Adventure and Games for Diabetes Prevention

According to the Centers for Disease Control and Prevention, diabetes prevention represents a critical need for the health education curriculum, given the rise of the disease and its precondition for today’s youth. An active understanding of diabetes encourages young people to take control of the nutritional and exercise factors that keep the disease in check. When teachers use experiential activities, or “adventure” education, students perform tasks that illustrate conceptual content and reinforce learning. Research has found that current modalities to be successful but lacking the physicality to meet the recommendations of the American Heart Association and the Society of Health and Physical Educators. Games such as Toll Road Boogie; Tom and Jerry, or Insulin and Sugar; Wacky Receptor; and Tusker Monster, or Fat Cell Tag help children meet the 60 min of physical activity that are required most days of the week. This article offers several examples of how to design and implement games and incentives into lessons that are both enjoyable and illustrative of diabetes prevention-based education for ages 8 to 18.

Developing mHealth Interventions with Implementation in Mind: Application of the Multiphase Optimization Strategy (MOST) Preparation Phase to Diabetes Prevention Programming (Preprint)

UNSTRUCTURED With thousands of mHealth solutions on the market, patients and healthcare providers struggle to identify which solution to use/prescribe. The lack of evidence-based mHealth solutions may be due to limited research on intervention development and continued use of traditional research methods for mHealth evaluation. The Multiphase Optimization Strategy (MOST) is a framework which aids in developing interventions which are economical, affordable, scalable, and effective (EASE). MOST Phase I highlights the importance of formative intervention development, a stage often overlooked and rarely published. The aim of MOST Phase I is to identify candidate intervention components, create a conceptual model, and define the optimization objective. While MOST sets these three targets, the framework itself does not provide robust guidance on how to conduct quality research within Phase I, and what steps can be taken to identify potential intervention components, develop the conceptual model, and achieve intervention EASE with the implementation context in mind. To advance the applicability of MOST within the field of implementation science, this paper provides an account of the methods used to develop an mHealth intervention. Specifically, we provide a comprehensive example of how to achieve the goals of MOST Phase I by outlining the formative development of an mHealth prompting intervention within a diabetes prevention program. Additionally, recommendations are proposed for future researchers to conduct formative research on mHealth interventions with implementation in mind. Given its considerable reach, mHealth has the potential to positively impact public health by decreasing implementation costs and improving accessibility. MOST is well-suited for the efficient development and optimization of mHealth interventions. By using an implementation-focused lens and outlining the steps in developing an mHealth intervention using MOST Phase I, this work can may guide future intervention developers towards maximizing the impact of mHealth outside of the research laboratory.

Serum Levels of Plasmalogens and Fatty Acid Metabolites Associate with Retinal Microangiopathy in Participants from the Finnish Diabetes Prevention Study

Diabetic retinopathy (DR) is the most common microvascular complication of diabetes, and retinal microaneurysms (MA) are one of the first detected abnormalities associated with DR. We recently showed elevated serum triglyceride levels to be associated with the development of MA in the Finnish Diabetes Prevention Study (DPS). The purpose of this metabolomics study was to assess whether serum fatty acid (FA) composition, plasmalogens, and low-grade inflammation may enhance or decrease the risk of MA. Originally, the DPS included 522 individuals (mean 55 years old, range 40–64 years) with impaired glucose tolerance who were randomized into an intervention (n = 265) or control group (n = 257). The intervention lasted for a median of four years (active period), after which annual follow-up visits were conducted. At least five years after stopping the intervention phase of DPS, participants classified as MA negative (n = 115) or MA positive (n = 51) were included in the current study. All these participants were free of diabetes at baseline (WHO 1985) and had high-sensitive C-reactive protein (hs-CRP), serum FA composition, and selected lipid metabolites measured during the active study period. Among the markers associated with MA, the serum plasmalogen dm16:0 (p = 0.006), the saturated odd-chain FA 15.0 (pentadecanoic acid; p = 0.015), and omega-3 very long-chain FAs (p < 0.05) were associated with a decreased occurrence of MA. These associations were independent of study group and other risk factors. The association of high serum triglycerides with the MA occurrence was attenuated when these MA-associated serum lipid markers were considered. Our findings suggest that, in addition to n-3 FAs, odd-chain FA 15:0 and plasmalogen dm16:0 may contribute to a lower risk of MA in individuals with impaired glucose tolerance. These putative novel lipid biomarkers have an association with MA independently of triglyceride levels.

Health Care Providers’ Knowledge, Attitudes, and Practices and the Association With Referrals to the National Diabetes Prevention Program Lifestyle Change Program

Purpose To examine how health care providers’ knowledge, attitudes, and practices affect their referrals to the National Diabetes Prevention Program. Design Cross-sectional, self-report data from DocStyles—a web-based survey Setting USA Sample Practicing family practitioners, nurse practitioners, pharmacists, and internists, n = 1,503. Measures Questions regarding health care providers’ knowledge, attitudes, and practices and their referrals to the National Diabetes Prevention Program. Analysis Bivariate and multivariate analyses were used to calculate predictive margins and the average marginal effect. Results Overall, 15.2% of health care providers ( n = 1,503) reported making a referral to the National Diabetes Prevention Program. Health care providers were more likely to make referrals if they were familiar with the program (average marginal effect = 36.0%, 95% CI: 29.1%, 42.8%), reported knowledge of its availability (average marginal effect=49.1%, 95% CI: 40.2%, 57.9%), believed it was important to make referrals to the program (average marginal effect = 20.7%, 95% CI: 14.4%, 27.0%), and used electronic health records to manage patients with prediabetes (average marginal effect = 9.1%, 95% CI: 5.4%, 12.7%). Health care providers’ demographic characteristics had little to no association with making referrals. Conclusion Making referrals to the National Diabetes Prevention Program was associated with health care providers’ knowledge of the program and its reported availability, their attitudes, and their use of the electronic health record system to manage patients with prediabetes.

Diabetes Prevention and Care Capacity at Urban Indian Health Organizations

American Indian and Alaska Native (AI/AN) people suffer a disproportionate burden of diabetes and cardiovascular disease. Urban Indian Health Organizations (UIHOs) are an important source of diabetes services for urban AI/AN people. Two evidence-based interventions—diabetes prevention (DP) and healthy heart (HH)–have been implemented and evaluated primarily in rural, reservation settings. This work examines the capacity, challenges and strengths of UIHOs in implementing diabetes programs.Methods: We applied an original survey, supplemented with publicly-available data, to assess eight organizational capacity domains, strengths and challenges of UIHOs with respect to diabetes prevention and care. We summarized and compared (Fisher's and Kruskal-Wallis exact tests) items in each organizational capacity domain for DP and HH implementers vs. non-implementers and conducted a thematic analysis of strengths and challenges.Results: Of the 33 UIHOs providing services in 2017, individuals from 30 sites (91% of UIHOs) replied to the survey. Eight UIHOs (27%) had participated in either DP (n = 6) or HH (n = 2). Implementers reported having more staff than non-implementers (117.0 vs. 53.5; p = 0.02). Implementers had larger budgets, ~$10 million of total revenue compared to $2.5 million for non-implementers (p = 0.01). UIHO strengths included: physical infrastructure, dedicated leadership and staff, and community relationships. Areas to strengthen included: staff training and retention, ensuring sufficient and consistent funding, and data infrastructure.Conclusions: Strengthening UIHOs across organizational capacity domains will be important for implementing evidence-based diabetes interventions, increasing their uptake, and sustaining these interventions for AI/AN people living in urban areas of the U.S.