FRESH Study (Fitness, Relaxation and Eating to Stay Healthy)

Inclusion Criteria

• Study participants must:
• Be capable of giving informed consent
• Understand and voluntarily sign the informed consent form.
• Be females at least 18 years of age and identify themselves as African-American
• Have prediabetes as defined by the American Diabetes Association: history of glycated hemoglobin (HgbA1c) 5.7-6.4 % or fasting blood glucose 100-125 mg/dL (5.6-6.9 mmol/L) (fasting defined as no caloric intake for at least 8 hours), or a 2-hour plasma glucose 140-199 mg/dL (7.8-11.0 mmol/L) during an oral glucose tolerance test (as described by the World Health Organization using a glucose load of 75 g anhydrous glucose dissolved in water)
• Have a body mass index (BMI, defined as weight in kilograms divided by height in meters squared) greater than or equal to 25

Exclusion Criteria

• Current or previous diagnosis of diabetes or a history of HgbA1c ≥ 6.5% or fasting blood glucose ≥ 126 mg/dL (7.0 mmol/L) (fasting defined as no caloric intake for at least 8 hours), or a 2-hour plasma glucose ≥ 200 mg/dL (11.1 mmol/L) during an oral glucose tolerance test or a history of classic symptoms of hyperglycemia or hyperglycemic crisis and a random plasma glucose ≥ 200 mg/dL (11.1 mmol/L).
• Normal glycemia or a currently with a HgbA1c < 5.7% or fasting blood glucose < 100 mg/dL (7.0 mmol/L) (fasting defined as no caloric intake for at least 8 hours), or a 2-hour plasma glucose < 140 mg/dL (11.1 mmol/L) during an oral glucose tolerance test
• Current or past use of oral hypoglycemic agents (including, but not limited to, metformin, rosiglitazone, pioglitazone, glipizide, and glyburide) or insulin
• Male gender
• History of congestive heart failure
• History of renal failure, dialysis, or creatinine greater than 2 mg/dL
• History of liver failure or a liver dysfunction with a increase by a factor of 2 above the upper limit of normal in alanine aminotransferase or aspartate aminotransferase
• History of gastrointestinal disorder that would prevent adherence to the recommended diet (e.g. celiac disease, inflammatory bowel disease, history of bariatric surgery, history of intestinal surgery)
• Presence of active cancer
• History of coronary artery disease or cerebrovascular disease
• History of uncontrolled hypertension
• Participation in another lifestyle modification trial
• Pregnancy or lactating or planning to be pregnant
• Current alcoholism or abuse of recreational drugs
• Hospitalization for depression in past 12 months
• Travel plans that do not permit full participation or participant lives too far from Health Center to permit full participation
• History of bariatric surgery, small bowel resection, or extensive bowel resection
• Chronic treatment with systemic steroids
• Current diagnosis of schizophrenia, other psychotic disorders, or bipolar disorder
• Inability to walk two blocks
• Other medial, psychiatric, or behavioral limitations that in the judgment of the principal investigator may interfere with study participation or the ability to follow the intervention protocol
• Amputation of lower limb for nontraumatic causes
• Self report of HIV-positivity or active tuberculosis
• Documented history of pulmonary embolus in past six months
• Chronic obstructive pulmonary disease that would limit ability to follow the study protocol
• Self-reported chronic hepatitis B or C or cirrhosis; inflammatory bowel disease requiring treatment in past year; Cushing's syndrome; acromegaly (clinical diagnosis or self-report); any major organ transplant
• Unwilling or uninterested in participating in group lifestyle education sessions
• Current regular corticosteroid use
• Active polycystic ovarian syndrome