African American (AA) women carry a disproportionate Type 2 diabetes burden. It is widely accepted fact that dietary intake patterns are a key determinate of diabetes outcomes. However, many life factors such as the cultural significance of food in the African American community and multi-caregiver roles make dietary self- care difficult for AA women. Previous interventions in this patient group have focused on evidence-based recommendations for managing carbohydrate consistency in meals/snacks and increasing intake of fruits and vegetables and low-fat foods. However, few have addressed motivation for these dietary behaviors in light of these known barriers and in a manner that is accessible, widely applicable, and sustainable. The objective of this study is to assess the efficacy and feasibility of translating medical nutritional therapy (MNT), using brief motivational interviewing strategies, via an existing local YMCA/ managed care organization (MCO) partnership. Specifically, this nine-month, one arm, interrupted time-series study tests the central hypothesis that a group-based, brief motivational interviewing MNT intervention will result in improved post- intervention dietary self-care behaviors and clinical outcomes relative to pre-intervention outcome assessments. The target patient group is AA women ages 34 to 50 (n=24) who are at risk for Type 2 diabetes complications and enrolled in the MCO's diabetes management program. In the first Specific Aim, we will test the feasibility of training dieticians in brief motivational interviewing. In the second, we will implement a nine- month, one arm interrupted time-series study to evaluate the efficacy of a group-based, brief motivational interviewing MNT intervention in improving dietary intake of carbohydrate, low fat foods, and fruit and vegetables (primary outcomes) and glycemic control, systolic blood pressure, and LDL cholesterol (secondary outcomes). In the third aim, we will assess intervention integrity, acceptability, and feasibility. The results will aid in evaluating the efficacy and feasibility of this intervention and estimation of the required sample size to conduct a randomized effectiveness trial involving multiple YMCA/MCO partnerships and a three-year follow- up period. PUBLIC HEALTH RELEVANCE: This study addresses a major public health problem, preventable diabetes-related death and disability among African American women. It is a critical step in translating and making accessible, via community-based resources, dietary interventions that have the potential to reduce this tremendous disease burden.

R34DK090670

2011-02-15

2013-10-31