Abstract

Diabetes has become a global noninfectious pandemic with rates rapidly rising around the globe. The major drivers of this increase in type 2 diabetes are obesity, an increase in processed foods, and a decrease in physical activity. In the United States, the National Diabetes Prevention Program (NDPP) has proven to be an effective lifestyle intervention to delay or prevent new-onset type 2 diabetes. However, there is limited evidence that such a lifestyle program will work in a South American community. This pilot program aims to determine if a modified version of the Centers for Disease Control and Prevention (CDC) Diabetes Prevention Program (DPP) would be feasible in an Ecuadorian population. The goals of this pilot program were a 7% weight loss, >150min of physical activity per week, and a reduction of fat calories to yield a reduced risk of type 2 diabetes. This program was led by family medicine physicians and was offered to people with prediabetes in Quito, Ecuador. The program was modified to include only the first half of the DPP curriculum, which included a schedule of 16 classes in the first 6months. Further, the program was provided in Spanish and modified to be more culturally specific to this population. Participants were recruited from the faculty and staff of Pontifical Catholic University of Ecuador (Pontificia Universidad Católica del Ecuador [PUCE]) in Quito. Outcomes measured included A1c reduction, weight loss, increase in physical activity minutes, and progression to type 2 diabetes mellitus (T2DM). The sample included 33 people with prediabetes. The mean age of the participants was 52 years (range, 41-66 years), the mean body mass index (BMI) was 27.6kg/m2 (range, 21.0-40.3kg/m2), and the mean HbA1C was 6.2% (range, 5.7-6.4%). The attendance was 97.8% at 6months. The mean weight loss was 3.4kg per participant (range, 1.5kg weight gain to 8.3kg weight loss); in percentage points, this was a mean weight loss of 3.6% (range, 2.3% gain to 11.8% weight loss). Three-fourths of the participants lost weight (78.3%). The majority of participants (75.8%) met the target physical activity level of 150min per week, and all participants increased their physical activity levels from baseline. No participants progressed to type 2 diabetes during this study. The DPP 6month pilot was effective in this population with prediabetes in Ecuador. The largest changes were made in physical activity time. Holding the program at worksites and providing lunch were key factors in the very high retention rate in this study.

Highlights

  • PhD, Department of Biomedical Sciences, Infectious and Tropical Disease Institute, Heritage College of Osteopathic Medicine, Ohio University, Athens, OH, USA; and Center for Research on Health in Latin America, School of Biological Sciences, Pontifical Catholic University of Ecuador, Quito, Ecuador. This pilot program aims to determine if a modified version of the Centers for Disease Control and Prevention (CDC) Diabetes Prevention Program (DPP) would be feasible in an Ecuadorian population

  • This study examines the feasibility of a modified DPP in a university setting in Quito, Ecuador to prevent new-onset type 2 diabetes mellitus (T2DM), to increase participant physical activity, and to alter dietary habits

  • At 6 months, 78.8% of the patients reached the goal of 150 min of physical activity per week, and all participants exhibited an increase in physical activity over baseline. This pilot study of the National Diabetes Prevention Program (NDPP) program yielded results that support its feasibility when applied to an Ecuadorian population, and the results are similar to what has been seen in the United States

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Summary

Objectives

This pilot program aims to determine if a modified version of the Centers for Disease Control and Prevention (CDC) Diabetes Prevention Program (DPP) would be feasible in an Ecuadorian population. Prior studies of lifestyle intervention programs in patients with impaired glucose tolerance have demonstrated increased effectiveness in preventing T2DM utilizing weight loss and physical activity vs metformin or other medications [20, 21] These programs have been shown to prevent or reduce the complications of diabetes for more than 10 years after the program ends [16, 22]. These rates have been linked to a sedentary lifestyle and a diet high in excess sugars [30, 31] Given these similarities, this study examines the feasibility of a modified DPP in a university setting in Quito, Ecuador to prevent new-onset T2DM, to increase participant physical activity, and to alter dietary habits. This pilot was designed to investigate if a modified DPP program would be able to be implemented in another language in another country and modified to be accepted in another culture while providing similar benefits to its participants

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