The Produce Drop: Using Food as Medicine to Lower A1C Levels and Blood Pressure

NCT ID: NCT04421755

Last Updated: 2023-01-10

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 85 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2019-07-16
• Study Completion Date: 2021-03-16

Brief Summary

Hypertension and diabetes, which are increasing in prevalence, contribute to significant morbidity and mortality in the U.S. Self-management of these diseases, including adherence to dietary guidelines such as daily fruit and vegetable intake, can improve outcomes, but low-income patients encounter many barriers to adherence, such as food insecurity and poor nutrition literacy. Few clinicians screen for food insecurity, and even when screening is performed, there are few tested clinical response models. This study will evaluate the benefits of fresh fruit and vegetable home delivery program, without and with small-group culinary medicine cooking classes, on blood pressure and glucose control among patients accessing care at the University of Oklahoma Internal Medicine Clinic in Tulsa, OK. The Produce Drop pilot study will evaluate the feasibility and potential health benefits of a clinic-community partnership between OU Internal Medicine and a fresh produce home-delivery service provider, to promote adherence to F/V dietary guidelines among patients with suboptimal blood pressure and blood glucose control. Among half of those assigned to receive food assistance, we will evaluate the additional benefits of participation in 3-session, small-group, hands-on culinary medicine curriculum.

Detailed Description

a diet rich in fruits and vegetables, is an essential requirement for optimal blood pressure and glucose control. Clinical practice guidelines for hypertension and diabetes both assign the highest grade of evidence for healthy eating behavior to treat these conditions. Unfortunately, fewer than one-quarter of patients adhere to dietary recommendations, with the largest disparities among lower socioeconomic groups and racial minorities. Patient adherence to nutrition guidelines are deeply hindered by poor access to fresh produce and inadequate knowledge about preparing medically-indicated foods. The proposed Produce Drop pilot study will evaluate the feasibility and potential health benefits of a fresh fruit and vegetable home-delivery program, with and without additional small-group culinary medicine cooking classes, among low-income, Medicaid patients with suboptimal blood pressure and glucose control. Patients (n=100) from OU-Tulsa Schusterman Internal Medicine Clinic will be randomized to 1) a fresh fruit and vegetable home-delivery program, or 2) the same home delivery program with supplementary small-group culinary medicine cooking classes. In addition, we will include a third arm of control patients (n=50) who will receive the standard of care. We will track blood pressure and glucose control in all three groups to determine the comparative impact of each intervention. The proposed pilot study, informed by the Institute for Healthcare Improvement's "Triple Aim" framework, will provide the formative information needed to develop a larger-scale intervention to enhance the patient care experience, improve population health status, and reduce the per capita cost of care.

Conditions

Diabetes; Hypertension; Nutrition Poor

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: FACTORIAL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

Produce Only

Receives weekly home delivery of fresh fruits and vegetables

Group Type: EXPERIMENTAL

Produce delivery

Intervention Type: OTHER

weekly home delivery of fresh fruits and vegetables

Produce + Cooking Classes

Receives weekly home delivery of fresh fruits and vegetables plus invitation to participate in a series of three small group culinary medicine cooking classes

Group Type: EXPERIMENTAL

Produce delivery

Intervention Type: OTHER

weekly home delivery of fresh fruits and vegetables

Cooking classes

Intervention Type: OTHER

weekly home delivery of fresh fruits and vegetables participants will be invited to participate in a Culinary Medicine cooking series. The OU Culinary Medicine cooking curriculum will involve a 3-part class series designed to build nutrition knowledge and cooking self-efficacy for preparing fresh F/Vs. Each session is \~2 hr. Core nutrition guidelines for blood pressure and blood sugar management will also be emphasized informed by an evidence-based Conceptual Model of Healthy Cooking. Classes will be conducted in small groups (\~16 participants) in an established teaching kitchen used by the culinary medicine program. Classes will be facilitated by a professional chef, a healthcare professional (dietitian, medical doctor, or trained medical student), and other support staff, including trained medical, dietetic, and public health students.

Control

Control group with no cooking classes or groceries

Group Type: NO_INTERVENTION

No interventions assigned to this group

Interventions

Produce delivery

weekly home delivery of fresh fruits and vegetables

Intervention Type: OTHER

Cooking classes

weekly home delivery of fresh fruits and vegetables participants will be invited to participate in a Culinary Medicine cooking series. The OU Culinary Medicine cooking curriculum will involve a 3-part class series designed to build nutrition knowledge and cooking self-efficacy for preparing fresh F/Vs. Each session is \~2 hr. Core nutrition guidelines for blood pressure and blood sugar management will also be emphasized informed by an evidence-based Conceptual Model of Healthy Cooking. Classes will be conducted in small groups (\~16 participants) in an established teaching kitchen used by the culinary medicine program. Classes will be facilitated by a professional chef, a healthcare professional (dietitian, medical doctor, or trained medical student), and other support staff, including trained medical, dietetic, and public health students.

Intervention Type: OTHER

Eligibility Criteria

Inclusion Criteria

• English-speaking;
• Between 18 - 64 years old;
• Enrolled in Medicaid at baseline
• Elevated blood pressure and/or A1C scores in the past three months
• Access to regular medical care
• Permission from physician to participate
• Physical home address that can accept grocery deliveries
• Lives inside the grocery service delivery area with no intention to move outside of the service areas in the next 9 months

Exclusion:

• Non-English speaking
• Less than 18 years of age or over 64 years of age
• Serious or terminal illness
• Pregnant or planning to become pregnant in the next 9 months
• Advanced end stage renal disease
• Current enrollment in any other research studies on high blood pressure or diabetes
• No other household member participating in the study

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 64 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

University of Oklahoma

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Marianna Wetherill, PhD

Role: PRINCIPAL_INVESTIGATOR

University of Oklahoma

Brent Beasley, MD

Role: PRINCIPAL_INVESTIGATOR

University of Oklahoma

Locations

Schusterman Clinic at the University of Oklahoma Health Science Center

Tulsa, Oklahoma, United States

Countries

United States

Other Identifiers

10360

Identifier Type: -

Identifier Source: org_study_id