Integrating a Prescription Produce Program within a Diabetes Prevention Program for the Prevention of Type 2 Diabetes

PROJECT SUMMARY / ABSTRACT More than 38 million American adults are diagnosed with Type 2 Diabetes (T2DM), and about 98 million have prediabetes. One factor for poor outcomes may be social determinants of health, such as food insecurity, associated with suboptimal diet quality and elevated glucose levels. T2DM prevention program focusing on self-management education and lifestyle behavior changes is the cornerstone to achieving glycemic control ─ assessed by glycosylated hemoglobin (HbA1C), which reflects the average blood glucose level over the previous three months. However, evidence suggests that T2DM prevention programs are heterogeneous in design and implementation and provide inconsistent effectiveness in improving glycemic control. Our team's research indicates that many adults experience improved dietary habits, enhanced food security, and reduced blood glucose levels after participating in a 6 to 12-week Prescription Produce Program (PPP). This community-based nutrition intervention provides health education, wellness and goal setting, and fresh fruits and vegetables to low-income adults with chronic diseases. We aim to fill the gaps in existing literature regarding the effectiveness of integrating a PPP into a diabetes prevention program to enhance glycemic control for individuals with prediabetes. We are expanding on our team's initial work on the PPP to incorporate this nutrition intervention into the Diabetes Prevention Program. This evidence-based diabetes prevention program has been implemented at over 1500 sites nationwide. Building on our team’s multi-disciplinary expertise and experience serving low-income adults from minoritized racial/ethnic groups, we propose a feasibility and pilot mixed methods using a randomized controlled trial and two focus groups. The study aims to evaluate the feasibility, acceptability, and preliminary effectiveness of a DPP that integrates a PPP (DPP+PPP) compared to a DPP only control group. Aims 1 and 2 focus on the feasibility, acceptability, and preliminary effectiveness among N=100 Adults with prediabetes. Aim 1 examines the feasibility and acceptability of DPP+PPP compared to a DPP only on recruitment, enrollment, attendance, retention rates, and treatment fidelity markers. Aim 1 also uses a qualitative methodology with n=20 participants to understand barriers/ facilitators of engaging in the study. Aim 2 examines the preliminary effects of the DPP+PPP versus DPP only blood glucose and weight changes. This study is important because DPP+PPP's innovative delivery method could potentially be more effective and acceptable for wider implementation. Diabetes prevention strategies such as this, addressing social determinants of health, may empower individuals to engage in early symptom self-management. This pragmatic study aims to test a diabetes prevention intervention among adults with pre-diabetes, with the potential for translation to a larger-scale community-based intervention.