Tailoring lifestyle programmes for diabetes prevention for US South Asians

Abstract

ObjectiveThe purpose of this study was to develop and test the feasibility of a culturally tailored Diabetes Prevention Programme (DPP) for US South Asians, a large population with high diabetes risk.DesignThe South Asian Health and Prevention Education (SHAPE) study included: (1) focus group discussions with South Asian adults to understand views of lifestyle behaviours and diabetes prevention; (2) modification of the US DPP for South Asians and (3) a pilot, pre–post study to test the feasibility and impact of delivering the culturally tailored programme.SettingThe study was conducted in Atlanta, Georgia, USA. Focus group discussions and intervention classes were held at locations within the community (eg, South Asian restaurants, a public library, university classrooms, a South Asian owned physical therapy studio).ParticipantsThe focus group discussions (n=17 with 109 individuals) included adults aged 25 years of older who self-identified as South Asian. Groups were stratified by age (25–40 years or older than 40 years) and sex. The SHAPE pilot study included 17 (76.5% male with a mean age of 46.9±12 years) South Asian adults aged 25 years or older with pre-diabetes and body mass index (BMI) >22 kg/m2.ResultsFormative data from 17 focus group discussions and a community board guided the modification of the DPP curriculum to reflect cultural food preferences and include tools to leverage social support, create a stronger foundation in exercise and overcome culturally specific barriers. The SHAPE pilot study included 17 South Asian adults with pre-diabetes and BMI >22 kg/m2. There were positive changes in participants’ weight, waist circumference, blood pressure, plasma lipids, HbA1c and other cardiometabolic markers postintervention and 55% of participants regressed to normoglycaemia.ConclusionThese results provide important information on the barriers faced by US South Asians in participating in ‘standard’ lifestyle change programs, indicate the feasibility of culturally tailored programmes and show positive impact of a culturally tailored programme for diabetes prevention in the South Asian population.

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

“…1 . Of the one protocol and two registered trials that passed through screening, study authors of only one registered trial ( Narayan, 2010 ) were able to provide an unpublished manuscript with both baseline and post-intervention data, which has since been published ( Weber et al, 2020 ).

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“…Eight studies were included in the final qualitative synthesis, including two randomized controlled trials ( Kandula et al, 2015 , Patel et al, 2017 ), two two-group pre-post studies ( Islam et al, 2014 , Lim et al, 2019 ), three one-group pre-post studies ( Gany et al, 2014 , Kandula et al, 2016 ), and one experimental study with only baseline data ( Sathe et al, 2013 ) ( Table 2 ). While the number of participants analyzed in intervention or control groups across most studies was between 20 and 54, one single-group pilot study had only 9 participants with follow-up data ( Weber et al, 2020 ), while another large intervention trial had 2726 participants ( Sathe et al, 2013 ).…”

“…Three studies focused on populations at risk for T2DM through the American Diabetes Association risk assessment tool ( Islam et al, 2014 , Lim et al, 2019 ) or the Madras Diabetes Research Foundation’s Indian Diabetes Risk Score ( Patel et al, 2017 ). One study focused on overweight (using the ≥22 kg/m2 cut-off identified for Asian populations ( WHO Expert Consultation, 2004 ) participants with pre-diabetes (FPG 100–125 mg/dl and/or 2-hour post-load glucose of 140–199 mg/dl) ( Weber et al, 2020 ). Other at-risk factors used for participant eligibility included BMI of ≥25 kg/m2 ( Kandula et al, 2016 ), family history of diabetes ( Kandula et al, 2016 ), or at least one cardiovascular disease risk factor (BMI ≥ 25 kg/m2, total cholesterol ≥ 200, LDL cholesterol ≥ 130, prediabetes using FPG > 100 or A1c 5.7–6.4, diabetes using FPG > 126 or A1c > 6.4, systolic blood pressure ≥ 140, or diastolic blood pressure ≥ 90) ( Kandula et al, 2015 ).…”

“…The structure of the community-based lifestyle interventions varied considerably ( Table 4 ). Group-class formats of positive lifestyle behavior promotion were most popular ( Islam et al, 2014 , Kandula et al, 2015 , Lim et al, 2019 , Patel et al, 2017 , Weber et al, 2020 ). Most interventions were between 12 and 16 weeks in duration, while some lasted 6 months ( Islam et al, 2014 , Lim et al, 2019 ) or 1 year ( Sathe et al, 2013 ).…”

“… Telephone-based follow-ups after sessions Gany et al (2014) 12 weeks Remote Daily pedometer usage N/A N/A N/A Multi-lingual research participants consented participants. Questionnaire administered in drivers’ preferred language Pedometer Kandula et al (2016) 16 weeks Community-based non-profit organization, local fitness facility 45 min (2+/wk) of moderate intensity exercise (Zumba, aerobics) Optional group classes: culturally tailored healthy eating, reducing fat and salt intake N/A Community partners involved in development of culturally tailored strategies as part of intervention Study staff participated in exercises for Hindi translation Pedometer (Fitbit Zip wireless activity tracker) Weber et al (2020) 16 weeks Community locations near city Group classes: physical activity awareness, traditional Indian dance exercises, group walks, work-out videos Group classes: diet awareness N/A Existing curriculum (DPP) culturally adapted through focus group research. N/A Video-based exercise routines Sathe et al (2013) 1 year Remote Health coach recommendations Health coach recommendations Health coach recommendations Health coaches trained to integrated culturally tailored strategies N/A Phone, email-based coaching …”