Effectiveness of and Implementation Strategies for 'Disfrutando': A Culturally Tailored, Bundled Intervention to Address Type 2 Diabetes Mellitus in High-burden Populations

The investigators have engaged a community-health-academic partnership that is working to move a program of research forward that addresses the 'epidemic' of T2DM in high burden populations in Missouri. The partnership developed the Disfrutando intervention in a non-controlled feasibility study with encouraging results: Hemoglobin A1C (i.e., average blood sugar levels) was lowered for 66% of 31 participants. Disfrutando is an interactive, culturally tailored, bundled intervention that aims to enhance self-efficacy and equip people with knowledge and skills about healthful behaviors (i.e., healthy eating, physical activity) and engage them in primary/diabetes/eye care to enhance diabetes health outcomes. What makes Disfrutando stand out is its facilitation by community health workers who focus on "meeting people where they are" and connecting them to no- or low-cost resources that increase access to/engagement in healthy eating, physical activity, and primary/diabetes/eye care. The investigators now propose a 1-year pilot study that will examine the effectiveness of and implementation strategies for Disfrutando using a two-group randomized, wait-list controlled design. Hypotheses are: (1) implementation quality and acceptability of the Disfrutando intervention will be high and (2) the intervention will lower HbA1C, change body weight, enhance self-efficacy, and mitigate adverse SDOH. Research Questions are: RQ1: What is the implementation quality of the intervention? (i.e., adherence to intervention content, characteristics of intervention delivery), RQ2: Are people engaged and satisfied with the intervention?, RQ3: What is the impact of Disfrutando on HbA1C and change in body weight?, and RQ4: What is the relationship between HbA1C, change in body weight and selected mediators (diabetes self-efficacy, quality of intervention delivery, mitigation of SDOH (i.e., access and linkage to resources for engagement in healthy eating, physical activity, and attendance at health care appointments) and moderators (personal and health characteristics)? This pilot project will provide critical effectiveness and implementation data to inform an application for a multi-site community trial. Early identification and management of pre-diabetes and T2DM is critical for the prevention of diabetes-related serious health problems and premature death.