = 0.001) and increased breast cancer-related knowledge (d = 0.48, p = 0.001) and attitude (d = 1.39, p < 0.01). No significant findings were found regarding diet self-efficacy, physical self-efficacy, or breast cancer screening barriers. The results suggest the intervention has great potential to promote the health and wellness of women.

A culturally adapted, social support-based, diabetes group visit model for Bangladeshi adults in the USA: a feasibility study

Background

Interventions focused on weight loss can prevent, delay, and improve management of type 2 diabetes (T2D). However, implementation of these programs is challenging in diverse populations. South Asians have higher risk for T2D, yet to date, there have been limited programs for this community in the USA. The aim of this project was to develop and test the feasibility of a tailored group visit model for Bangladeshis with type 2 diabetes (T2D) or prediabetes based in primary care.

Design

Mixed-methods single-arm feasibility study.

Setting

An academic health center-based primary care clinic in Atlanta, Georgia.

Participants

Bangladeshi adults > 18 years old with T2D or prediabetes

Methods

In conjunction with a community-academic board, we conducted focus groups to tailor an existing evidence-based curriculum to a culturally acceptable intervention. Fourteen participants enrolled in the 16-week program focusing on healthy diet, exercise, and weight loss. The primary feasibility outcomes were number of sessions attended and participant satisfaction with the intervention. Weight, blood pressure, cholesterol, and HbA1C were measured at beginning and end of study. Participants were asked to evaluate each session on level of satisfaction. One tailed paired t tests were used to test significance of pre-post changes in outcomes.

Results

Key themes from the formative focus groups (n = 50) were closely tied to sociocultural beliefs and included: dietary patterns, physical activity perceptions, and healthcare access concerns. In the intervention, 10 of 14 participants had baseline and follow-up data. Participant attendance averaged 50%. Statistically significant reductions in mean weight (− 2%, 95%CI: − 3.1, 0.2 kg), systolic/diastolic blood pressure (− 12.7 mmHg [95%CI: − 23.2, − 2.2]/− 3.7 mmHg [95%CI: − 7.6, − 0.1], respectively), and triglycerides (− 62.6 mg/dl, 95%CI: − 123.1, − 2.0) were noted. Overall, participants reported high levels of satisfaction with the program.

Conclusion

A lifestyle program based in primary care is feasible and acceptable for Bangladeshi immigrants. Larger studies testing the effectiveness of group programs, in primary care, to improve cardiometabolic factors are important.

Trials registration

ClinicalTrials.gov; NCT03861546. Registered 28 February 2019.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40814-022-00974-9.

Prevention of Type 2 Diabetes

The global diabetes burden is staggering, and prevention efforts are needed to reduce the impact on individuals and populations. There is strong evidence from efficacy trials showing that lifestyle interventions promoting increased physical activity, improvements in diet, and/or weight loss significantly reduce diabetes incidence and improve cardiometabolic risk factors. Implementation research assessing the feasibility, effectiveness, and cost-effectiveness of delivering these proven programs at the community level has shown success, but more research is needed to overcome barriers to implementation in different settings globally. New avenues of research should be considered to combat this public health issue.

Lifestyle Interventions for Diabetes Prevention in South Asians: Current Evidence and Opportunities

PURPOSE OF REVIEW

This review summarizes the burden of diabetes in South Asian populations and reviews recent evidence for diabetes prevention through lifestyle modification among South Asians worldwide. We indicate important gaps in the current literature and point to opportunities for additional research in this area.

RECENT FINDINGS

Randomized, controlled, efficacy studies and implementation research show that lifestyle intervention can be an effective, cost-effective, and feasible method for reducing diabetes risk, improving cardiometabolic health, and improving lifestyle behaviors in South Asian populations, a population at high diabetes risk and elevated rates of diabetes risk factors. Additional research is needed to address diabetes risk reduction in normal-weight South Asians and individuals with impaired fasting glucose; improve community-level implementation, individual uptake, and dissemination of proven programs; and assess long-term outcomes of interventions.

Preventing type 2 diabetes among South Asian Americans through community-based lifestyle interventions: A systematic review

Ethnic South Asian Americans (SAAs) have the highest relative risk of type 2 diabetes mellitus (T2DM) in the United States (US). Culturally tailored lifestyle interventions have the potential to promote South Asian diabetes prevention; however, the extent of their use and evaluation in US settings remains limited. This systematic review characterizes and evaluates outcomes of community-based lifestyle interventions targeted towards T2DM indicators among South Asians living in the US. A PRISMA-informed search of Pubmed, Embase, Cochrane, Web of Science, and clinical trial registry databases using key words pertaining to South Asians migrants and diabetes indicators (glucose and insulin outcomes) was conducted of community-based lifestyle interventions published up until October, 31 2019. Of the eight studies included in the final synthesis, four interventions focused on cultural and linguistic adaptations of past chronic disease prevention curricula using group-based modalities to deliver the intervention. Hemoglobin A1c (A1c) was the most common outcome indicator measured across the interventions. Three of the five studies observed improvements in indicators post-intervention. Based on these findings, this review recommends 1) greater exploration of community-based lifestyle interventions with high quality diabetes indicators (such as fasting blood glucose) in ethnic SAA communities, 2) expanding beyond traditional modalities of group-based lifestyle interventions and exploring the use of technology and interventions integrated with passive, active, and individualized components, and 3) development of research on diabetes prevention among second generation SAAs.