Change in Physical Activity, Food Choices and Hemoglobin A1c Among American Indians and Alaska Natives with Type 2 Diabetes

The prevalence of diabetes among American Indian and Alaska Native (AI/AN) adults is the highest of all US racial/ethnic groups. Health behaviors, including regular physical activity and healthy food choices, are important components in the management of diabetes. We estimated the cross-sectional association between physical activity and food choices with hemoglobin A1c (HbA1c) and the association between physical activity/food choices and change in HbA1c over three years of the Special Diabetes Program for Indians-Healthy Heart demonstration project (SDPI-HH) intervention. Associations of physical activity with food choices were also examined. Among 3,039 SDPI-HH participants at baseline, those reporting being physically active and having high healthy food scores had statistically significant lower HbA1c (mean=7.67±2.01) compared to inactive participants with low healthy food scores (7.90±1.92). Among the 1,150 SDPI-HH participants who attended the three-year follow-up visit, participants who increased physical activity and/or consumption of healthy foods had a larger decrease in HbA1c (β=-0.29, P=0.03) over the study period compared to participants with no improvement in physical activity or increase in consuming healthy foods. This association was statistically significant among women (β=-0.35, P=0.04) but not among men (β=-0.08, P=0.70). We found an increase in healthier behaviors, including physical activity and healthy food choices, was associated with a small improvement in HbA1c in the subset of women who participated in the SDPI-HH through the three-year follow up. Although the decrease in HbA1c was small, physical activity and healthy food choices are important behaviors to incorporate into everyday life among AI/AN adults, particularly those with diabetes