Lifestyle Intervention in African American Patients With Diabetes and CKD

According to Mukoso N. Ozieh, MD, and Leonard E. Egede, MD, MS, of the Medical College of Wisconsin, behavioral factors, including lifestyle, are associated, in part, with the ~24% of excess risk for chronic kidney disease (CKD) among African American patients. However, there have been few intervention studies culturally tailored to African American patients with type 2 diabetes mellitus and CKD.

The researchers conducted a study designed to assess the feasibility and preliminary efficacy of a culturally tailored lifestyle intervention among African Americans with type 2 diabetes and CKD. Results were reported in JMIR Formative Research [doi:formative.jmir.org/2022/3/e34029].

The feasibility of a lifestyle intervention was tested using a pre-post design. The study cohort included 30 African American adults who were recruited from the Medical University of South Carolina between January 2017 and February 2017. A research nurse delivered the manualized study intervention each week for 6 weeks.

At baseline and following the intervention, hemoglobin A1C, blood pressure, and estimated glomerular filtration rate (eGFR) were measured. Validated structured questionnaires were used to measure disease knowledge, self-care, and behavior outcomes at baseline and following completion of the intervention. Clinically relevant changes were calculated using descriptive statistics and effect sizes.

There were significant mean differences pre- and post-intervention in hemoglobin A1c (mean 0.75%; 95% CI, 0.16-1.34; P=.01), total cholesterol (mean 16.38 mg/dL; 95% CI, 5.82-26.94; P=.004), low-density lipoprotein (mean 13.73; 95% CI, 3.91-23.54; P=.008), and eGFR (mean 6.73 mL/min/1.73 m², 95% CI, 0.97-12.48; P=.02). There were also significant mean differences pre- and post-intervention in CKD self-efficacy (mean –11.15; 95% CI, –21.55 to –0.75; P=.03), CKD knowledge (mean –2.62; 95% CI, –3.98 to –1.25; P<.001), exercise behavior (mean –1.21; 95% CI, –1.96 to –0.46; P=.003), and blood pressure testing (mean –2.15; 95% CI, –3.47 to –0.83; P=.003).

In conclusion, the researchers said, “This study provides preliminary data for a large-scale appropriately powered randomized controlled trial to examine a culturally tailored lifestyle intervention in African Americans with type 2 diabetes and CKD in order to improve clinical knowledge, self-care, and behavior outcomes in this population.”