The prevalence of both obesity and diabetes are high among Hispanic/Latino populations, especially persons of Mexican ancestry (CDC 2011). There is ample evidence nationally that Latinos are at increased risk for incident T2DM. Individuals at high risk for developing diabetes can be identified based on weight, family history, and abnormal glucose (either impaired fasting glucose, or impaired glucose tolerance) (ADA 2011). Those at high risk for diabetes also frequently have at least one other clinical abnormality (e.g., dyslipidemia, high blood pressure) such that they also have metabolic syndrome (MetS). MetS is associated with increased risk of T2DM and CVD, although the highest risk of T2DM is among those with prediabetes (whether or not they also have MetS).The NC Latino population is rapidly growing, and we have observed a high prevalence of overweight/obesity, prediabetes, and T2DM in this population. The overall goal of the Latino Diabetes Prevention Trial is to test whether a church-based, culturally adapted lifestyle intervention changes behaviors (diet and exercise) will produce improvements in weight, glycemia, and clinical and biochemical parameters (central adiposity, triglycerides, HDL, blood pressure, insulin, inflammation) associated with obesity among a high risk population (Latinos). A key translational element of this study will be to utilize HbAI c rather than oral glucose tolerance testing or fasting glucose to identify at-risk participants. This work is based up on prior experience working with Latino Health Advisors, and existing relationships with five faith communities serving both Protestant and Catholic Latinos (Dr. Calles) and a pilot church-based intervention targeting MetS among in a non-Hispanic community (Dr. Chilton). This program will use a design modeled after the Diabetes Prevention Program (DPP) with an initial, 6 month acute intervention phase followed by a maintenance phase of 18 months. The design of the intervention will be culturally-relevant, linguistically appropriate, and multifaceted (dietary counseling, intensive exercise). The intervention will be delivered and evaluated using a randomized, controlled design with two conditions?a group-based arm, in which content is delivered to participants in weekly group meetings vs. an control arm, in which participants receive intervention content via mail, handbooks and pamphlets and are encouraged to engage in behaviors on their own. Data will be collected at baseline, 16 weeks, and 6, 12, and 24 months, to determine the short and longer term effect of the intervention. The intervention will be administered using churches as leverage points, delivered by Latino Health Advisors who will receive intensive training from the investigators prior to delivering the program in their churches, and will include faith based tenets which are common to the denominations among which this program will be conducted. Finally, the investigators will evaluate the program's effect on health-related quality of life (HRQL) and determine the cost effectiveness of the intervention in terms of the primary and major secondary outcomes. It is anticipated that, if successful, this intervention will contribute to strategies that if implemented widely, will reduce the burden of diabetes in this high risk population.
