Total prevalence of diabetes in the US is estimated at 20.8 million currently and projected to be 39 million by 2050, with non-Hispanic blacks being 1.8 times as likely to have diabetes as non-Hispanic whites. Complications and comorbidities of diabetes are associated with increased medical expenses, disability and decreased quality of life. Maintaining HbA1c levels at or below 7% in patients with diabetes is associated with decreased medical expenses and lower rates of health complications, with more pronounced benefit for African Americans compared to Caucasians. Improving glycemic control through diabetes self-management is particularly important in African Americans to reduce risk of health complications from type 2 diabetes. Diabetes self-management education programs delivered in faith- based settings appear to be particularly effective for African Americans, should include spiritual leaders, and should address self-efficacy, social support and outcome expectations in addition to general education on diabetes and rationale for recommended self-care behaviors. The proposed study will implement a community-based diabetes education program guided by Social Cognitive Theory (SCT), Dining with Diabetes in Virginia (DwDVA), that is designed to be delivered in partnership with local Cooperative Extension Agents and healthcare professionals (registered dietitians/certified diabetes educators). In the proposed study, DwDVA will be delivered in partnership with the health ministry program of the statewide association of Baptist Churches that are predominantly African American and will target medically underserved areas of Virginia using a community-based participatory approach. Three churches in each of eight geographic locations will be randomly assigned to one of three conditions: DwDVA, DwDV+ (plus monthly support groups) or delayed treatment control. The primary outcome variable will be glycosylated hemoglobin (HbA1c) as a marker of glycemic control. Secondary outcome measures will include blood pressure, body weight, nutrition and physical activity behaviors and SCT variables. Hypotheses include: 1) compared to the delayed treatment control condition at 3 months, DwDVA will be associated with improved HbA1c levels, body weight, nutrition and physical activity behaviors, and SCT variables;2) compared to DwDVA, DwDVA+ will be associated with further improvement in outcome measures at 6 months;3) change in SCT variables will mediate treatment effects on primary and secondary intervention outcomes. Both Cooperative Extension and the church- based health ministry are charged with delivering health education programs to communities across the state and have resources available to sustain and disseminate the program if it is found to be successful. .
The prevalence of type 2 diabetes among adults in the United States has increased dramatically since the 1990s and continues to increase. Expenses related to medical expenditures and lost productivity associated with health complications related to type 2 diabetes total over $100 billion annually. African Americans are 1.8 times as likely to have diabetes as Caucasians and suffer disproportionately from health complications related to diabetes. Reaching medically underserved African Americans with type 2 diabetes via an evidence-based diabetes education program delivered through an established community education system (Cooperative Extension) in partnership with a church-based health ministry is culturally appropriate and may reduce risk of health complications in this vulnerable population. Because Cooperative Extension is nationwide and already allocates resources for community education, similar partnerships could be established in other states, allowing for widespread dissemination.
