Addressing Food Access and Physcial Activity to Improve Diabetes Prevention Outcomes Among Underserved African Americans - PROJECT SUMMARY/ABSTRACT Diabetes is one of the most pressing public health challenges in the U.S., with over 98 million adults – more than one in three – already living with pre-diabetes mellitus (pre-DM), placing them at heightened risk for type 2 diabetes and its severe complications. African Americans (AA) face a disproportionate burden, with DM rates nearly twice that of Whites (13% vs. 7.5%), obesity prevalence exceeding 60% and lower rates of fruit/vegetable intake and physical activity (PA). A critical component of national efforts to curb the diabetes epidemic is the Diabetes Prevention Program (DPP), a lifestyle intervention proven to reduce or delay DM onset by 58 to 71% through structured diet changes, increased exercise, and modest weight loss (5-7%) in a rigorously evaluated national trial. Despite the proven efficacy of the DPP, AA experience only half the weight loss of White participants – highlighting a critical gap in effectiveness that must be addressed. Our enhanced DPP model builds upon our promising pilot studies by integrating culturally tailored healthy food delivery, on- site physical activity, and linkages to existing food and PA community resources to extend support beyond class and the duration of this study. These enhancements are designed to overcome social determinants that impede clinically meaningful weight loss among underserved AA populations. To assess the impact of this enhanced model, we propose a cluster randomized controlled trial of 408 pre-DM AA participants recruited from churches in communities with the highest risks of DM. Participants will be assigned to either a standard, culturally tailored DPP (S-DPP) – which incorporates tailoring of language, culturally relevant foods, religiosity, and community norms and values – or a culturally tailored, enhanced DPP (E-DPP), which further addresses systematic barriers to food access, healthy eating, and physical activity over 12 months. We will: 1) examine the effects of E-DDP on percent weight loss (primary outcome) and secondary outcomes (food and nutrition insecurity, healthy eating, physical activity, DPP attendance, hbA1c, and blood pressure) at 6 and 12 months, 2) identify key mediators/moderators related to weight loss among AA participants at 6 and 12 months to determine modifiable facilitators and barriers, and 3) conduct a process evaluation to examine E-DPP acceptability, feasibility, and fidelity, cost-effectiveness, and the link between program delivery and outcomes to identify and improve essential intervention components. This study represents the first effort to integrate culturally tailored DPP adaptations with direct food and physical activity access supports, addressing systemic barriers in a way that could redefine national diabetes prevention efforts. By leveraging trusted church settings and addressing key barriers, this innovative model holds promise for national scalability and long-term sustainability. This approach has the potential to set a new standard for diabetes prevention in high-risk populations and inform future policy and practice at the national level.
