At the American Diabetes Association’s (ADA) 84th Scientific Sessions, experts discuss how educational nutrition programs are not a one-size-fits-all solution and should focus on the community populations served.
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Sarah A. Stotz, PhD, MS, RDN, CDCES, of Colorado State University, serves American Indians and Alaska Natives. She stated that there are 9.7 million individuals who identify as one or both populations, and approximately 70% live in urban areas.
“Food that is indigenous or native to a particular people who are themselves indigenous is usually based on their region of origin, their climate, their land, where they call home,” Stotz said. “We must also consider the decimation of tribal food sovereignty as we know it from the past, in relation to the consequences of colonization, forced removal from native lands and boarding schools.”
She added that there are high rates of diabetes and related complications among Alaska Native patients, and suggested that taking a multi-level approach to addressing diabetes health disparities could help solve these problems. Nutrition education for a specific audience is only useful if that education is tailored to that specific audience, Stotz said.
The What can I eat? program is a partnership between the ADA and the Shakopee Mdewakanton community. As part of the program, researchers used needs assessments, literature reviews, interviews and focus groups of people with type 2 diabetes (T2D), family members, caregivers, traditional healers, experts and indigenous food practices. A health literacy survey was also conducted. They started a number of sites in the United States, collected feedback and reviewed reviews. The researchers then developed a curriculum based on the feedback.
“It ultimately became a curriculum of five lessons. 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 were created through community feedback,” said Stotz.
Features included original photography 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 include their own traditional foods in the curriculum insert. on their communities.
After the program’s first year, it was hit by the COVID-19 pandemic, but researchers pivoted, creating Zoom-based classes, shorter classes, retaining site supervisors and sending teaching materials to patients.
“We found that across the curriculum for those in the immediate intervention, there were indeed improvements in self-efficacy in using the diabetes plate, confidence in making healthy food choices, and frequency of healthy eating behaviors,” Stotz added to it.
Food insecurity can impact diabetes management, Stotz said. This will therefore be further investigated in the coming years and the program will be continued.
Elise Mitchell, MS, MPH, project manager for Produce Prescriptions, discussed food insecurity and the risk of developing diabetes.
“Some of you may have heard of the concept of food as medicine,” Mitchell said. “This is a framework of policy and behavioral interventions aimed at improving public health by expanding access to healthy food and increasing both food and nutrition security.”
Produce Prescriptions is a food-as-medicine approach that allows healthcare providers to prescribe fruits and vegetables to patients experiencing food insecurity and diet-related chronic diseases, including diabetes. The recipes are a financial incentive that can be redeemed for fresh fruits and vegetables at participating retailers, Mitchell said. The program is community-based and partners with healthcare systems.
“It is implemented at the individual level through the patient-provider relationship, and this allows for greater program sustainability,” Mitchell said.
Screen patients for eligibility in a clinic setting determined by income or food insecurity, diagnosis of/at risk for a specific health condition, and characteristics such as household size or pregnancy status. Providers refer patients to the program by referring them to community organizations or writing a referral for reimbursement. Patients may also need to formally enroll in the program. The program also included educational nutrition advocates.
There were 22,571 patients enrolled nationwide, many of whom had diabetes. Patients used the program to purchase nearly $4.5 million worth of products, which Mitchell said was about $3,000 per month.
Researchers found that patient intake of fruits and vegetables increased from 2.6 to 2.8 cups per day, and participants also reported better perceived health. Mitchell said the PPT2D study is currently underway, with the primary outcome being change in hemoglobin A1c percentage. Individuals participating in the study will receive random treatment with the standard of care or the standard of care with the product program for six months.
At baseline, the population, which included 204 individuals, reported approximately 71% food insecurity, 70% had poor or fair health, and 59% had diabetes-related problems. The study is currently ongoing and researchers hope to evaluate its impact on T2D, cost-effectiveness, feasibility and best practices.
“Education is a cornerstone of diabetes and self-management. Research and education in diabetes and self-management can help things like blood sugar management, blood pressure management and increasing food security,” Stotz said.