At the 84th Scientific Sessions of the American Diabetes Association (ADA), experts argue that educational nutrition programs are not a one-size-fits-all solution and should target the community populations served.
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Sarah A. Stotz, PhD, MS, RDN, CDCES, of Colorado State University serves American Indian and Alaska Native populations. She noted that there are 9.7 million people who identify as one or both populations, with approximately 70% living in urban areas.
“Foods that are indigenous or indigenous to a particular people who are themselves indigenous are often tied to their original region, their climate, their soil, and the place they call home,” Stotz said. “We must also consider the destruction of tribal food sovereignty as we know it from the past, associated with the consequences of colonization, forced removal from indigenous lands, and residential schools.”
He added that there are high rates of diabetes and related complications among American Indian Alaska Native patients, noting that multilevel approaches to addressing diabetes health disparities could help solve these problems. Nutrition education aimed at a specific audience is only beneficial if the education is tailored to that specific audience, Stotz said.
What Can I Eat? program is a collaboration between the ADA and the Shakopee Mdewakanton community. As part of the program, researchers used needs assessments, literature reviews, interviews, and focus groups that included people with type 2 diabetes (T2D), family members, caregivers, traditional healers, experts, and local food methods. A health literacy review was also conducted. They launched several sites in the United States, collecting feedback and reviewing reviews. The researchers then developed a curriculum based on the feedback.
“Ultimately, it became a 5-lesson curriculum. Each class had a nutrition lesson and activity, a physical activity component, and a conscious nutrition component. Some of the unique features we are particularly proud of came to us from community feedback,” said Stotz.
These features included original photos from the program, scripted lessons so non-dietitians could teach the curriculum, a lesson on what to eat with a heavy emphasis on traditional foods, and placeholders where each member could add their own traditional foods based on the curriculum. on their own communities.
After the program’s first year, the COVID-19 pandemic impacted the program, but researchers pivoted, creating Zoom-based lectures, making lectures shorter, retaining site facilitators, and sending lecture materials to patients.
“We found that across the curriculum for emergency responders, there were indeed improvements in self-efficacy for using the diabetes plate, confidence in making healthy food choices, and frequency of healthy eating behaviors,” Stotz added.
Food insecurity can impact diabetes management, Stotz said. Therefore, this issue will be investigated in more detail in the coming years and the program will continue.
Elise Mitchell, MS, MPH, project manager for Product Recipes, discussed food insecurity and the risk of developing diabetes.
“Some of you may have heard that food is medicine,” Mitchell said. “This is a framework of policy and behavioral interventions that aims to improve population health by expanding access to healthy foods and improving both food and nutrition security.”
Prescribe Produce is a food-as-medicine approach that allows healthcare providers to prescribe fruits and vegetables for patients with food insecurity as well as diet-related chronic diseases, including diabetes. Mitchell said the prescriptions are a financial incentive that can be redeemed for fresh fruits and vegetables at participating retailers. The program is community-based and partners with health systems.
“It is implemented at the individual level through the patient-provider relationship, which allows for greater program sustainability,” Mitchell said.
Patients are screened for eligibility in a clinical setting determined by characteristics such as income or food insecurity status, diagnosis/at-risk status for a particular health condition, and household size or pregnancy status. Providers refer patients to the program by referring them to community-based organizations or writing a referral for payment. Patients may also be required to formally enroll in the program. The program also featured nutrition education advocates.
Nationwide, 22,571 patients were registered, most with diabetes. According to Mitchell, patients have used the program to purchase approximately $4.5 million worth of products; That meant about $3,000 a month.
Researchers found that patient intake of fruits and vegetables increased from 2.6 cups per day to 2.8 cups per day, and participants reported better perceived health. The PPT2D study is currently being conducted and the primary outcome is change in hemoglobin A1c percentage, Mitchell said. Individuals included in the study will receive random treatment with standard of care or standard of care with production schedule for 6 months.
At baseline, approximately 71% of the population of 204 were reported to be food insecure, 70% were in poor or good health, and 59% were suffering from diabetes. Research is currently ongoing and researchers hope to evaluate impact on T2D, cost-effectiveness, feasibility and best practices.
“Education is the cornerstone of diabetes and self-management. Research and education on diabetes and self-management can help with issues such as blood sugar management, blood pressure management and increased food safety, Stotz said.