La Comunidad
Latinos Combatiendo la Diabetes
.jpg?n=5004 "Jennifer Cantwell Wood Photo")
Jennifer Cantwell-Wood, MPH, RD, LDN
Clinical Research Dietitian |
Type 2 diabetes mellitus is a major health concern in the United States, accounting for 90 to 95% of the more than 25 million diagnosed cases of diabetes in 2010. Diabetes mellitus increases the risk of mortality from all causes, and is a major risk factor for cardiovascular disease, renal disease, blindness, and lower extremity amputations. Because current treatment does not prevent a substantial proportion of these related complications, and application of proven therapies is inconsistent, prevention of diabetes mellitus is preferable to reducing related sequelae once the disease is established. Racial and ethnic minorities are disproportionately affected by the diabetes epidemic, specifically African Americans, Hispanic Americans, and Native Americans.
In the last decade, several large clinical trials have demonstrated the potential for the prevention of diabetes through lifestyle change, primarily through interventions focused on weight loss, physical activity and nutrition. A number of recent studies have attempted to implement these lifestyle interventions in community settings, including primary care, cardiac rehabilitation programs, churches, YMCAs, health care facilities, and community-based facilities. Although the cumulative evidence suggests that lifestyle interventions to prevent diabetes can be implemented across a variety of settings with diverse personnel, numerous barriers to widespread dissemination in minority populations still exist.
This study is designed to address these barriers by further adapting a community-based lifestyle intervention for Latinos. Latinos Combatiendo la Diabetes (La Comunidad) is a group-based, behavioral lifestyle intervention delivered by LHAs and integrated within the Latino community. It will be population-based, proactive and community member-centered, consistent with the chronic care model. La Comunidad will provide much-needed information regarding the effectiveness of a community-based, behavioral intervention for the prevention of diabetes mellitus in Latinos. If the proposed approach is cost-effective, it will enable the rapid dissemination of this model to the many areas with Latino communities in the United States. Because many chronic diseases are influenced by activity and diet, this approach should translate into public health benefits in other areas (obesity, hypertension, cardiovascular disease) multiplying the potential social benefits and serving as a model for Latino community-based health promotion programs. Our overarching aim is translating evidence based, lifestyle strategies to eliminate health disparities in diabetes prevention.
Specific Aims of the Core:
- To test the hypothesis that a community-based lifestyle weight-loss intervention implemented within the accountability and structure of existing Latino communities will have a more beneficial and clinically meaningful impact on HbA1c, insulin metabolism, and markers of the metabolic syndrome when compared to an enhanced usual care condition.
- The primary outcome is change in HbAlc.
- The secondary outcomes consist of clinical (body weight, blood pressure) and biochemical (glucose, HDL, triglycerides) markers of the metabolic syndrome.
- The tertiary outcomes include biomarkers of insulin sensitivity and inflammation (fasting insulin, homeostatic model assessment [HOMA], CRP, IL-6, leptin, adiponectin, expression of IL-8 in circulating mononuclear cells, Omega 3 and 6 fatty acids, free fatty acids).
- Evaluate the program's effect on health-related quality of life (HRQL) and determine the costs and cost-effectiveness of the intervention in terms of the primary and major secondary outcomes.