Assessment of a National Diabetes Education Program diabetes prevention toolkit: The D2d experience

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Type 2 diabetes is a serious disease that has reached epidemic proportions among Americans in the past decade (Centers for Disease Control and Prevention, 2014). An array of prevention tools and programs are available for individuals at risk to learn about the disease and how to make lifestyle changes to prevent or delay diabetes onset. Furthermore, various delivery mechanisms and approaches to reaching those at risk with these critical resources have been explored for effectiveness.
Nishigaki, Sato, Ochiai, Shibayama, and Kazuma (2011) delivered susceptibility and prevention information to adults with type 2 diabetes and their offspring using a combination of genetic counseling and/or a computerized behavioral program. Both parents and offspring experienced positive changes in attitudes and behaviors regarding diabetes prevention, but using patients as the information channel had limited effectiveness.
Additionally, various programs and tools exist to address prevention of a broader range of chronic diseases through awareness and lifestyle changes. For example, the Families Sharing Health Assessment and Risk Evaluation (SHARE) Workbook is a plain language “educational tool outlining disease risk and healthy guidelines to reduce risk of heart disease, diabetes, breast cancer, and colorectal cancer” (Koehly, Morris, Skapinsky, Goergen, & Ludden, 2015). This family health history tool was developed at a Grade 8 reading level and evaluated by key stakeholders for later use in intervention studies among individuals at risk for these diseases; however, the tool was neither tailored nor intended to be diabetes specific.
While information delivery mechanisms described above show promise, primary care providers, especially nonphysicians, are uniquely positioned to counsel patients at risk for type 2 diabetes on the risk factors and lifestyle changes to prevent or delay the onset of disease. However, primary care providers are increasingly pressed for time during patient visits, and “supplementary” counseling around prevention of chronic diseases like diabetes may not be a priority during the time available (Østbye et al., 2005). In a study by Campbell‐Scherer et al. (2014), family physicians, nurse practitioners, nurses, and dieticians set out to develop guidelines and tools best suited for the primary care setting through the BETTER trial: Building on Existing Tools to Improve Chronic Disease Prevention and Screening in Family Practice. However, the effort was limited by a lack of quality evidence and high‐quality tools.
Diabetes prevention information must be accessible, culturally tailored, engaging, contain high‐impact information, and be delivered at an appropriate readability level. One assessment of diabetes prevention materials among a Northern Plains Tribe found that prevention materials, including pamphlets, booklets, and fact sheets, were written at a readability level higher than recommended (Simonds, Rudd, Sequist, & Colditz, 2011). This study highlights the need to tailor materials to target audiences and engage audience members in testing and evaluation studies to ensure materials are appropriate.
This study was designed to assess how Small Steps. Big Rewards. GAME PLAN., an evidence‐based diabetes prevention resource, performs in a clinical trial setting. Objectives of this study were to:
To conduct the study, the National Diabetes Education Program (NDEP) partnered with the vitamin D and type 2 diabetes (D2d) study, which used the paper booklet GAME PLAN toolkit as a standardized educational tool at the start of study participation. The D2d study sought to enroll approximately 2400 participants at risk for type 2 diabetes across 22 sites in the United States to test whether vitamin D supplementation is safe and effective at lowering the risk of progression to diabetes (Pittas et al., 2014). Diabetes risk was defined as meeting two of three glycemic criteria for prediabetes established in 2010 by the American Diabetes Association.
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