Relevance and Rigor: Community-Based Diabetes Prevention

Objective: Research elucidating underlying reasons for the explosion of diabetes globally has not translated into interventions that show the promise of curbing the diabetes epidemic. Partnerships with individuals from the communities most impacted by diabetes may uncover novel, practical, scalable, sustainable diabetes prevention strategies. A community-academic research team in Spanish Harlem, the epicenter of diabetes in New York City, aimed to assess and address the individual, environmental and structural contributors to diabetes.

Methods: Using a community-based participatory research approach, the diabetes prevention team conducted focus groups, individual, environmental and policy surveys, photovoice assessments, local public health and environmental interventions, and a community-based peer-led randomized controlled diabetes prevention trial.

Results: This work led to capacity building (community co-authors, co-PI's, grant reviewers and recipients), and local systems and policy changes related to food and physical activity. Assessments revealed higher than expected prevalence of hyperglycemia (only 29% of overweight adults undergoing oral glucose tolerance testing were normoglycemic) and progression from pre-diabetes to diabetes (25% in one year). The prevention trial among 99, primarily poor, undereducated, uninsured, Spanish-Speaking overweight pre-diabetics demonstrated weight loss in intervention versus control participants (4.2% vs. 1.6%, p<0.01) at 6 months, that was maintained at one year follow-up.

Conclusion: Research can be both rigorous and practical in community settings. Community-partnered diabetes prevention efforts can yield novel insights, interventions that pre-diabetics from vulnerable populations want and benefit from, and build community capacity to lead future effective, culturally appropriate, sustainable diabetes prevention efforts locally, and in similar communities globally.