Improving the Health of Americans through Prevention and Management of Diabetes, Heart Disease, and Stroke

The UTHealth School of Public Health - Center for Health Promotion and Prevention Research in collaboration with the UTHealth School of Biomedical Informatics - Gulf Coast Regional Extension Center will assist the Texas Department of State Health Services (DSHS) in carrying out the proposed activities for the project.

The primary aim is to improve the healthcare system's ability to identify patients at risk for developing diabetes and cardiovascular disease. Specifically, this includes identifying and developing an intervention for patient populations who have either pre-diabetes or uncontrolled hypertension, treatment, and management of patients with diabetes, heart disease, and associated risk factors.

SCAN

Diabetes is one of the most preventable, yet prevalent chronic diseases in the United States, affecting 30.3 million people or 9.4% of the population. Another 84 million are diagnosed with prediabetes. Nearly 20% of all healthcare spending in the U.S. is focused on diabetes. Diabetes can often be prevented by developing a healthy lifestyle including diet and exercise, yet those changes can be difficult to maintain. The National Diabetes Prevention Program (DPP) is an evidence-based, individually administered program capable of reducing diabetes incidence rates through intensive, individualized nutrition and exercise management. Also, it has been shown to be effective when culturally tailored to a specific population. However, DPP retention rates remain low leading to poorer long-term outcomes. There is a clear need to develop incentives for participants to stay in the DPP programs in order to maximize its effectiveness.

For this purpose, we designed a study to determine the impact of an enhanced, food incentive program called SCAN (Sustainable Culturally Adapted Nutrition) that integrates DPP and a food prescription framework whose aim is to improve participant adherence. This study is significant because it: 1) addresses diabetes prevention in a medically underserved urban population,  2) targets a diverse minority population which has a high prevalence of diabetes in the population, 3) applies established theories of behavior change to inform and incorporate a food incentive program model into the DPP,  4) applies techniques of motivational interviewing to counseling participants, and 5) demonstrates the ability of a food incentive program to improve adherence rates to the Diabetes Prevention program (DPP). If successful, this study has the potential to guide the incorporation of SCAN into DPP programs nationally.