“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

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.