Cultural Adaptation of the Group Lifestyle Balance Program for Chinese Americans

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.

Identification of Intervention Characteristics Within Diabetes Prevention Programs Using the Template for Intervention Description and Replication: A Scoping Review

OBJECTIVES

Diabetes prevention programs (DPPs) targeting dietary and physical activity behaviour change have been shown to decrease the incidence of type 2 diabetes; however, a more thorough reporting of intervention characteristics is needed to expedite the translation of such programs into different communities. In this scoping review, we aim to synthesize how DPPs are being reported and implemented.

METHODS

A scoping review using Arkey and O'Malley methods was conducted in accordance with the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analysis. MEDLINE, CINAHL, PsycINFO, EMBASE, and SPORTDiscus were searched for studies relating to diabetes prevention and diet/exercise interventions. Only studies delivering a diet/exercise intervention for adults identified as "at risk" for developing type 2 diabetes were included. The Template for Intervention Description and Replication (TIDieR) was used to guide data extraction, and each DPP was scored on a scale from 0 to 2 for how thoroughly it reported each of the items (0 = did not report, 2 = reported in full; total score out of 26).

RESULTS

Of the 25,110 publications screened, 351 (based on 220 programs) met the inclusion criteria and were included for data extraction. No studies comprehensively reported on all TIDieR domains (mean TIDieR score: 15.7 of 26; range 7 to 25). Reporting was particularly poor among domains related to "modifications," "tailoring," and "how well (planned/actual)." "How well (planned)" assesses the intended delivery of an intervention, detailing the initial strategies and components as per the original design, whereas "how well (actual)" evaluates the extent to which the intervention was executed as planned during the study, including any deviations or modifications made in practice.

CONCLUSIONS

Although there is evidence to suggest that DPPs are efficacious, a more thorough reporting of program content and delivery is needed to improve the ability for effective programs to be implemented or translated into different communities.

Linking biomarkers with healthy lifestyle outcomes after stroke: Supplementary results of a 12-month randomized controlled trial

BACKGROUND AND AIMS

Participation in a healthy lifestyle intervention such as the Diabetes Prevention Program Group Lifestyle Balance-adapted for stroke (GLB-CVA) may reduce stroke burden. Identifying biomarkers associated with lifestyle changes may enhance an individualized approach to stroke recovery. We investigated metabolic biomarkers related to cardiovascular and neurological function in individuals with stroke in the GLB-CVA study and healthy (non-stroke) individuals.

METHODS AND RESULTS

Participants with chronic (>12 months) stroke were recruited to this wait-list randomized controlled trial if they were overweight (BMI ≥25 kg/m2). Participants were randomized to (1) the GLB-CVA program to complete 22 educational sessions addressing behavioral principals of dietary and physical activity or (2) a 6 month wait-list control (WLC). Biomarkers [Plasma irisin, vascular endothelial growth factor, lipoprotein-associated phospholipase A2 (Lp-PLA2), insulin-like growth factor 1 and brain-derived neurotrophic factor (BDNF)] were collected at baseline, 3, and 6 months. Age-matched healthy individuals were recruited for biomarker assessment. Compared to healthy adults (n = 19), participants with stroke (GLB-CVA = 24; WLC = 24) at baseline had higher tHcy levels (p < 0.001) and lower PLA2 levels (p = 0.016). No statistically significant interactions were observed for any biomarkers between the GLB-CVA and WLC or between people who achieved 5% weight loss and those who did not.

CONCLUSION

Participation in a 6-month healthy lifestyle program did not result in statistically significant changes to select metabolic biomarker levels for our participants with chronic stroke. However, participants with stroke demonstrated a unique biomarker profile compared to age-matched healthy individuals.

Results of a 12-Month Randomized Controlled Trial Testing the Efficacy of the Diabetes Prevention Program Group Lifestyle Balance (DPP-GLB) for People Post Stroke (GLB-CVA)

BACKGROUND

Experience of stroke is associated with an increased risk for diabetes and metabolic syndrome, yet few interventions exist that have been tailored to the population's unique needs.

PURPOSE

To examine adherence and efficacy of the Diabetes Prevention Program Group Lifestyle Balance program (DPP-GLB) modified for individuals post stroke (GLB-CVA) using a randomized controlled trial.

METHODS

Adults (18-85 years of age), >12 months post stroke, and body mass index ≥25 kg/m2 were included in this study. Sixty-five individuals were assigned to either the GLB-CVA intervention or a 6-month wait-list control. Participants completed the 12-month GLB-CVA intervention, with attendance and assessment of weight, anthropometric, biomarker, functional, and patient reported outcome data collected at baseline, 3, 6, and 12 months.

RESULTS

High attendance (90%) and dietary and activity tracking (71%) suggest high adherence to the 12-month GLB-CVA. Six-month randomized controlled trial data indicate significant weight loss (p = .005) in the GLB-CVA group (7.4 ± 13.6 lbs, 3.65%) compared with the wait-list control (0.1 ± 10.1 lbs, 0%), and improvements in arm circumference (p = .04), high-density lipoprotein (HDL) cholesterol (p = .028), 8-year diabetes risk (p = .011), and pain interference (p < .001). Combined 12-month data showed participants lost 10.1 ± 16.8 lbs (4.88%) and improved waist circumference (p = .001), HbA1c (3.6%), diastolic blood pressure (p < .001), pain (p = .001), social participation (p = .025), and eating practices (p = .01) and habits (p < .001).

CONCLUSIONS

Engagement in the GLB-CVA can result in weight loss and improved health for individuals who are overweight or obese following stroke. Future efforts should examine effectiveness in real-world settings and focus on knowledge translation efforts.

Family Involvement in Asian American Health Interventions: A Scoping Review and Conceptual Model

Family members play a crucial role in the health of Asian American communities, and their involvement in health interventions can be pivotal in optimizing impact and implementation. To explore how family members can be effectively involved in Asian American health interventions and develop a conceptual framework of methods of involvement at the stages of intervention development, process, and evaluation, this scoping review documented the role of Asian American family members in interventions (across any health objective). Of the 7175 studies identified through database and manual searches, we included 48 studies in the final analysis. Many studies focused on Chinese (54%) or Vietnamese (21%) populations, were conducted in California (44%), and involved spouses (35%) or parents/children (39%). We observed involvement across 3 stages: (1) intervention development (formative research, review process, material development), (2) intervention process (recruitment, receiving the intervention together, receiving a parallel intervention, enlisting support to achieve goals, voluntary intervention support, agent of family-wide change, and participation gatekeepers), and (3) intervention evaluation (received evaluation together, indirect impact evaluation, and feedback during intervention). Impact of family member involvement was both positive (as sources of encouragement, insight, accountability, comfort, and passion) and negative (sources of hindrance, backlash, stigma, obligation, and negative influence). Suggestions for future research interventions include (1) exploring family involvement in South Asian or young adult interventions, (2) diversifying types of family members involved (eg, extended family), and (3) diversifying methods of involvement (eg, family members as implementation agents).

Prevalence and management of type 2 diabetes among Chinese Americans

AIMS

: This study examines: (a) the prevalence rate of type 2 diabetes mellitus (T2DM) in Chinese Americans (CAs); (b) the influence of acculturative status (i.e. generational status and linguistic fluency) on T2DM prevalence; (c) and differences in diabetes management between CAs and Non-Hispanic Whites (NHWs).

METHODS

: We used 2011-2018 data from the California Health Interview Survey (CHIS) to analyze the prevalence rate and management of diabetes among the CAs. Chi-squares, linear regressions, and logistic regressions were used to analyze the data.

RESULTS

: After controlling for demographic, socioeconomic, and health behaviors, there were no significant differences in the T2DM prevalence rate between CAs overall or of varying acculturative statuses compared with NHWs. However, there were differences in diabetes management, with first-generation CAs being less likely to exam glucose daily, have medical care plans developed by medical providers, or have confidence in controlling diabetes compared to NHWs. CAs with limited English proficiency (LEP) were less likely to perform self-monitoring of blood glucose or have confidence in managing their diabetes care compared to NHWs. Finally, non-first generation CAs were also more likely to take diabetes medication compared to NHWs.

CONCLUSIONS

: Although the prevalence rate of T2DM was found to be similar between CAs and NHWs, significant differences were found in diabetes care and management. Specifically, those who were less acculturated (e.g. first generation and those with LEP) were less likely to actively manage and have confidence in managing their T2DM. These results highlight the importance of targeting immigrants with LEP in prevention and intervention efforts.

Efficacy of the Diabetes Prevention Program Group Lifestyle Balance Program Modified for Individuals with TBI (GLB-TBI): Results from a 12-month Randomized Controlled Trial

BACKGROUND

Obesity after traumatic brain injury (TBI) is a public health issue and no evidence-based weight loss interventions exist to meet the unique needs of individuals after TBI.

PURPOSE

To (a) examine the efficacy of the Diabetes Prevention Program Group Lifestyle Balance for TBI (GLB-TBI) weight-loss intervention compared to an attention control for primary (weight-loss) and secondary health outcomes; (b) determine participant compliance with the GLB-TBI; and (c) determine if compliance is associated with improved outcomes.

METHODS

Individuals with moderate to severe TBI, age 18-64 years, ≥6 months postinjury, and body mass index of ≥25 kg/m2 were randomized to a 12-month, 22-session GLB-TBI intervention or attention control condition. Weight-loss (lbs.), anthropometric, biomarkers, and patient-reported outcomes were collected at baseline, 3, 6, and 12 months.

RESULTS

The GLB-TBI group (n = 27) lost 17.8 ± 41.4lbs (7.9%) over the 12-month program and the attention control group (n = 27) lost 0 ± 55.4lbs (0%). The GLB-TBI group had significant improvements in diastolic blood pressure, triglycerides, and HDL cholesterol. GLB-TBI attendance was 89.6% and weekly self-monitoring of diet and activity was 68.8%. Relative to baseline, the GLB-TBI compliant group (≥80% attendance; ≥85% self-monitoring; n = 10) had a statistically significant decrease in weight at each assessment, the noncompliant group had a significant decrease between 6 and 12 months (n = 17), with no change in weight in the attention control group (n = 27).

CONCLUSIONS

Findings suggest for adults with TBI who are overweight or obese, participation in the GLB-TBI can significantly reduce weight and metabolic risk factors and increase self-reported habits for diet and exercise.

Type 2 Diabetes Self-Management Interventions Among Asian Americans in the United States: A Scoping Review

Introduction:

Type 2 diabetes (T2D) is one of the leading causes of death among Asian Americans. Despite being a culturally diverse racial group with differences in history, language, religion, and values, Asian Americans are often viewed as a monolith. With the high prevalence rate of T2D, a careful examination of self-management interventions across Asian Americans is needed to develop effective and culturally sensitive interventions.

Objective:

To describe existing literature by examining study characteristics, different intervention components, and outcome measures of various T2D interventions among Asian Americans.

Methods:

Using Arksey and O'Malley's framework to ground this review, six online databases were used to identify studies.

Results:

A total of 18 publications were included. Thirteen studies were published after 2013, with 44% and 22% of these studies focused on Chinese Americans and Korean Americans. We found a lack of geographic diversity in the location of the studies. Majority of the participants were females. Most of the interventions were implemented in person. Licensed health care providers were the most common interventionists, with a number of studies using community health workers. Outcome measures focused on three key areas: physiological, psychosocial and behavioral, and program-related outcomes. Many of the studies measured changes in HbA1C, self-efficacy, distress, depression, and quality of life. Overall, we saw improvements in physiological measures in most of the studies. For example, majority of the studies showed a decline in the participants' HbA1C. Most studies showed an increase or improvement in healthy behaviors. Studies that measured efficacy, knowledge, attitude, motivation, quality of life, or general health showed improvement from baseline. All the studies that measured distress or depression showed a reduction of symptoms postintervention.

Conclusion:

Overall, we found that culturally tailored interventions that focus on specific Asian American subpopulations saw an improvement in physiological, psychosocial, or behavioral measures. There were several gaps in the existing T2D self-management programs or interventions among Asian Americans studied in the United States. Based on our analysis, we recommend when designing or implementing self-management interventions among Asian Americans, considerations should be made for targeted recruitment for understudied Asian American subgroups, gender, and location.

A Social Media-Based Diabetes Intervention for Low-Income Mandarin-Speaking Chinese Immigrants in the United States: Feasibility Study

BACKGROUND

Chinese immigrants bear a high diabetes burden and face significant barriers to accessing diabetes self-management education (DSME) and counseling programs.

OBJECTIVE

The goal of this study was to examine the feasibility and acceptability and to pilot test the potential efficacy of a social media-based DSME intervention among low-income Chinese immigrants with type 2 diabetes (T2D) in New York City.

METHODS

This was a single group pretest and posttest study in 30 Chinese immigrants with T2D. The intervention included 24 culturally and linguistically tailored DSME videos, focusing on diabetes education and behavioral counseling techniques. Over 12 weeks, participants received 2 brief videos each week via WeChat, a free social media app popular among Chinese immigrants. Primary outcomes included the feasibility and acceptability of the intervention. Feasibility was evaluated by recruitment processes, retention rates, and the video watch rate. Acceptability was assessed via a satisfaction survey at 3 months. Secondary outcomes, that is, hemoglobin A_1c (HbA_1c), self-efficacy, dietary intake, and physical activity, were measured at baseline, 3 months, and 6 months. Descriptive statistics and paired 2-sided t tests were used to summarize the baseline characteristics and changes before and after the intervention.

RESULTS

The sample population (N=30) consisted of mostly females (21/30, 70%) who were married (19/30, 63%), with limited English proficiency (30/30, 100%), and the mean age was 61 (SD 7) years. Most reported an annual household income of <US $25,000 (24/30, 80%) and a high school education or less (19/30, 63%). Thirty participants were recruited within 2 months (January and February 2020), and 97% (29/30) of the participants were retained at 6 months. A video watch rate of 92% (28/30) was achieved. The mean baseline HbA_1c level was 7.3% (SD 1.3%), and this level declined by 0.5% (95% CI -0.8% to -0.2%; P=.003) at 6 months. The mean satisfaction score was 9.9 (SD 0.6) out of 10, indicating a high level of satisfaction with the program. All strongly agreed or agreed that they preferred this video-based DSME over face-to-face visits. Compared to baseline, there were significant improvements in self-efficacy, dietary, and physical activity behaviors at 6 months.

CONCLUSIONS

This pilot study demonstrated that a social media-based DSME intervention is feasible, acceptable, and potentially efficacious in a low-income Chinese immigrant population with T2D. Future studies need to examine the efficacy in an adequately powered clinical trial.

Effectiveness and Acceptability of a Nutrition Intervention Targeting Chinese Adult Immigrants With Type 2 Diabetes in Canada: A Study Using Mixed Methods Analysis

OBJECTIVES

Although culturally tailored diabetes treatment is recommended, there is a lack of relevant dietary resources for the Chinese population in Canada. In this study we assessed the feasibility and efficacy of a culturally tailored menu plan combined with nutrition education on clinical outcomes, diet quality and qualitative outcomes among Chinese immigrants with type 2 diabetes.

METHODS

Participants were 17 Chinese immigrants living with type 2 diabetes in Edmonton, Alberta, Canada. The design was a 12-week, single-arm intervention that included weekly nutrition education supported by a culturally tailored menu plan with mixed methods evaluation. Diet quality, clinical and other outcomes were assessed pre- and postintervention. One-on-one interviews were conducted postintervention to identify program feasibility and obstacles to adherence.

RESULTS

Waist circumference (mean ± standard deviation: -2.0±2.5 cm; p=0.004), total cholesterol (-21.4±28.2 mg/dL; p=0.007) and low-density lipoprotein cholesterol (-18.4±24.6 mg/dL; p=0.007) were decreased when compared with baseline. No significant change was detected in glycated hemoglobin. Postintervention, the Healthy Eating Index (p=0.01) and diabetes knowledge score (p=0.009) also increased. Participants reported that the program was culturally acceptable, easily understood and feasible to implement. Participants indicated the program helped them to improve their diabetes knowledge, adhere to the dietary guidelines, choose low glycemic index food and read food labels when shopping.

CONCLUSIONS

A flexible, culturally tailored menu plan was a feasible and effective tool for improving diabetes knowledge, diet quality and metabolic outcomes among Chinese immigrants with type 2 diabetes.

On Psychology and Psychiatry in Diabetes

Managing diabetes requires dealing with diet, medications, and self-monitoring, besides other pressures of daily living. It, therefore, requires collaboration among individuals with diabetes, their families, and significant others including the social milieu in which they reside. Psychological stress plays critical role in the cause and course of diabetes, particularly in mastering various self-management skills, which are essential for adequate management of diabetes. It is possible to measure and to resolve such stressors. Besides the patient and the family, the built environment which the person occupies must be conducive for healthy living. This is a key component in providing an appropriate physical and psychosocial environment. Lacunae in any of the built environmental parameters compromise social and psychological well-being. Psychiatric conditions are also common in diabetes. Both depression and distress are bi-directionally associated with diabetes. The presence of one condition increases the risk of developing the other. In addition, medications used for the treatment of psychiatric conditions have adverse effects on body weight and insulin sensitivity. One must carefully weigh the risk and benefit of the drug class with potential adverse effects. Therefore, identification and management of psychological and psyciatric aspects in subjects with diabetes is an integral and critical component in treating subjects with diabetes.

Bodyweight Misperception by Chinese American Females Influenced by Cultural and Social Ideals: Implication for Home Health Care

Bodyweight misperception results from the desire to achieve an ideal body emphasized by cultural mores and societal norms. It is sustained by the desire to be cultural compliant, especially for ethnic minority women such as Chinese American females. Through cultural beliefs, these women’s self-perceived weight status is distorted, which strengthens the impact of bodyweight misperception in their daily life as poor physical health, distressed psychosocial health, risky and unsafe health practices and behaviors, and diminished quality of life. Evidently, bodyweight misperception promotes maladaptive health behaviors. However, bodyweight misperception is barely captured in the current science about women’s health, and is minimally explored in research about Chinese American females’ desire and efforts to achieve the ideal body type. Therefore, the purpose of this literature review was to explore (1) body weight perception, (2) the factors associated with it, and (3) the negative health consequences triggered by it, in Chinese American females. Studies confirm that Chinese American females shape their body weight perception by internalized cultural ideals, acculturative stress, mass media, and social pressures. They overestimate their body weight more than underestimate it as evident by frequent weight-loss attempts. This internalized bodyweight misperception affects their physical and psychological health, with undesirable consequences on their quality of life. Home health care professionals interact closely with patients from diverse cultural backgrounds; remaining culturally sensitive is crucial in their practice. Knowledge from this literature review emphasizes the need for culturally appropriate weight management strategies for the delivery of competent home health care to Chinese American females.

Effectiveness of diet and physical activity interventions among Chinese-origin populations living in high income countries: a systematic review

BACKGROUND

This review examines the effectiveness of diet and physical activity interventions to reduce cardiometabolic risk among Chinese immigrants and their descendants living in high income countries. The objective of this review is to provide information to help build future interventions aimed at improving diet and increasing physical activity levels among Chinese immigrants.

METHODS

Outcomes included BMI, weight, waist circumference (WC), waist-hip ratio (WHR), cholesterol (LDL, HDL), systolic and diastolic blood pressure (SBP, DBP), hemoglobin A1c (HgbA1c), fasting blood glucose (FBG), and HOMA-IR. Six databases were systematically searched from database inception to date of search (February 2020). Meta-analyses used random effect models to estimate pooled effects of outcomes with 95% confidence intervals. The outcomes assessed were changes in mean outcomes (post-intervention versus baseline) among the intervention group versus control groups.

RESULTS

Twenty-one articles were included for synthesis, and eight of these were included in the meta-analysis. Among children/adolescents, there were no significant effects of intervention for any of the outcomes having sufficient data for meta-analysis (BMI, WHR, SBP, and DBP). Among adults, the pooled effect including three studies showed significant changes in BMI (effect size = - 1.14 kg/m2; (95% CI: - 2.06, - 0.21), I2 = 31%). There were also significant effects of intervention among adults in terms of changes in SBP and DBP, as the pooled effect across three studies was - 6.08 mmHg (95% CI - 9.42, - 2.73), I2 = 0% and - 3.81 mmHg (95% CI: - 6.34, - 1.28), I2 = 0%, respectively. Among adults there were no other significant effects among the meta-analyses conducted (weight, WC, LDL, HgbA1c, and FBG).

CONCLUSIONS

This review is the first to summarize the effectiveness of diet and physical activity interventions specifically designed for Chinese immigrants living in high income countries. There were clinically meaningful changes in BMI and blood pressure among adults, but evidence was weak for other cardiometabolic outcomes (weight, WC, LDL, HgbA1c, and FBG), and among children, there was no evidence of effect for any cardiometabolic outcomes. Given our mixed findings, more work is needed to support the design of successful interventions, particularly those targeting children and their families.

TRIAL REGISTRATION

The systematic review protocol was registered in PROSPERO on December 17, 2018, the international prospective register of systematic reviews (registration number: CRD42018117842 ).

Using a RE-AIM framework to identify promising practices in National Diabetes Prevention Program implementation

BACKGROUND

The National Diabetes Prevention Program (National DPP) is rapidly expanding in an effort to help those at high risk of type 2 diabetes prevent or delay the disease. In 2012, the Centers for Disease Control and Prevention funded six national organizations to scale and sustain multistate delivery of the National DPP lifestyle change intervention (LCI). This study aims to describe reach, adoption, and maintenance during the 4-year funding period and to assess associations between site-level factors and program effectiveness regarding participant attendance and participation duration.

METHODS

The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework was used to guide the evaluation from October 2012 to September 2016. Multilevel linear regressions were used to examine associations between participant-level demographics and site-level strategies and number of sessions attended, attendance in months 7-12, and duration of participation.

RESULTS

The six funded national organizations increased the number of participating sites from 68 in 2012 to 164 by 2016 across 38 states and enrolled 14,876 eligible participants. By September 2016, coverage for the National DPP LCI was secured for 42 private insurers and 7 public payers. Nearly 200 employers were recruited to offer the LCI on site to their employees. Site-level strategies significantly associated with higher overall attendance, attendance in months 7-12, and longer participation duration included using self-referral or word of mouth as a recruitment strategy, providing non-monetary incentives for participation, and using cultural adaptations to address participants' needs. Sites receiving referrals from healthcare providers or health systems also had higher attendance in months 7-12 and longer participation duration. At the participant level, better outcomes were achieved among those aged 65+ (vs. 18-44 or 45-64), those who were overweight (vs. obesity), those who were non-Hispanic white (vs. non-Hispanic black or multiracial/other races), and those eligible based on a blood test or history of gestational diabetes mellitus (vs. screening positive on a risk test).

CONCLUSIONS

In a time of rapid dissemination of the National DPP LCI the findings of this evaluation can be used to enhance program implementation and translate lessons learned to similar organizations and settings.

Nutrition Interventions for Type 2 Diabetes in Chinese Populations: A Scoping Review

Developing culturally appropriate diabetes nutrition interventions for immigrants could be facilitated knowing what is successful in the home country and other relevant countries. The primary purpose of this scoping review was to identify the design and delivery methods of nutrition interventions for Chinese populations with type 2 diabetes, in their home countries and as immigrants to western countries. A total of 14 articles was retrieved and included. Overall, the approaches used in China often were modelled on intensive lifestyle programs although alternative strategies were also identified. Most interventions were not focussed solely on nutrition, and only a few were conducted in community settings. Most of the interventions were delivered in a group format, while those conducted in China also included individual counselling, particularly for nutrition. In addition, the diabetes and nutrition-related outcomes, cultural relevance and acceptability, and other factors that influenced protocol compliance were considered. Improvements in blood glucose control were observed in participants in all interventions where it was measured. Participants reported increased nutritional knowledge but nutritional behaviour was generally not well documented. Trials conducted in the United States emphasized the importance of cultural adaptation of intervention programs, particularly with respect to dietary patterns and specific foods. Practice-transferable characteristics are highlighted. Research gaps included trials conducted in community settings with pragmatic implementation and evaluation, comparative trials of interventions to gauge relative effectiveness, and measuring and reporting dietary outcomes for better understanding of the impact on dietary behaviours and their relationship to health outcomes.

Academic and Government Partnerships to Address Diabetes in the USA: a Narrative Review

PURPOSE OF REVIEW

Multi-sector partnerships are broadly considered to be of value for diabetes prevention and management. The purpose of this article is to summarize academic and government collaborations focused on diabetes prevention and management.

RECENT FINDINGS

Using a narrative review approach, we identified 17 articles describing 10 academic and government partnerships for diabetes management and surveillance. Challenges and gaps in the literature include complexity of diabetes management vis a vis current healthcare infrastructure; a paucity of racial/ethnic diversity in translational efforts; and the time/effort needed to maintain strong relationships across partner institutions. Academic and government partnerships are of value for diabetes prevention and management activities. Acknowledgment that the key priorities of government programming are often costs and feasibility is critical for collaborations to be successful. Future translational efforts of diabetes prevention and management programs should focus on the following: (1) expansion of partnerships between academia and local health departments; (2) increased utilization of implementation science for enhanced and efficient implementation and dissemination; and (3) harnessing of technological advances for data analysis, patient communication, and report generation.