Diabetes Prevention Programs in Rural North America: a Systematic Scoping Review

Aims: The aims of this systematic scoping review were to characterize the extent to which diabetes prevention programs have focused on rural populations in North America and where possible, identify efficacious program components. Methods: The review was guided by the PRISMA statement and five steps for scoping studies. Searches were conducted in August 2017 in Tucson, Arizona. Two teams of three independently screened full texts, excluding prior reviews, systematic reviews, and opinion pieces. Two authors abstracted data, which were reviewed by other team members. Results: Of the 12,840 articles identified, 12 met all criteria. Nine studies were based in the USA and three were Canadian. Demographics reflected high enrollment of underrepresented minorities, adults, and females. Methodological rigor was low; most studies were single-arm interventions evaluated using pre-/post-measures. Weight was measured across all studies, although biological, behavioral, and psychosocial outcomes were inconsistently assessed. Eight studies reported significant changes in primary outcomes. Duration and intensity were variable; delivery was led by trained volunteers or health professionals. Seven studies reported recruitment, retention, and adherence data. Conclusions: Surprisingly, few rural diabetes prevention studies have been published. Published programs were notable for lack of youth and/or family involvement, integrated prevention and treatment programs, and heavy reliance on self-reported outcomes.