Translating Lifestyle Programs for Diabetes Prevention in South Asian Communities 公开

Weber, Mary Beth (2012)

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Translating Lifestyle Programs for Diabetes Prevention in South Asian
South Asians, people from the Indian subcontinent, are at increased risk for
developing diabetes. Translating successful diabetes prevention programs to
create culturally appropriate lifestyle interventions for South Asian populations
worldwide is a prudent method for preventing diabetes in this population. The
aims of this dissertation are to understand the determinants of lifestyle behaviors
and excess weight and evaluate the ability of a culturally tailored lifestyle
intervention to improve anthropometric measures related to diabetes risk in the
South Asian population. This dissertation describes research using data from two
different studies which seek to plan, implement, and evaluate lifestyle programs
for diabetes prevention in South Asian populations: the formative research phase
of the US-based South Asian Health and Prevention Education (SHAPE) study
and cross-sectional and longitudinal data from the Diabetes Community Lifestyle
Improvement Program (D-CLIP) in Chennai, India. A thematic analysis of
verbatim transcripts from seventeen focus group discussions conducted with US
South Asians showed that immigration to the US and gender expectations,
particularly the desire to ensure the comfort and happiness of family members,
were barriers to healthy lifestyle behaviors. Conversely, family can also be a
motivator and a source of social support for healthy lifestyles. A cross-sectional
analysis of D-CLIP screening data (N=1,281) assessed the relationship between
factors associated with healthy weight maintenance (fruit and vegetable intake,
weekly exercise, weight loss history, and weight loss and exercise self-efficacy)
and BMI and waist circumference. Weekly fruit consumption,
past weight loss experience, and weight loss self-efficacy, along with gender, age,
and marital status, explained 13.7% and 25.8% of the variation in BMI and waist
circumference, respectively, in this population. Finally, changes in BMI, weight,
and waist circumference during the first six months of the D-CLIP randomized
controlled intervention trial were compared in intervention (n=294) and control
(n=304) participants. Intervention participants showed significantly greater
reductions (p<0.0001 for all) in weight, BMI, and waist circumference (2.86 kg,
1.05 kg/m2, and 3.72 cm) compared to controls (0.73 kg, 0.31 kg/m2, and 1.58
cm). Based on the results of this research, recommendations for diabetes
prevention in South Asian populations are proposed.

Table of Contents

Table of Contents

Chapter 1: Introduction........ 1

Research Aim 1:..... 3

Research Aim 2:..... 3

Research Aim 3:..... 4

Chapter 2: Background........ 5

Diabetes: The Scope of the Epidemic..... 5

Diabetes in South Asians..... 6

Key Risk Factors For Diabetes..... 7

Diabetes Risk Factors in South Asians..... 10

Lifestyle Interventions for Diabetes Prevention..... 11

The Da Qing IGT and Diabetes Study.. 11

Diabetes Prevention Studies in Japan.. 12

The Finnish Diabetes Prevention Study.. 13

The Diabetes Prevention Program.. 14

The Indian Diabetes Prevention Programme.. 16

Summary of Lifestyle Interventions for Diabetes Prevention.. 17

Translation of the DPP for the South Asian Population..... 19

Chapter 3: Methods........ 22

The SHAPE study..... 22

Formative Research to Inform the SHAPE Program.. 23

The SHAPE Pilot Study.. 26

The D-CLIP Trial..... 26

Study Population.. 28

The D-CLIP Lifestyle Intervention.. 29

Study Testing.. 30

CHAPTER 4: Barriers to and Opportunities for Lifestyle Change to Prevent Diabetes in US South Asians........ 33

Abstract..... 33

Introduction/Background..... 34

Research Design and Methods..... 35

Study Participants and Procedures.. 35

Data Collection.. 37

Data Analysis.. 37

Results..... 38

The Role of Immigration in Lifestyle Behaviors.. 38

The Role of Gender in Lifestyle Behaviors.. 40

Overcoming Barriers to Healthy Lifestyle Behaviors.. 44

Discussion..... 46

Conclusion..... 49

Chapter 4 Tables..... 50

CHAPTER 5: Correlates of BMI and Waist Circumference and Healthy Lifestyle Factors in Asian Indians........ 51

Abstract..... 51

Introduction/Background..... 52

Research Design and Methods..... 54

Study Participants and Procedures.. 54

Data Collection.. 54

Data Analysis.. 57

Results..... 58

Discussion..... 62

Conclusion..... 65

Chapter 5 Tables and Figures..... 66

CHAPTER 6: Changes in Anthropometric Measurements in Asian Indians Enrolled in a Lifestyle Intervention Program: Six Month Results of the D-CLIP Trial........ 73

Abstract..... 73

Introduction/Background..... 74

Research Design and Methods..... 75

Study Participants and Procedures.. 75

Data Collection.. 76

Data Analysis.. 78

Results..... 79

Discussion..... 81

Conclusion..... 85

Chapter 6 Tables and Figures..... 87

Chapter 7: Summary and Conclusions........ 95

Summary of Findings..... 95

Limitations..... 102

Suggestions for Improving Studies like SHAPE and D-CLIP..... 105

Strengths and Innovations..... 108

Public Health Implications..... 109

Gaps in the Published Literature.. 109

Recommendations for Diabetes Prevention in the South Asian Community.. 111

Future Directions.. 114

Conclusion..... 115

References........ 117

Appendices........ 131

Appendix A: SHAPE Study Focus Group Discussion Questions..... 131

Focus Group Discussion Questions, Set #1.. 131

Focus Group Discussion Questions, Set #2.. 132

Appendix B: Article Attachment Pending Permission of Journal..... 134

List of Tables

Table 1: Diagnostic criteria for diabetes and prediabetes... 5

Table 2: D-CLIP trial study testing... 31

Table 3: Demographic characteristics of SHAPE focus group discussion participants by age and gender... 50

Table 4: Study sample characteristics: means and proportions for demographic and anthropometric variables in South Asian adults attending screening for the D-CLIP study... 66

Table 5: Association of body mass index (BMI) and waist circumference (WC) with health beliefs and behaviors in South Asian adults attending screening for the D-CLIP study... 67

Table 6: Pearson Correlation Coefficients for associations between independent variables in South Asian adults attending screening for the D-CLIP study... 68

Table 7: Beta Coefficients and F statistics for bivariate models using BMI or waist circumference as outcomes in South Asian adults attending screening for the D-CLIP study... 69

Table 8: Baseline characteristics of D-CLIP study participants (N=599)... 86

List of Figures

Figure 1: Influence of behavioral and personal factors on body mass index (BMI) in South Asian adults attending screening for the D-CLIP study... 70

Figure 2: Influence of behavioral and personal factors on waist circumference (WC) in South Asian adults attending screening for the D-CLIP study... 71

Figure 3: Plot of heterogeneity in change in waist circumference, weight, and BMI in controls and intervention participants from 0 to 6 months in subgroups of the D-CLIP study population... 87

Figure 4:Changes in outcome measures during months 0-6 in D-CLIP participants*... 90

Figure 5: Change in waist circumference during months 0-6 by glucose intolerance groups for intervention and control participants in the D-CLIP trial... 91

Figure 6: Change in measures of adiposity in lifestyle participants in D-CLIP at six months and other major diabetes prevention trials at one year... 92

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