Help Educate to Eliminate Diabetes (HEED)

Community and academic partners from East Harlem, New York City, New York wrote a grant to target and address health disparities on a local level. Once funding was secured, the Community Action Board was formed, and it consisted of 20 leaders and activists, 15 of whom were residents, to implement a randomized controlled trial through a community-based participatory research method to help prevent the onset of diabetes in overweight, prediabetes individuals in East Harlem. The board then created 5 subcommittees who developed a culturally appropriate and community based peer-led lifestyle intervention (Project HEED). These peer-led lifestyle interventions promoted and encouraged healthier life-style changes amongst the participants of the study by educating them in portion control, physical activities, and healthier and affordable food options.

The Community Action Board recruited participants in two phases. Phase 1 screened individuals for eligibility and phase 2 determined those who had glucose levels that were in the prediabetes range. At the end of the process, adults who met the criteria (aged 18 years or older, resided in East Harlem, spoke English or Spanish, were overweight, were not currently pregnant, did not have diabetes, did not use glucose-altering medication, and were able to participate in a group session) were selected to participate. The study participants were then divided into the intervention group and the control group. Those who were in the intervention group received and attended 1.5 hour peer-led lifestyle interventions over a span of 10 weeks. The participants’ weights, blood pressure, and waist circumferences were then measured at 3, 6, and 12 months after enrollment and those who continued to participate were given the incentive of a $50 gift card and lunch after each follow up.

The goal of Project HEED is to lessen the incidence of diabetes in ethnic minority communities through peer-led educational interventions focusing on weight loss.

Project HEED was evaluated in a randomized controlled trial. Adults who met the criteria were randomized into an intervention group (received HEED intervention immediately) and a control group (HEED was delayed one year); n=50 and n=49, respectively. The intervention group participated in the HEED program, consisting of eight 1.5 hour sessions over 10 weeks. Overall, there were no significant differences between the intervention and control participants at baseline in demographic characteristics, anthropometric measures, or behaviors, except that intervention participants drank significantly more juice.

Those in the intervention group lost significantly more weight than the control group, who had non- significant weight loss. At 12 months, the intervention group had lost 7.2 pounds while the control group lost 2.4 pounds on average (5.5 pounds and 2.3 pounds; p-value < 0.01).

Although intervention participants achieved significant and sustained weight loss, they reported very limited behavior changes and there was no difference in the incidence rate of diabetes between the intervention and control groups. In addition, there was no observed change in blood pressure, LDL cholesterol, or glucose levels in the intervention participants. Fat and fast-food intake, label reading, binge eating, television watching, self-efficacy to prevent diabetes, and perceived importance of losing weight were also unchanged in both groups. Overall, the incidence rate of diabetes was also similar in both groups (intervention, 0.36 cases per person-year; control, 0.33); however, even though diabetes incidence was similar, the results suggested that weight loss among people with prediabetes, the most effective means of diabetes prevention, may be achievable through low-cost, peer-led programs.