Diabetes prevention through genetics, familial history and behavior change - type 2 diabetes (T2D) affects 38.4 million U.S. Adults, with 97.6 million at risk due to prediabetes, and that burden…

The National Institute for Minority Health and Health Disparities, a component of the National Institutes of Health under the Department of Health and Human Services, awarded $702,086 to the Morehouse School of Medicine on August 16, 2026, under the Minority Health and Health Disparities Research program (CFDA 93.307).

The award funds research adapting the Diabetes Prevention Program to integrate family engagement and family health history assessment as mechanisms to improve adherence and glycemic outcomes in populations at elevated type 2 diabetes risk. The project includes three specific aims: developing a six-session family component using the CDC My Family Health Portrait tool and personalized risk communication, tested formatively with forty index participants and family members across rural and urban sites; conducting a two-arm randomized controlled trial with two hundred index participants with prediabetes and their family members, stratified by geography and block randomized to receive either adapted DPP with family components or standard DPP, measuring weight loss percentage, HbA1c reduction, and session attendance at six and twelve months; and evaluating family outcomes and mechanisms of change through actor-partner interaction analysis.

Work is performed in Atlanta, Georgia. The project period runs through January 31, 2031.

Diabetes prevention through genetics, familial history and behavior change - type 2 diabetes (T2D) affects 38.4 million U.S. Adults, with 97.6 million at risk due to prediabetes, and that burden concentrates in racially/ethnic families or those living in rural communities, or both. Diagnosed diabetes prevalence among black/african american, hispanic/latino, and american indian/alaska native adults is roughly 1.5-2 times that of non-hispanic white adults, and prediabetes prevalence in rural communities exceeds urban communities by 17%. Although the diabetes prevention program (DPP) effectively reduces T2D incidence, adherence is highly variable and remains the strongest predictor of outcomes. Current DPP delivery emphasizes the individual, overlooking the family context, which strongly influences behavior change. Family health history (FHH) increases T2D risk 2.5-4.5-fold and motivates preventive action, yet structured FHH collection and family participation have not been integrated into DPP interventions. Our central hypothesis is that embedding family engagement and FHH assessment into the DPP will improve adherence, weight loss, and glycemic outcomes. Specific aim 1 will systematically adapt existing curricula to develop a 6-session family component integrating comprehensive FHH collection using the validated CDC my family health portrait tool and personalized T2D risk communication, with mixed-methods formative testing among 40 index participants and family members across rural and urban sites. Specific aim 2 will conduct a 2- arm randomized controlled trial with 200 index participants with prediabetes plus their family members, stratified by geographical location and block randomized to receive either adapted DPP with family components or standard DPP. Primary outcomes include weight loss percentage, HBA1C reduction, and session attendance rates at 6 and 12 months. Specific aim 3 will evaluate family outcomes and mechanisms of change using the actor-partner interdependence model to test whether health improvements extend beyond index participants and identify moderators explaining variation in family-level outcomes. The impact of this project directly addresses adherence barriers by leveraging family context within a multilevel prevention framework consistent with nimhd priorities. The expected outcome is a scalable, family-centered model that strengthens DPP impact and advances diabetes prevention across rural and urban populations.