Diabetes prevention: It takes a village

Modifying neighborhood environments may represent a complementary, population-based approach to prevention of type 2 diabetes.

Healthcare professionals should be thinking about neighborhood environments as potential targets for public health action to aid in the prevention of type 2 diabetes, according to a study published in the June 29 online edition of JAMA Internal Medicine.

“Most discussion of diabetes prevention is focused on individuals…our study points to the need to consider neighborhood environments as potentially useful public health targets that may complement and strengthen individual-based prevention programs [e.g. the CDC’s National Diabetes Prevention Program],” lead study author Paul Christine, MPH, tells Medical Economics. “For clinicians and hospital systems interested in disease prevention, this may entail partnering with public health agencies, city planners, and community organizations to ensure that modifying neighborhood environments is part of the diabetes prevention discussion.”

Christine of the University of Michigan School of Public Health in Ann Arbor, Mich., and colleagues followed more than 5,000 people for approximately 10 years to track whether living in a neighborhood with more health-promoting resources reduced the risk for developing diabetes over time.

The researchers employed several different methods to measure health-promoting neighborhood resources, including Geographic Information System-based methods and residential surveys. Individuals were followed at five different visits during the 10-year study to assess whether they had developed diabetes and to gather information about their general health status.

“We estimated the association between living in a neighborhood with more health-promoting resources and the risk of developing type 2 diabetes using survival analysis methods [Cox proportional hazards models],” Christine says.

There were several basic findings from the study. First, Christine and the other authors found that simply having more supermarkets or fruit and vegetable markets in the neighborhood did not necessarily translate to a lower risk for developing diabetes.

“However, this result was somewhat contingent upon the method that we used to assess the availability of healthy food,” he says. “If, for instance, we surveyed individuals in the neighborhood and asked them to rate the availability of healthy food, it turns out that those living in neighborhoods with higher ratings did indeed have a slightly lower risk of developing diabetes.”

The researchers said that they were also somewhat surprised to find that residing in a neighborhood rated as more safe and socially cohesive was not associated with a lower risk for developing diabetes.

“Finally, we did find that individuals residing in neighborhoods with greater availability of recreational resources, including recreational facilities and pleasant places to walk, had a lower risk of developing diabetes over time,” Christine says.

“While altering neighborhood environments is beyond the typical physician's scope of practice, considering the impact that a patient's residential environment may have on their ability to adhere to a particular diabetes prevention program certainly is not,” he says.

“A good first step for physicians is to recognize that the effectiveness of the diabetes prevention programs they prescribe is likely to be influenced by the neighborhood environments in which their patients live,” Christine says. “Furthermore, physicians interested in diabetes prevention may wish to partner with public health agencies, city planners, and community organizations to ensure that modifying neighborhood environments is part of the diabetes prevention discussion.”