Understanding Barriers to Engagement in the Diabetes Prevention Program among Low-Income Latino Patients: Design and Implementation of an Intervention in Community Health Centers

ABSTRACT:
My long-term career goal is to be an independent investigator in health services research, conducting investigations that improve outcomes for high-risk populations. My short-term (five-year) career goal is to gain quantitative skills in secondary data analysis, strengthen my expertise in causal inference, and learn to implement pragmatic community- based clinical trials that address structural barriers to health. Disparities in diabetes care and outcomes persist in under-resourced settings. Among Latinos, the prevalence of T2D is alarmingly high, with approximately 1 in 2 US Latinos at risk for developing T2D during their lifetime. Efforts to translate evidence-based diabetes prevention have also had limited effectiveness among Latino and under-resourced populations. The Diabetes Prevention Program (DPP) study demonstrated that participation in a structured lifestyle change program to achieve 5-7% weight loss and/or use of metformin in overweight and obese individuals with prediabetes can prevent and/or delay the onset of diabetes. However, studies show that Latinos and under-resourced patients face significant barriers to participation in the Diabetes Prevention Program (DPP). Therefore, we need new and sustainable patient-centered approaches to recruit, engage, and retain high-risk populations in the DPP. To this end, California Senate Bill/SB 97 mandates that as of January 2019, Medicaid (i.e., Medi-Cal) health plans must cover the DPP for interested and eligible beneficiaries with prediabetes. In the current application, we propose to evaluate SB 97 as a natural experiment. Using analytic techniques that enhance causal inference, we will determine the effectiveness of SB 97 for subgroups of Medi-Cal beneficiaries with prediabetes (Aim 1). We will supplement these analyses with qualitative data collection from patients and other stakeholders at three federally qualified health centers (FQHCs) serving a predominantly under-resourced patients in Los Angeles. Through a community-partnered approach, we will identify barriers and facilitators to DPP participation and inform the development of a sustainable patient-informed intervention by linking participants to local resources that support lifestyle change and weight loss (e.g., partnerships with food banks) to improve patient recruitment, engagement, and retention in the DPP (Aim 2). Finally, we propose a feasibility and acceptability pilot study of this intervention among patients with prediabetes at the FQHCs (Aim 3). This award will enable me to work with an experienced team of mentors to gain the necessary career development skills in community-based pragmatic clinical trials, best practices to engage under-represented groups in research, and interventions promoting health equity. The preliminary data collected will support a future R01 grant for a larger randomized trial of the community-partnered DPP intervention designed to overcome barriers that impede lifestyle change and weight loss in under-resourced setting in patients with prediabetes.

Grant Number: 5K23DK129828-04
NIH Institute/Center: NIH
Principal Investigator: Yelba Castellon-Lopez