"What Can I Eat?" Healthy Choices for American Indian and Alaska Native Adults With Type 2 Diabetes: Outcomes From a Randomized Waitlist-Controlled Trial of a Diabetes Nutrition Education Program.

Luciana E Hebert, Angela G Brega, Sarah A Stotz, Kelly R Moore, Luohua Jiang, Monica McNulty, Kelli Begay, Teresa Hicks, Gemalli Austin, Nilofer Couture, Heather Garrow, Nancy O'Banion

Journal: Journal of nutrition education and behavior 2025;57(8):746-758

PMID: 40481826

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Abstract

OBJECTIVE

To evaluate the "What Can I Eat?": Healthy Choices for American Indian and Alaska Native Adults With Type 2 Diabetes (AI/AN WCIE) intervention.

DESIGN

Pilot randomized waitlist-controlled trial. Recruitment through diabetes registries and randomized to either the immediate intervention (n = 35) or waitlist control group (n = 25). Immediate arm started classes immediately on randomization; waitlist arm started classes 3 months after randomization.

SETTING

Classes were taught synchronously online by registered dietitian nutritionists at 5 reservation-based or urban intertribal clinical sites nationwide in 2021.

PARTICIPANTS

American Indian and Alaska Native adults with type 2 diabetes (n = 60).

INTERVENTION

Topics in AI/AN WCIE classes include: the Diabetes Plate, sugar-sweetened beverages, decreasing sodium, increasing consumption of healthful traditional Native foods. Class activities included didactic sessions, hands-on interactive learning, physical activity, mindful eating, and goal setting.

MAIN OUTCOME MEASURE

Diabetes nutrition self-efficacy, behavior, and clinical measures.

ANALYSIS

Linear mixed models examined change in outcomes from baseline to 1 month and 3 months by randomization group. By 3 months, immediate intervention participants had completed the classes; the waitlist control group had not yet begun the intervention.

RESULTS

After 3 months, confidence in using the Diabetes Plate (β = 0.80 [95% confidence interval (CI), 0.56-1.03], P < 0.001) and healthy nutrition behavior (β = 0.88 [95% CI, 0.57-1.19], P = 0.004) improved significantly in the immediate intervention group but not in the waitlist control group; confidence in making healthy nutrition choices (β = 0.65 [95% CI, 0.43-0.88], P = 0.02) improved significantly more in the immediate intervention group than in the waitlist control group. No significant changes were identified in clinical outcomes.

CONCLUSIONS

The AI/AN WCIE program enhanced self-efficacy and healthful nutrition choices among adults with type 2 diabetes.

Address: Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, CO. Electronic address: [email protected].; Institute for Research and Education to Advance Community Health, Washington State University, Seattle, WA.; Center for American Indian and Alaska Native Health, University of Colorado Anschutz Medical Campus, Aurora, CO.; Department of Epidemiology and Biostatistics, Susan and Henry Samueli College of Health Sciences, University of California Irvine, Irvine, CA.; Maven Collective Consulting, LLC, Edmond, OK.; Teresa Hicks, LLC, Bozeman, MT.; Lake County Tribal Health Consortium, Lake County, CA.; Cherokee Indian Hospital, Cherokee, NC.; Saint Regis Mohawk Tribe Diabetes Center, Akwesasne, NY.; Indian Health Care Resource Center of Tulsa, Tulsa, OK.

DOI: 10.1016/j.jneb.2025.04.004

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MeSH Terms: Humans, Diabetes Mellitus, Type 2, Female, Male, Middle Aged, Adult, Alaska Natives, Health Education, Diet, Healthy, Aged, Pilot Projects