Diabetes Intervention Works Best at Home

Public Health; Research

A public health research team at the Brown School at Washington University in St. Louis has taken one of the most effective Type 2 diabetes intervention programs and made it more accessible by partnering with an existing home-visit organization dedicated to working with mothers of preschool-aged children.

The researchers, led by Debra Haire-Joshu, the Joyce Wood Professor at the Brown School, and director of the Center for Diabetes Translation Research and the Center for Obesity Prevention and Policy Research, adapted a lifestyle intervention from the Diabetes Prevention Program (DPP), which is held as the “gold standard” of diabetes interventions through weight management.

The DPP intervention, however, has had challenges when it comes to reaching groups such as busy mothers. It is time-consuming and intense, consisting of individual and group meetings and personal health coaching.

“Our team adapted core DPP content and made it simple to fit within an existing organization,” Haire-Joshu said. That organization, Parents as Teachers, visits women with young children at their homes, working to empower the mothers to raise their children and ready them for school.

The researchers worked to incorporate their diabetes intervention program, called Healthy Eating and Active Living Taught at Home (HEALTH), into the existing Parents as Teachers program. The HEALTH program focuses on changing lifestyle behaviors as well as the environment at home.

“We focused on simple messages, such as limiting soda in the house, avoiding TV in the bedroom and getting up to walk around,” Haire-Joshu said. “It was consistent with the child development and family-oriented Parents as Teachers program.

“And it worked.”

Mothers who received the intervention were significantly more likely to achieve clinically meaningful weight loss after two years — about a 5 percent reduction — compared with those who received home visits without the HEALTH intervention. The intervention also prevented weight gain between treatment groups at both one and two-years. In the U.S., on average, people gain about 1-2 pounds per year. Prevention of that weight accumulation, as seen in HEALTH, can show a continuing impact on the risk for diabetes.

Each 2-pound loss is associated with a 16-percent reduction in Type 2 diabetes incidence.

“Weight loss can sometime seem to be a daunting task,” she said. “This is all about the prevention of weight gain. Our end-goal is to prevent diabetes, but framing the challenge as the prevention of weight gain can also be effective.”

Both outcomes — weight maintenance and clinically significant weight reduction — were achieved through interventions embedded within a program that didn’t rely on traveling to a physician’s office or clinic, and instead allowed mothers to stay home with their children, changing their home environment for the better and setting an example as they changed their lifestyle behaviors.