Strong in Body and Spirit

Abstract

OBJECTIVE—To determine the effects of a culturally appropriate diabetes lifestyle intervention for Native Americans on risk factors for complications of diabetes.RESEARCH DESIGN AND METHODS—A nonrandomized, community-based diabetes intervention trial was conducted in three Native American sites in New Mexico from 1993–1997. Participants were assigned to intervention or control based on community of residence. Intervention sessions were held ∼6 weeks apart over ∼10 months. The intervention was delivered in site A in family and friends (FF) groups (n = 32); site B received the same intervention in one-on-one (OO) appointments (n = 39); and site C received usual medical care (UC) (n = 33) (total participants, n = 104). Primary change in HbA1c level was assessed at 1 year.RESULTS—Adjusted mean change in HbA1c value varied significantly across the three arms at 1 year (P = 0.05). The UC arm showed a statistically significant increase in adjusted mean HbA1c change (1.2%, P = 0.001), whereas both intervention arms showed a small nonsignificant (P > 0.05) increase in the adjusted mean change (0.5% and 0.2% for FF and OO arms, respectively). The increase was statistically significantly smaller in the combined intervention arms (0.4%) compared with the UC arm (1.2%, P = 0.02).CONCLUSIONS—Lifestyle intervention has the potential to substantially reduce microvascular complications, mortality, and health care utilization and costs if the change is sustained over time.