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Weighty Issues: Preventing Type 2 Diabetes in At-Risk Populations

Posted: Nov. 9, 2017

Sharon Brown, PhD, RN, FAAN and professor at UT Austin School of Nursing

For more than 25 years, Sharon Brown, PhD, RN, FAAN and professor at UT Austin School of Nursing, in collaboration with Craig Hanis, PhD, Genetics Center, School of Public Health, The University of Texas Health Science Center at Houston, has led the Starr County Border Health Initiative, a series of research studies conducted in an impoverished Texas-Mexico border community. During those years, Brown developed and tested culturally tailored, community-based methods designed to help Mexican Americans take control of their diabetes and improve their health.

Before she began in 1988, efforts to help Mexican-American diabetics curb obesity and make healthy lifestyle changes were largely unsuccessful because they failed to take into account the population’s language and cultural differences, particularly related to dietary preferences. Brown knew she would have to do things differently to be effective in educating Hispanics on how to manage their disease. She didn't want to change their way of life, just help them live it in a healthier way. As Brown and her team focused on self-management education, they began to see blood glucose control improve, weight more successfully managed and other positive health outcomes.

Her newest research study, Diabetes Prevention Culturally Tailored for Mexican Americans, also uses self-management education, but instead of working with people who already have diabetes, Brown is recruiting 300 individuals who are at risk (diagnosed with prediabetes) but haven’t yet developed the disease.

“We always aimed at diabetes management so individuals could learn how to keep their blood glucoses under control,” Brown said. “Clearly it would be so much better if we could get to people earlier before they have diabetes and try to prevent or, at least, delay it.”

She and co-principal investigator Hanis have based their new intervention on a large nationwide study on diabetes prevention initially published in 2002 that found in a comparison of lifestyle changes in diet and exercise versus a diabetes drug (metformin), lifestyle changes was the most effective in preventing diabetes in persons already diagnosed with prediabetes.

Everyone in the Starr County population has a high risk of developing diabetes, Brown explained. In general, nearly 90 percent of individuals with type 2 diabetes are either overweight or obese, and few get the physical activity they need. As in her past interventions in which participants voiced their displeasure with complicated lifestyle guidelines, there is no carb-counting; just practical dietary guidance on portion control, food preparation demonstrations, and supervised trips to the grocery stores to learn how to read food labels and locate healthier food choices.

“We provide general principles and knowledge about food preparation and eating, such as lowering fat and sodium content and portion control,” Brown said. “The participants know they are likely to get diabetes because almost everyone they know has it. Our intervention is designed to decrease the number of people who eventually convert to diabetes and experience damage, such as kidney failure and blindness. We’re hoping to slow that process down.”

Traditionally, 60 percent of the cause of diabetes has been attributed to lifestyle and 40 percent to genetics. This study will also look at whether these individuals have any genes that predict how well they respond to the lifestyle intervention.

“Are there genetic differences in people who respond to this intervention and those who don’t? Because some people have such a severe form of diabetes, lifestyle changes may not work as well for them,” Brown said.

At the same time, if it does work for them, the earlier they begin to make healthy changes, the better off they will be. By bringing blood glucoses down to near normal, it’s possible to prevent or at least decrease the rate of significant complications by 25 to 75 percent, depending on the type of complication, Brown added.

“The genetic aspect is very exploratory and will be directed by Dr. Hanis,” Brown said. “If it turns out that cases in which people experience a more severe, downhill disease process are linked to a genetic profile, then that will need further, more in-depth investigation.”

Her team is also integrating motivational interviewing, a new communication tool she anticipates will prompt a desire to make healthy lifestyle changes. Dr. Mary Velasquez from the Steve Hicks School of Social Work is a co-investigator on the project and an expert in motivational interviewing.

The current intervention consists of three months of weekly educational sessions in which participants are taken on food shopping trips, taught to cook healthier versions of their favorite foods and given Fitbits to record physical activity. This is followed by nine months of support group meetings aimed at goal setting and problem solving. Booster sessions will be held every six months thereafter, and data collection will continue until 2022.

Brown and Hanis received approximately $3 million from the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, for the five-year study.

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