We Can Prevent Diabetes: A Behavioral Intervention to Reduce Diabetes Risk in African Americans

Pre-diabetes, characterized by glucose levels that are above normal but below the diagnostic
criteria for diabetes, is an increasingly common condition affecting approximately 54
million U.S. adults. African Americans are disproportionately affected by pre-diabetes and
experience high rates of diabetes-associated morbidity and mortality including damage to the
circulatory system, kidneys, and nervous system. Patients with pre-diabetes who increase
their physical activity and improve their diets have reduced risk of developing diabetes.
Psychological distress negatively influences the course of the disease by increasing
deleterious health behaviors; preventing scheduling and maintenance of positive behavior
change; and stimulating HPA-axis activation and dysregulation, which may have a direct
impact on insulin resistance and glucose metabolism. African Americans may have increased
exposure to stress and increased vulnerability to adverse stress-related health outcomes
like diabetes, because of their unique history, sociocultural experiences, and societal
position in the U.S. Helping individuals to reduce stress and to increase healthy coping
strategies may enhance conventional diabetes prevention efforts, especially among African
Americans.

Mindfulness-based stress reduction (MBSR), a mind-body practice with a wide range of health
benefits, has been shown to result in statistically significant reductions in psychological
stress and anxiety in randomized, controlled studies. Mindfulness training is cost-effective
in comparison with other small-group or individualized programs, and can be taught safely
and effectively by well-trained instructors. There is little research, and no randomized,
controlled trials of MBSR as a treatment for individuals with pre-diabetes. There is also
little research on the acceptability of MBSR program to a prediabetic subgroup of African
Americans, or on the acceptability of an MBSR program for a general population of African
Americans.

Overall goals of this exploratory pilot study are to study the potential efficacy of a
diabetes prevention education program that includes training in mindfulness-based stress
reduction for pre-diabetic African Americans. Specific Aims are 1) to determine the
feasibility of developing a clinical trial to compare the effectiveness of a
mindfulness-based diabetes prevention program (treatment group) with a conventional diabetes
prevention program (control group) in improving glucose metabolism in pre-diabetic African
American adults; 2) to identify relevant physiological and psychological secondary outcomes
associated with a mindfulness-based, educational self-care program in African-Americans with
pre-diabetes; 3) to assess the acceptability and cultural relevance of MBSR for pre-diabetic
African Americans via a post-intervention qualitative study, to include interviews of
participants, dropouts, and instructors; and 4) to identify, and find solutions for,
problems in conducting a well-powered clinical trial to assess the efficacy of a
mindfulness-based diabetes prevention program in improving glucose metabolism in
pre-diabetic African-Americans.