UCSF

The Diabetes Prevention Program (DPP) trial demonstrated that lifestyle interventions could reduce the incidence of type 2 diabetes mellitus (T2DM) in adults at high-risk. Only a small percentage of adults at high-risk are aware of their T2DM risk status and implementation of lifestyle interventions modeled on the DPP intervention has not been achieved.

The aims of the research presented in these three manuscripts address areas of needed action and research to speed up primary prevention efforts recommended by a Centers for Disease Control and Prevention, Division of Diabetes Translation advisory group: the need to effectively communicate T2DM risk, use mobile interactive technologies, and focus on vulnerable populations disproportionately impacted by T2DM.

The first two manuscripts describe a 2-phase clinical research project in a sample of foreign-born Latino adults living in California and speaking predominately Spanish at home to describe risk perceptions of developing diabetes and associated risk factors. A new Spanish-language adaptation of a published risk perception questionnaire was developed and tested. The results supported validity and reliability of the instrument and validation of inferences in Latino, foreign-born, Spanish-speaking at-risk populations. Of the 135 participants with complete data, 31% had higher risk perceptions of developing diabetes. In univariate logistic regression analyses, 9 of 18 potential variables tested were significant predictors of risk perception of developing diabetes. In the multiple logistic regression model, 5 variables were significant predictors of risk perception: optimistic bias, worry, perceived personal disease risk, educational attainment of high school graduate, and history of gestational diabetes. The results contribute to knowledge of risk perception of developing T2DM in this at-risk population and suggest further need for culturally accessible T2DM primary prevention research.

The final manuscript presents the results of a systematic review of DPP modeled T2DM preventive lifestyle interventions delivered via distance learning technologies. The evidence of efficacy is mixed and inconclusive due to heterogeneity of study designs, lack of targeted participant samples, variable intervention components, and inconsistent measures of weight loss outcome. Further, ethnic/racial minority groups were underrepresented in the samples. No trials tested Spanish-language interventions delivered via distance learning technologies and none tested mobile interventions.