Change in physical activity, food choices and hemoglobin A1c among American Indians and Alaska Natives with type 2 diabetes

Ricky Camplain, Nicolette I. Teufel-Shone, Luohua Jiang, Jennifer Chang, Spero M. Manson

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


The prevalence of diabetes among American Indian and Alaska Native (AI/AN) adults is the highest of all United States 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 healthy food scores, separately, and combined (PAHF) with hemoglobin A1c (HbA1c) over three years of the Special Diabetes Program for Indians-Healthy Heart demonstration project (SDPI-HH) intervention. The relationship between physical activity and food choices was 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, consumption of healthy foods, or both 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). Our findings indicated that 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.

Original languageEnglish (US)
Article number101945
JournalPreventive Medicine Reports
StatePublished - Oct 2022


  • American Indian and Alaska Natives
  • Health behaviors
  • Health promotion
  • Special Diabetes Program for Indians

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Health Informatics


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