A Culturally Tailored LIfestyle Intervention to Prevent Diabetes in South Asians:

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DESCRIPTION (provided by applicant): South Asians, a rapidly growing segment of the US population, have significantly higher rates of Type 2 Diabetes Mellitus (T2DM), get T2DM at younger ages, and do worse health-wise once they have T2DM than the general population. Lifestyle interventions effectively prevent T2DM in high-risk populations; there is a need for culturally appropriate, lifestyle interventions to prevent diabetes in the South Asian community. This pilot study aims to: (1) Develop a culturally appropriate lifestyle intervention for South Asians with sensitivity to socio-cultural norms in the South Asian community. The design of the intervention will be developed based on the results of focus group discussions. This proposal describes a preliminary, skeleton lifestyle intervention based on the Diabetes Prevention Program (DPP) lifestyle protocol and including: (a) An exercise intervention component, designed to increase program flexibility and acceptability, which includes both in-class group exercise sessions and at-home exercise using a DVD. Both the exercise classes and the DVD include exercises based on culturally appropriate activities, including traditional folk dances, yoga, and walking, and use South Asian music and instructors. (b) Lifestyle classes will be based on the curricula developed for the DPP, but modified to focus on nutrition information and foods that are pertinent to this population, with a focus on modifying the South Asian diet for weight loss, portion control, and making healthy food choices. (c) Peer support groups will be formed to increase acceptability of and adherence to the program. The intervention will be designed to be low-cost and sustainable. (2) Implement the culturally specific lifestyle intervention in the South Asian community as a randomized controlled pilot study. Sixty South Asian men and women, aged 25 years or more, with prediabetes and a BMI of 22 kg/m2 will be randomized to receive either the intensive lifestyle program or standard lifestyle advice (30 individuals per group). The intervention will last for 16 weeks, followed by an 8-week less intense, maintenance period, and three months of follow-up. (3) Evaluate the intervention. The primary outcome will be change in body weight, with the study participants counseled to lose 7% body weight and maintain the weight loss over the course of the study. Secondary outcomes are changes in percent body fat, body mass index, waist-to-hip ratio, fasting glucose, blood pressure, plasma lipids, activity, and diet. The acceptability of the program to the participants will be assessed in focus group discussions. Final results of the study will be used to develop a larger, definitive study of a culturally appropriate, lifestyle intervention for the prevention of T2DM in the South Asian population to be submitted as a R18 grant proposal. PUBLIC HEALTH RELEVANCE: The South Asian Community, people with origins in India, Pakistan, Bangladesh, Maldives, Nepal, Sri Lanka, or Bhutan, are more likely to get diabetes, get diabetes at younger ages, and do worse health-wise once they have diabetes than the general population. This R34 proposal describes the development, implementation, and evaluation of a culturally appropriate lifestyle intervention for the prevention of diabetes in the South Asian community. The outcomes of this project could be used to plan larger interventions to prevent diabetes in South Asians, a rapidly growing segment of the US population.