Texas strength through resilience in diabetes education (TX STRIDE): Protocol for a non-randomized cluster-controlled trial among African American adults with type 2 diabetes.

OBJECTIVE

African American (AA) adults have the highest prevalence of type 2 diabetes mellitus (T2DM) and face more severe complications compared with Hispanic and non-Hispanic White populations. Lifestyle interventions that address the distress inherent in T2DM and unique stressors faced by AAs that worsen diabetes-related health outcomes are critically needed. We describe the protocol of a non-randomized cluster-controlled trial that uses a resilience-based diabetes self-management education and support (RB-DSMES) intervention to help participants manage the psychosocial and behavioral demands of T2DM.

PARTICIPANTS

A total of 284 AA adults were recruited through 27 churches in Austin, TX, and the surrounding areas using church announcements and on-site glucose screenings.

METHODS

Churches were allocated to a comparison (standard diabetes self-management education and support; DSMES) or intervention (DSMES plus resilience resource integration; RB-DSMES) arm. Following baseline data collection, both arms received 8 educational classes, 8 support groups, and 2 booster sessions.

OUTCOMES: T2DM physical (primary outcome HbA1c) and mental (primary outcome depressive symptoms) health outcomes in intervention vs. comparison arms will be compared at 6-, 12-, and 24-months post-study entry. We also will examine potential mediators of treatment effects at 24 months via changes in resilience resources at 6 months and T2DM self-management and hypothalamic-pituitary-adrenal (HPA) axis function at 12 months.

DISCUSSION: If successful, this project will provide crucial guidance for addressing the T2DM burden among AAs by establishing the real-world efficacy of the RB-DSMES program and identifying behavioral and biological mechanisms through which the program impacts T2DM health outcomes.