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Access Type

WSU Access

Date of Award

January 2022

Degree Type


Degree Name



Nutrition and Food Science

First Advisor

Diane Cress


Low-income individuals experience barriers to participation in programs to reduce Type 2 diabetes (T2DM) risk, resulting in more than two-fold increased risk of developing T2DM. Retention is a major factor impacting successful T2DM programming, particularly in non-Hispanic black, low-income communities. Our goal was to improve health outcomes by improving retention and engagement through the integration of non-traditional community health programs. Outcomes from a pilot combining food management training with diabetes prevention education were compared to outcomes from a historic control, run in parallel. Outcome measures included session attendance, program completion, weight loss and glycemic control. We observed increased attendance and a likelihood of program completion 1.5-time greater as a result of the pilot study (CI 1.3, 1.6). The pilot study resulted in weight loss of 7.2% (CI 4.9, 9.5) compared to 3.6% (CI 2.8, 4.6) for the historic control, and 69.5% from the pilot study lost ≥5% weight. The likelihood of losing ≥ 5% body weight was 2.6 greater in the pilot study group (CI, 1.8, 3.7). HbA1c declined from 6.1% (CI 5.6, 6.5) to 5.5% (CI 5.1, 5.9) in the pilot study. Inclusion of food management training within an evidence-based diabetes education program can significantly improve program retention in low-income, urban communities. This work demonstrates that improving retention can reduce T2DM predisposition in at-risk communities. Investigation into factors that lead to better retention would be informative across a variety of intervention models.

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