Piloting Diet and Exercise Interventions in Older Hispanics With Diabetes

The pilot study will show the potential individual and combined effects of nutrition and exercise programs for disadvantaged older Hispanics with type 2 diabetes. The benefits to the participants include: 1) enhanced type 2 diabetes management; 2) improved diet quality and nutritional status; 3) improved physical function; 4) reduced rates of falls; and, 5) reduced rates of diabetes and fall-related emergency room visits and hospitalizations. The expected product is an effective type 2 diabetes management and falls prevention program for underserved Hispanic older adults with type 2 diabetes. If effective, the program may be expanded to additional congregate meal sites and communities serving older Hispanics.

The proposed study is a pilot cluster-randomized pilot trial for socioeconomically disadvantaged older Hispanics with type 2 diabetes. The participants will be cluster-randomized to one of the following four groups (n=10/group) based on the facilities they go for congregate meals: 1) Control (no intervention); 2) Exercise program only; 3) Nutrition program only; 4) Exercise and nutrition program. The interventions groups (2-4) will also receive basic diabetes education. The interventions will be randomized to sites to avoid cross-contamination. The interventions will last 6 months and assessments will be completed at baseline, 3, 6, 9, and 12 months.

The proposed pilot study is innovative because there are no exercise and nutrition programs for older Hispanics with type 2 diabetes; because it targets understudied socioeconomically disadvantaged older Hispanics with type 2 diabetes; it tests the separate and combined effects of nutrition and exercise interventions, and because we will assesses the outcomes as well as the mechanisms of falls reduction and improved type 2 diabetes management based on hemoglobin A1C levels, Healthy Eating Index scores, blood pressure, balance, gait, strength, and health care use.

We will assess the effects of the programs when delivered in isolation and in combination in relation to a control group. The client-centered programs will be delivered in the congregate meal sites and the participants will track their exercise, diet and medication adherence behaviors. We will evaluate the effects of the programs in physical function (gait, strength and balance), diet quality, nutritional status, falls rates and associated emergency room visits and hospitalizations. Glycemic control, physical function and falls in older people with type 2 diabetes can be addressed with exercise and adequate nutrition, but the uptake and implementation of these evidence-based interventions in the community is limited, especially among socioeconomically disadvantaged minority groups.

The interventions will be tailored culturally and to needs of older Hispanics with type 2 diabetes by respecting the participants' language choice, physical abilities and impairments, and food preferences. The nutritional intervention will consider the participants eating habits, preferences, food availability and costs, and the participants own goals. The exercise sessions will consider the participants limitations and health conditions.