ADELANTE

Latinos account for the largest share of SARS-CoV-2 (COVID-19) cases (60%) and deaths (48%) compared to any other racial/ethnic group in California. Additionally, Latino households have experienced a dramatic increase in household food insecurity due to the pandemic. This is especially distressing for Latinos with type 2 diabetes (T2D) as household food insecurity is associated with worse glycemic control, which has life-threatening consequences during the COVID-19 pandemic. Effective multi-level interventions to improve household food insecurity and glycemic control are urgently needed for Latinos with diabetes to mitigate disparities due to COVID-19.

The goal of ADELANTE is to determine whether a multi-level intervention to improve household food insecurity and glycemic control is effective for Latino patients with diabetes.

Participants and two of their household members will be randomized to our two arms: 1) healthy food box home delivery for 12 weeks plus a 12-month remotely delivered lifestyle behavioral intervention, Vida Sana, which incorporates family members and is aligned with Latino cultural values, or 2) a waitlist control arm, receiving the intervention 6 months later. The Vida Sana intervention is a cultural adaptation of Group Lifestyle Balance, a 12-month group adaptation of the intensive lifestyle intervention that has shown to be effective in promoting clinically significant, modest weight loss and significant improvements in moderate-intensity physical activity. Participants receive a total of 23 group sessions over 12 months. A trained health coach provides personalized feedback on self-tracking emphasizing moderate caloric reduction by 500-1,000 calories per day through healthy substitutions, incremental increases in moderate physical activity such as brisk walking, and behavioral strategies to support successful adoption and maintenance of health behaviors. Behavioral strategies include realistic goal setting, fostering social support, and stress management. In addition, we will add COVID-specific topics to ensure that participants are equipped to change behavior and manage stress during the pandemic.

Each healthy food box delivery will include a 2-lb bag of beans/legumes. Participating households will receive a rotation of whole grains and 100% whole grain options (3+ grams of fiber/serving) of foods such as cereal, pasta, tortillas, bread, and crackers. Common foods as well as (intentionally) unfamiliar items are included, limiting to items that participants can find at low-cost grocery stores. The quantity is scaled to three household sizes (capped at 6 people). The content and size of the deliveries are intended to supplement a family’s food supply and provide opportunities for trying new fiber-rich foods recommended by the Vida Sana intervention.