A Trial to Assess T2D Prevention With A Family-Focused Approach

A study of T2D prevention strategies looked at whether individuals with diabetes can impact their family and friends to prevent new-onset diabetes.

One-third of all babies born in the year 2000 are predicted to develop diabetes within their lifetime. According to the 2020 National Diabetes Statistics Report, over 10.5% of Americans of all ages currently have diabetes. The incidence among adults reveals no change in trend for over 20 years. Prevention is the most effective way to combat future diabetes prevalence. Only 70 years ago, prevention measures for diabetes excluded exercise. Currently, there are hundreds of self-help programs and approaches to diabetes prevention. For example, the Diabetes Prevention Program (DPP) was designed to address two different target lifestyle interventions, maintaining at least 7% weight loss and 700 kcal/week of physical activity, with the physical intensity similar to a “brisk walk.” Nevertheless, the projection of new-onset type 2 diabetes continues to rise. 

Dr. H.C. Felix is a University of Arkansas researcher who focused on the social impact of the Diabetes Self-Management Education (DSME) program. He wanted the participant’s family and close friends to be more involved in hopes of increasing awareness of type 2 diabetes in the community. The DSME program provides the knowledge and skills to properly manage type 2 diabetes with goals to improve glycosylated hemoglobin (A1c).  Separating the participants and family members’ assessments individually made this study enlightening.  

The participant population was a group of Pacific Islanders, the Marshallese, from the Republic of the Marshall Islands. Over 38% of Marshallese have type 2 diabetes, the highest rate globally. The two-arm randomized controlled trial assessed the effect of the family (n=110) that participated in the DSME classes compared to the standard (n=111) DSME participants, without the social support. The invited “family members” were defined as someone with whom the patient regularly shared meals.  

“The intent,” Dr. Felix conveys, “was to determine whether family DSME could serve as a diabetes prevention program among participating family members at risk of developing diabetes.”  

The family members and the leading participant took ten hours of material covering core elements of DSME and eight 75-minute classes over eight weeks with a personal coach. Marshallese community health “coaches” are bilingual and complete 60 hours of training with an additional 40 hours of intervention specific training while completing a four-hour continuing education program each month. The A1c was collected at four different intervals; baseline, nine weeks, six months, and 12 months post-intervention. A $20 gift card was incentivized for every appointment attended.   

Almost 32% of the family members failed to attend class. The family members’ mean A1c and BMI failed to show any difference compared to the control group. Unfortunately, the family members’ only significant findings were the increase in BMI (+0.38 points, p = .020), A1c (+0.24 points, p < .001), and unhealthy food consumption scores (+3.21 points, p < .001) within one year. Furthermore, the study reveals that individuals with diabetes alone are the only ones significantly benefiting from the DSME intervention. Over 10% of the family members, with no prior dysglycemia complications, developed type 2 diabetes after one year.  

The demand for advancement in modern screening techniques, diabetes, social engagement, and clinical technology is desperately needed. By 2030, diabetes-related mortality is projected to additionally increase by 385,800 Americans, draining more than $622 billion annually. Although the intervention did not significantly impact the family member’s control of their A1c levels, it did impact the participants with diabetes themselves. While future studies should address why family member attendance was low, navigating different methods of engagement is recommended. 

Publisher’s Note:  Educating the public about the importance of knowing your A1c number can motivate the public to a better understanding of how nutrition and physical activity can not only improve your quality of life but increase longevity.   

Practice Pearls: 

• Support from friends and family for the individual with diabetes makes a significant difference when they are actively involved, but it is only one-sided.  
• The family members involved do not receive any significant prevention benefits.   
• Future diabetes prevention programs must continue to develop new methods that increase community engagement.  

References for “A Trial to Assess T2D Prevention With A Family-Focused Approach”:

Bernstein, Richard. Diabetes Solution. Little, Brown and Company, 2011 

“National Diabetes Statistics Report, 2020.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, February 11, 2020, www.cdc.gov/diabetes/library/features/diabetes-stat-report.html 

Diabetes Prevention Program (DPP) Research Group. “The Diabetes Prevention Program (DPP): description of lifestyle intervention.” Diabetes care vol. 25,12 (2002): 2165-71. doi:10.2337/diacare.25.12.2165 

Felix, H. et al. “Effects of a Family Diabetes Self-Management Education Intervention on the Patients’ Supporters.” American Psychological Association. 2020, Vol. 38, No. 2, 121–129  https://dx.doi.org/10.1037/fsh0000470 

Rowley, William R et al. “Diabetes 2030: Insights from Yesterday, Today, and Future Trends.“ Population health management vol. 20,1 (2017): 6-12. doi:10.1089/pop.2015.0181 

Peter Jay Won, Pharm.D. Candidate, University of South Florida, Taneja College of Pharmacy 

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