Title: Pilot Study of the Feasibility of a Worksite Plant-based Diabetes Prevention Program
Description: Worldwide, there were 463 million adults (20-79 years) with diabetes in 2019. These figures are expected to increase to 700 million by 2045. Additionally, approximately 4.2 million deaths worldwide were attributable to diabetes, and global health care expenditures on individuals with diabetes were estimated to be 760 billion U.S. dollars. One of the most effective ways to control this debilitating disease is to prevent it before it happens, which, based on evidence from the Diabetes Prevention Program (DPP) randomized controlled trial and other studies in different countries, is feasible with a change in weight, dietary habits, and physical activity levels. While many studies have shown the benefits of plant-based diets in diabetes prevention, no DPP studies have been found that have incorporated a plant-based diet for their dietary component. The purpose of this pilot study was to explore the feasibility, acceptability, and preliminary efficacy of implementing a worksite plant-based diabetes prevention program to inform larger randomized trials to be conducted in the future.

This was a mixed-methods pilot study using a one group pretest-posttest design. The study was delivered to Teachers College, Columbia University employees and staff and was designed to use a modified version of the CDC’s national curriculum, one that emphasizes plant-based eating patterns. The sessions ran during lunch hour where a healthy lunch that supported the behavior change goal of the session was provided. The Health Action Process Approach (HAPA) framework was used for both curriculum design and program evaluation. The principles of facilitated group discussion in a safe environment were used to deliver the sessions. The program was conducted in the spring semester of 2020, once a week, for a series of 13 weeks plus two voluntary booster sessions held 1 and 2 months after the program was completed. Midway through the semester, the program went virtual using synchronous video-conferencing technology due to the COVID-19 pandemic. Data on consumption of healthy and unhealthy plant- and animal-based foods, physical activity, and psychosocial variables were measured pre and post program using validated questionnaires; blood glucose values were measured as HbA1c using A1CNow® SELFCHECK; and weights were measured weekly using Tanita SC-331S scales when classes were in-person and home scales when classes went virtual.

Evaluations of participants’ acceptability and satisfaction were assessed at the end of the program both quantitatively and through interviews. Finally, fidelity to the plant-based curriculum and evaluation of educational plan completion and engagement were done weekly. Forty-one individuals expressed interest in the study, but only 18 met the eligibility criteria, of whom 14 were finally enrolled, constituting 78%. The participants were ethnically/racially diverse. Attrition was very low with only one dropout, and this did not change when the program went virtual. Program delivery was in fact feasible and all 13 lessons and booster sessions were completed. The plant-based DPP was received with a high degree of acceptability and satisfaction by the participants. Participants described the safe environment created and the facilitated dialogue approach in the sessions, along with peer support as instrumental for their behavior changes. There were some significant improvements in the physiological, behavioral, and psychosocial outcome measures explored in the study which included: weight, diet quality in terms of plant-based and animal-based foods, physical activity levels, blood glucose levels, and behavioral and psychosocial determinants of behavior change of the Health Action Process Approach (HAPA) theoretical framework.

After study completion and analysis of results, it is clear that conducting a worksite plant-based diabetes prevention program is in fact feasible and acceptable, and may be efficacious at eliciting positive changes in physiological, behavioral, and psychosocial variables that can potentially attenuate risk of developing diabetes. The findings will be useful for designing larger controlled studies.