Nurse-Led Peer Facilitated Diabetes Prevention and Early Intervention Program

Abstract

BACKGROUND: Prediabetes, an antecedent to type 2 diabetes (T2D) - the 7th leading cause of death and disability in the U.S., poses a greater impact on marginalized populations. The risk factors include excessive weight, unhealthy eating habits, sedentary lifestyle, and smoking. Diabetes prevention program (DPP) lifestyle intervention can delay or halt the progressions of prediabetes to T2D. PROBLEM: The formerly homeless men in an inner-city residential employment center on the East Coast of the U.S. exhibited high rates of risk factors for T2D: tobacco use (83%), obesity (54%), pre-hypertension (39%), hypertension (14%), and family history of diabetes (42%). OBJECTIVES: This nurse led DPP project implemented and evaluated a peer facilitation approach for reduction of T2D risks among the formerly homeless men in this employment program. METHODS: Five formerly homeless men who were previously trained as diabetes prevention lifestyle coaches (“peer facilitators”) using the Group Lifestyle Balance curriculum delivered twelve (12) weeks of the DPP core interventions to their peers. Each peer kept weekly logs of dietary and smoking habits, the number of times per day that they replaced sugar-sweetened beverages (SSB) with water, and physical activity. Data analyses of changes in all variables were conducted using self-reported data from the participants’ weekly logs and statistical significance was analyzed using the paired t-tests. RESULTS: All these men (N=15) met the required inclusion criteria of having a score of five (5) or higher on the American Diabetes Association (ADA) risk assessment test (mean=5.53; SD=0.74; range=5-7 of a maximum 11 points) combined with being aged 18 years or older. At baseline, most of these men were smokers (73%) and had a family history of diabetes (73%). Data from the participants’ weekly logs for weeks 1 to 12 showed statistically significant changes in behavioral modifications except for physical activity between weeks 1 and 4 (p=0.5). However, there was a significant increase in the participants’ mean number of days for physical activity from week 1 to week 8 (p=0.007) and week 1 through week 12 (p<0.001). Significant reductions were also observed in participants’ mean weights from weeks 1 to 12 (p<0.001). CONCLUSION: Implementation of a nurse-led, peer-facilitated, diabetes prevention in formerly homeless men significantly reduced their risks for T2D; fostered strong relationships among peers; increased program’s relevance and participants’ attendance, as well as provided enormous opportunities for these facilitators to seek employment in other community-based support programs. As well-informed community leaders, these men can also reach numerous other, often hard-to-reach individuals in their network of family and friends. Thus, commitments from local partners will be extremely valuable for sustainability and future evaluations of this tailored, community-based, quality improvement project.