Research by Anna Gorczyca, Ph.D.
Diabetes disproportionately impacts the 60 million individuals (19.3% of the U.S. population) living in rural areas. The Center for Disease Control’s (CDC) National Diabetes Prevention Program (NDPP), which includes a minimum of 16 weekly core sessions over six months and six monthly maintenance sessions, provides the framework for the prevention of type 2 diabetes (T2D) in the U.S. NDPP recognized programs are available in ~28% of U.S. counties; however, access to at least one NDPP recognized program is significantly lower in rural (2.6%) compared with urban areas (11.1%).
Low population density and lack of financial resources represent significant barriers to the implementation and dissemination of the NDPP in rural areas. The Cooperative State Research, Education and Extension Service, a partnership between the U.S. Department of Agriculture, land-grant universities and county governments represents a potentially effective but underutilized site for delivery of NDPP to rural residents. However, evidence to support the effectiveness of the NDPP lifestyle intervention in rural adults with prediabetes defined by CDC criteria, with the intervention delivered by CES staff who have completed CDC approved training and using CDC recommendations for both program curriculum and meeting schedule is unavailable. The time and expense required to travel to attend traditional face-to-face (FTF) group sessions represents a significant barrier to participation in NDPP in adults living in rural areas. Distance learning, e.g. group video using Zoom and online platforms such as Facebook for delivery of NDPP are currently approved for CDC recognition. Remote delivery platforms provide a potentially cost-effective strategy for improving participation and retention, which are both important predictors of weight loss and reduced diabetes incidence in NDPP.
The proposed 12 month, three-arm cluster-randomized non-inferiority trial will compare the effectiveness of the NDPP protocol delivered via Zoom, Facebook or FTF at program completion (12 months). Kansas State University Research and Extension (KSRE) sites serving rural counties in Kansas (n=3) will be randomized to deliver one of the three intervention arms. Each site will recruit 15 adults with prediabetes (NDPP criteria) living in the county served by the participating KSRE site. KSRE staff who will complete CDC-NDPP training will serve as lifestyle coaches. The primary aim will determine the effectiveness by comparing mean changes in body weight (kg/%), percent achieving ≥ 5% weight loss, PA (min/day)/percent achieving the 150min/wk. goal, energy/fat intake, and HbA1c at both six and 12 months across the three intervention arms. Additionally, we will assess the feasibility of the intervention by comparing participant recruitment and retention rates, duration of program participation, session attendance, participant engagement with Facebook, compliance with self-monitoring (diet, PA, weight), and the fidelity of intervention delivery across the three intervention arms.