High Prevalence of Diabetes and Barriers to Diabetes Prevention in East Harlem

Introduction: Modest weight loss can prevent or delay the onset of diabetes. A community-academic partnership in East Harlem, the epicenter of diabetes in New York City, aimed to assess and address factors that challenge diabetes prevention. Methods: Using a community-based participatory research approach, the diabetes prevention team tested overweight adults (with no known diabetes) for pre-diabetes using oral glucose tolerance testing, and surveyed them regarding dietary attitudes and behaviors. Results: Of the 598 people included, 60% had pre-diabetes and 10% had diabetes. They were female (84%), Latino (75%), uninsured (35%), 43% had less than a high school education and 39% lived in poverty. Many eat fast food more than weekly (45%) and never choose food based on calories (61%). Only 26% were confident reading food labels. Common barriers to eating healthy include taste (71%), cost (50%), being raised to finish everything on ones plate (69%), not finding healthy foods when eating out (60%), or when in a hurry (66%). Many (55%) leave the neighborhood to find healthy foods. Overall, 72% were food insufficient and 52% find it difficult to eat healthy.

Conclusions: Surprisingly, only a minority of overweight adults surveyed had normal glucoses. This rate of pre-diabetes among predominantly food insufficient Latina women is well above that cited in the literature. Common factors that could contribute to this finding include unhealthy eating related to barriers including cost, taste, upbringing and access. Community-partnered efforts can yield novel insights and build community capacity to lead culturally appropriate, sustainable diabetes prevention efforts.