Activities of the Fellows and Senior Fellows of the Coastal Research Group: Dr John Boltri and the Church-Based Diabetes Prevention and Translation Study Project

John Boltri, MD

The Department of Family Medicine at Mercer University School of Medicine and the University of Connecticut School of Medicine have become nationally recognized for the community-based diabetes prevention program lead by the team of Drs. John Boltri, Judith Fifield, Monique Davis-Smith and Paul Seale.

This $3.1 million National Institutes of Health (NIH) funded project is a university-hospital-community collaboration designed to reduce health disparities and decrease complications from diabetes in high-risk African Americans. The CBDPT-2 is a 5-year study based on the NIH Diabetes Prevention Program (DPP) that includes 42 African American churches in two states Georgia and Connecticut (14 churches per year).

The goal is to mitigate the burden of suffering and health disparities related to diabetes mellitus in the African American community. It combines the efforts of the community, health, educational and faith institutions with the united purpose of improving the health status of the community by decreasing the number of African Americans who develop diabetes. This study is a group-based diabetes prevention curriculum designed to be implemented in churches. It teaches participants how to achieve and maintain health through lifestyle modification, specifically increasing exercise levels and improving dietary intake.

The group-based program is implemented in African-American churches and incorporates faith as well as ongoing peer support and encouragement. The church-based lifestyle curriculum is brief, relatively inexpensive, and designed for widespread dissemination. Dr. Boltri and his team are excited to be partners with the community on this unique Church-Based Diabetes Prevention and Treatment project.

Using a community based participatory research approach (CBPR), the NIH Diabetes Prevention Program was translated into a cost-effective, culturally enhanced program for African Americans at risk for developing Type 2 Diabetes (DM). The church-based program is designed for efficient and cost-effective delivery. Churches are randomized to an intensive lifestyle intervention group (ILI) or a control group (CG) that receives standard lifestyle advice. The primary hypothesis is the ILI will have lower Fasting Glucose (FG) and Body Mass Index (BMI) compared to the CG. The secondary hypotheses are that the ILI will have lower blood pressure (BP), improved diet, and increased physical activity (PA). All recruitment, testing and programs for ILI and CG are conducted at each church. African American congregants are recruited via a diabetes risk assessment (DRA) performed during Sunday services followed by FG and BMI testing.

Those with pre-diabetes (PDM) FG 100-125mg/dl, and BMI greater than or equal to 25 are recruited as participants. The CG receives three educational sessions (0, 6, and 12 months) on healthy lifestyles and monthly educational mailings. The ILI receives an intensive church-based 6-session DPP led by diabetes educators followed by 36 monthly faith based maintenance program (FBMP) meetings. BMI, FG, BP, change in PA and dietary intake are assessed at 0, 6 and 12 months. Implementation began in July, 2009. Preliminary results from the first 10 churches indicate a high participation rate; 1051 DRAs completed, 558 (55%) were high risk (DRA great or equal to 10), 327 (59%) followed up for FG testing, 86 have both PDM and BMI greater than or equal to 25, and 15 have new onset DM. Mean participation rates for 6-sessions is 71%. Mean weight loss after the first 6-sessions is 3 pounds.

Conclusion: Church-based translation of the DPP using a CBPR is well accepted in the African American community as evidenced by high rates of recruitment, follow-up FG testing and program participation. Initial weight loss is promising. Further outcome data will asses the effectiveness of the intervention on diabetes prevention.

Mission of the Church Based Diabetes Prevention and Translation Study

To reduce suffering from diabetes in African Americans through university community partnerships.  The Church Based Diabetes Prevention and Translation Study (CBDPT-2) will identify methods to help people at high risk for diabetes make lifestyle improvements that will reduce their complications from diabetes.  This will occur through sustainable church based diabetes prevention programs in the African American faith community.

The objectives of the CBDPT-2 are to:

  • Combine the efforts of the community, health and educational institutions with the united purposes of reducing the burden of diabetes in the community and improving the health status of the community by decreasing the number of people who develop diabetes.
  • Prevent diabetes complications through lifestyle improvement programs that focus on improved dietary choices and increased physical activity.
  • Implement sustainable church based diabetes prevention programs and faith based maintenance programs that provide ongoing support to persons at risk for disease complications.