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      Participation in a farmers' market fruit and vegetable prescription program at a federally qualified health center improves hemoglobin A1C in low income uncontrolled diabetics

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          Abstract

          Fruit and vegetable prescription programs have been shown to increase consumption of fresh produce, but whether they have an impact on medical outcomes is unknown. The purpose of this study was to examine the role of participation in a farmers' market and fruit and vegetable prescription program on changes in hemoglobin A1C (HbA1C), blood pressure (BP) and weight in patients with uncontrolled type 2 diabetes at a federally qualified health center (FQHC) in Detroit, MI.

          The 13-week Fresh Prescription program (June 2015–October 2015) was designed to improve access and consumption of produce among low-income patients with uncontrolled type 2 diabetes. The program allotted up to $40 ($10 per week for up to four weeks) for purchase of produce from a FQHC located farmers' market. Adult, non-pregnant patients with a history of type 2 diabetes that had an elevated HbA1C > 6.5 within three months before Fresh Prescription program were eligible to participate. HgA1c, BP and weight were collected within three months of program start and within three months of completion.

          There were 65 eligible participants with complete biometric data. A statistically significant ( p = 0.001) decrease in HbA1C was found (9.54% to 8.83%). However, weight (208.3 lbs. to 209.0 lbs.) and BP (135.1/79.3 mm Hg to 135.8/77.6 mm Hg) did not change from pre- to post-study ( p > 0.05).

          Access to a fruit and vegetable prescription program over a 13-week period led to decreased HbA1C concentrations in uncontrolled type 2 diabetic patients living in an urban area of predominately-lower socioeconomic status.

          Highlights

          • •

            We evaluated efficacy of a fruit and vegetable prescription program.

          • •

            To date, there has been no research investigating the quantitative health benefits.

          • •

            A significant decrease in hemoglobin A1C was found in diabetics after program.

          • •

            There was no change in weight and blood pressure.

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          Overview of the health benefits of fruit and vegetable consumption for the dietetics professional: selected literature.

          E Pivonka, Marc Van De Velde (2000)
          Epidemiologic evidence of a protective role for fruits and vegetables in cancer prevention is substantial. The strength of this scientific base guides US national policymaking in diet and health issues and facilitates community and local programs that address national dietary goals to increase fruit and vegetable consumption. Current scientific evidence also suggests a protective role for fruits and vegetables in prevention of coronary heart disease, and evidence is accumulating for a protective role in stroke. In addition, a new scientific base is emerging to support a protective role for fruits and vegetables in prevention of cataract formation, chronic obstructive pulmonary disease, diverticulosis, and possibly, hypertension. This article provides an overview of the health benefits associated with fruit and vegetable consumption for each of these conditions, including brief discussions of underlying protective mechanisms, identifies key scientific findings regarding the health benefits of fruit and vegetable consumption, and outlines applications of these findings for dietetics professionals. The evidence reviewed provides additional support for increased consumption of a wide variety of vegetables, in particular, dark-green leafy, cruciferous, and deep-yellow-orange ones, and a wide variety of fruits, in particular, citrus and deep-yellow-orange ones. Continued attention to increasing fruit and vegetable consumption is a practical and important way to optimize nutrition to reduce disease risk and maximize good health.
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            Motivational interviewing to improve weight loss in overweight and/or obese patients: a systematic review and meta-analysis of randomized controlled trials.

            M J Armstrong, T A Mottershead, P Ronksley … (2011)
            Motivational interviewing, a directive, patient-centred counselling approach focused on exploring and resolving ambivalence, has emerged as an effective therapeutic approach within the addictions field. However, the effectiveness of motivational interviewing in weight-loss interventions is unclear. Electronic databases were systematically searched for randomized controlled trials evaluating behaviour change interventions using motivational interviewing in overweight or obese adults. Standardized mean difference (SMD) for change in body mass, reported as either body mass index (BMI; kg m(-2) ) or body weight (kg), was the primary outcome, with weighted mean difference (WMD) for change in body weight and BMI as secondary outcomes. The search strategy yielded 3540 citations and of the 101 potentially relevant studies, 12 met the inclusion criteria and 11 were included for meta-analysis. Motivational interviewing was associated with a greater reduction in body mass compared to controls (SMD = -0.51 [95% CI -1.04, 0.01]). There was a significant reduction in body weight (kg) for those in the intervention group compared with those in the control group (WMD = -1.47 kg [95% CI -2.05, -0.88]). For the BMI outcome, the WMD was -0.25 kg m(-2) (95% CI -0.50, 0.01). Motivational interviewing appears to enhance weight loss in overweight and obese patients. © 2011 The Authors. obesity reviews © 2011 International Association for the Study of Obesity.
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              The Effect of Oral Antidiabetic Agents on A1C Levels

              Diana Sherifali, Kara A Nerenberg, Eleanor Pullenayegum … (2010)
              OBJECTIVE Previous reviews of the effect of oral antidiabetic (OAD) agents on A1C levels summarized studies with varying designs and methodological approaches. Using predetermined methodological criteria, we evaluated the effect of OAD agents on A1C levels. RESEARCH DESIGN AND METHODS The Excerpta Medica (EMBASE), the Medical Literature Analysis and Retrieval System Online (MEDLINE), and the Cochrane Central Register of Controlled Trials databases were searched from 1980 through May 2008. Reference lists from systematic reviews, meta-analyses, and clinical practice guidelines were also reviewed. Two evaluators independently selected and reviewed eligible studies. RESULTS A total of 61 trials reporting 103 comparisons met the selection criteria, which included 26,367 study participants, 15,760 randomized to an intervention drug(s), and 10,607 randomized to placebo. Most OAD agents lowered A1C levels by 0.5−1.25%, whereas thiazolidinediones and sulfonylureas lowered A1C levels by ∼1.0–1.25%. By meta-regression, a 1% higher baseline A1C level predicted a 0.5 (95% CI 0.1–0.9) greater reduction in A1C levels after 6 months of OAD agent therapy. No clear effect of diabetes duration on the change in A1C with therapy was noted. CONCLUSIONS The benefit of initiating an OAD agent is most apparent within the first 4 to 6 months, with A1C levels unlikely to fall more than 1.5% on average. Pretreated A1C levels have a modest effect on the fall of A1C levels in response to treatment.
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                Author and article information

                Contributors
                Richard Bryce
                Journal
                Journal ID (nlm-ta): Prev Med Rep
                Journal ID (iso-abbrev): Prev Med Rep
                Title: Preventive Medicine Reports
                Publisher: Elsevier
                ISSN (Electronic): 2211-3355
                Publication date PMC-release: 27 June 2017
                Publication date Collection: September 2017
                Publication date (Electronic): 27 June 2017
                Volume: 7
                Pages: 176-179
                Affiliations
                [a ]Community Health and Social Services (CHASS) Center, 5635 W. Fort St, Detroit, MI 48209, United States
                [b ]Ecology Center, 339 E. Liberty St., Suite 300, Ann Arbor, MI 48104, United States
                [c ]Henry Ford Health System, 2799 W. Grand Blvd., Detroit, MI 48202, United States
                Author notes
                [* ]Corresponding author. rbryce@ 123456chasscenter.org
                Article
                Publisher ID: S2211-3355(17)30107-9
                DOI: 10.1016/j.pmedr.2017.06.006
                PMC ID: 5496208
                PubMed ID: 28702315
                SO-VID: b10c32e9-51d3-4071-83c9-2c80984ae808
                Copyright © © 2016 Published by Elsevier Inc.
                License:

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Date received : 21 October 2016
                Date revision received : 12 June 2017
                Date accepted : 18 June 2017
                Categories
                Subject: Regular Article

                Keywords: bp, blood pressure (mm hg),chass, community health and social services center,fqhc, federally qualified health center,fresh rx, fresh prescription program,hba1c, hemoglobin a1c concentration (%),farmers' market,low-income communities,federally qualified health centers,type 2 diabetes,food access,fruit and vegetables
                Data availability:
                Keywords: bp, blood pressure (mm hg), chass, community health and social services center, fqhc, federally qualified health center, fresh rx, fresh prescription program, hba1c, hemoglobin a1c concentration (%), farmers' market, low-income communities, federally qualified health centers, type 2 diabetes, food access, fruit and vegetables

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