Effectiveness of a Latino(a) Community Health Worker Led National Diabetes Prevention Program.

IntroductionObesity has reached epidemic proportions in children and adolescents in the United States. Children’s behaviors are strongly influenced by parental behaviors, and weight loss in parents is positively associated with weight changes in their overweight/obese children. Research is limited on how parents’ National Diabetes Prevention Program (DPP) participation affects the health outcomes of their dependent children. Analyzing the impact of parental DPP participation on weight loss in their dependent children may provide valuable insight into an important secondary benefit of DPP participation.MethodsIn this study, we identified 128 adults with prediabetes who were offered the opportunity to participate in a DPP (n = 54 DPP participants and n = 74 DPP non-participants) and who had at least one child 3 to 17 years of age living with them. Age and BMI percentile for dependent children were collected from insurance claims data for 203 children (n = 90 children of DPP participants and n = 113 children of DPP non-participants). Parental practices related to diet and physical activity were assessed by surveys.ResultsThere were no significant changes in BMI percentiles of overweight or obese children (i.e. BMI percentile ≥ 50%) of DPP participants vs DPP non-participants with prediabetes over one-year. Parents who enrolled and did not enroll in the DPP did not report differences in their parenting practices related to diet and physical activity.DiscussionThese results are not consistent with the literature that suggests parent-based interventions may influence their children’s weight trajectories. Limitations include small sample size, short time span of intervention, and limited availability of additional health/biographic data on dependent children. Future studies should collect primary outcome data on children, investigate whether there is a minimum duration of parental involvement and level of parental adherence, and assess the effect of parent–child dynamics on child weight trajectories.

Introduction and Objective: In 2010, the Centers for Disease Control and Prevention (CDC) established the National Diabetes Prevention Program (National DPP) to address the growing rate of type 2 diabetes (T2D) in the United States and the millions of adults at high risk for the disease. The National DPP supports a structured lifestyle change program (LCP) based on the Diabetes Prevention Program (DPP) research study and subsequent translation studies. Our objective is to compare outcomes from the lifestyle intervention arm of the DPP to that of the National DPP LCP using data from CDC’s Diabetes Prevention Recognition Program. Methods: This study compares participant outcomes from the DPP (n=1,079) to two groups from the National DPP LCP: all participants (n=634,545) and those who more closely matched criteria for DPP inclusion (n=116,330). Outcomes include weight loss at ~6 months and percentage who met the 150 minutes/week of physical activity (PA) goal at ~6 months. Analysis was done using SAS 9.4. Results: Median weight loss was higher for DPP participants (7.2%) than for the two groups of LCP participants: 4.3% (all) and 4.7% (matched). Weight loss in the 5-7% range, the goal of the LCP, was the same or better for those in the LCP, 14% (all) and 16% (matched), compared to the DPP (14%). DPP participants met the PA goal of 150 weekly minutes at a rate of 74%. Among LCP participants, the percentage reporting meeting the goal during the 6-month period was 56% (all) and 62% (matched). Conclusion: The National DPP LCP is offered by various organizations in real-world settings, whereas the DPP was conducted in a controlled environment that included individualized support. Despite this, LCP participants are meeting weight loss goals at similar rates and showing increases in PA. The National DPP shows promise as a model to scale a proven lifestyle intervention from research into widespread practice, helping adults with prediabetes lower their risk for T2D. Disclosure E. Ely: None. M. Bell: None.

Previous interventions to lower diabetes risks among pregnant women have been largely ineffective (1–3), and the identification of effective prevention tools is needed to protect both maternal and child health (4). The National Diabetes Prevention Program (NDPP) is a widely disseminated translation of the highly successful lifestyle change intervention from the Diabetes Prevention Program research study (5,6). The NDPP promotes weight loss of ≥5% through diet and physical activity, benefiting individuals who participate regularly (6). Eighty percent of participants are women (6), but most are beyond child-bearing years (7), and those who are pregnant at enrollment are excluded (8). Increasing enrollment in the NDPP among women of childbearing age has been identified as a priority (7), yet outcomes for those who become pregnant during the year-long program are unknown. To explore whether the NDPP may support beneficial outcomes during pregnancy, we examined case studies of women who became pregnant while participating in the NDPP. We delivered the year-long NDPP intervention in a Denver, Colo., health care system to eligible adults with diabetes risks (i.e., ≥24 kg/m2 and prediabetes, history of gestational diabetes mellitus [GDM], or positive score on a diabetes risk questionnaire [8]). Participants were largely referred by their primary care providers. Trained NDPP coaches led 22–25 group sessions over 1 year following guidelines developed by the Centers for Disease Control and Prevention (9). From March 2013 to March 2018, 924 women participated. Five women who subsequently reported having become pregnant were able to continue, but were no longer prescribed the NDPP’s weight loss goal. This article describes diabetes-related outcomes in pregnancy among three women using medical records available as of May 2018. An additional case was excluded because detailed records were unavailable, and another was excluded because of the early stage of the pregnancy. …

Black and Latino men are at increased risk for poor diabetes health outcomes but are underrepresented in lifestyle interventions for weight loss and diabetes prevention. Although relatively few men participate in the National Diabetes Prevention Program (NDPP), it remains the most widely available evidence-based approach to type 2 diabetes prevention in the United States. Thus, an NDPP tailored to Black and Latino men has the potential to address prior limitations of NDPP implementation and reduce gender, racial, and ethnic diabetes disparities. It also provides an opportunity to define a population for targeted outreach and evaluate the reach of our recruitment methods and interventions. We tailored the US Centers for Disease Control and Prevention Prevent T2 curriculum for the NDPP for Black and Latino men, called Power-Up, and will evaluate its effects in comparison to standard mixed-gender NDPP groups via virtual delivery. The primary aim of the project is to assess the effect of Power-Up versus NDPP on weight loss among men with prediabetes. The secondary aim is to compare the engagement and retention of men with prediabetes in Power-Up versus NDPP. We will also examine the reach of our recruitment methods and engagement in our screening, consenting, and assessment procedures prior to the point of randomization. We hypothesized that men randomized to Power-Up would achieve greater percent weight loss from baseline at 16 weeks (end of Core sessions) and 1 year (end of Maintenance sessions) than men randomized to standard, mixed-gender NDPP. Power-Up is also expected to have better engagement and retention. Using the electronic health record (EHR) systems of a large academic medical center and a network of small to medium independent primary care practices throughout New York City, we identified Black and Latino men who met eligibility criteria for NDPP and enrolled them in a randomized controlled trial in which they were assigned 1:1 to receive Power-Up or the standard, mixed-gender NDPP over 1 year via online videoconferencing. Coaches delivering these interventions were trained according to the standards for the NDPP. Power-Up will be delivered by men coaches. Weight will be collected with home-based electronic scales for primary outcome analyses. Engagement will be assessed by session attendance logs. We identified 11,052 men for outreach based on EHR data, successfully screened 26% of them, consented and enrolled 22% of these, and randomly assigned 48% of consented participants. Primary and secondary outcome analyses will be assessed among randomized men. This study highlights the effort required to reach and engage Black and Latino men for virtually delivered diabetes prevention programs. Forthcoming trial results for weight loss and engagement will further inform efforts to address disparities in diabetes prevention through tailored programming for Black and Latino men. ClinicalTrials.gov NCT04104243; https://clinicaltrials.gov/study/NCT04104243. DERR1-10.2196/64405.

An estimated 96 million Americans over the age of 18 have prediabetes. The Centers for Disease Control and Prevention’s National Diabetes Prevention Program (DPP) aims to promote lifestyle changes and weight loss to prevent or delay the onset of type 2 diabetes. While stress can play a significant role in weight management, little is known about the association between participant stress and weight loss in this program. The Scripps Whittier Diabetes Institute delivers the DPP within a large healthcare system in Southern California and administers the Perceived Stress Scale (PSS-10) at baseline and month 6 as part of the program. This analysis was conducted to examine the association between changes in stress and weight over 6 months. During a five-year timeframe that spanned the onset of the COVID-19 pandemic, and the transition from in-person to virtual delivery (October 2016 - January 2020), N = 341 individuals participated in the Scripps DPP. The majority of the participants were female (80.2%), married (65.4%), and reported an annual household income ≥ $24,000 (82.5%); 48.8% were non-Hispanic White. Baseline M(SD) age = 59.9 ± 13.66 and BMI = 32.15 ± 6.16. In a linear regression model, controlling for attendance, sex, and household income, a 1-point decrease in perceived stress was associated with a 0.28 lb. decrease in weight (p=0.02). At 6 months, overall mean weight loss was 4.24%, 8.13 lbs. The DPP addresses stress in one session during the core phase, with two additional sessions related to coping and problem solving. Collecting data with the PSS-10 can help provide additional insights into the effects of the DPP intervention. These findings indicate that reduction of stress over time in the DPP is associated with greater weight loss, thus highlighting the importance of the focus on stress management and coping in the DPP curriculum. Disclosure M.Chichmarenko: None. E.San diego: None. E.Soriano: None. S.R.Spierling bagsic: None. N.Orendain: None. A.Philis-tsimikas: Advisory Panel; Dexcom, Inc., Novo Nordisk A/S, Sanofi, Other Relationship; Medtronic, Research Support; Novo Nordisk A/S, Lilly, Viking Therapeutics, NIH - National Institutes of Health. A.L.Fortmann: Employee; Dexcom, Inc. M.Ruiz: None.

BackgroundThe Center for Disease Control and Prevention’s National Diabetes Prevention Program (NDPP) aims to help individuals with prediabetes avoid progression to type 2 diabetes mellitus (T2DM) through weight loss. Specifically, the NDPP teaches individuals to follow a low-fat, calorie-restricted diet and to engage in regular physical activity to achieve ≥ 5% body weight loss. Most NDPP participants, however, do not achieve this weight loss goal, and glycemic control remains largely unchanged. One promising opportunity to augment the NDPP’s weight loss and glycemic effectiveness may be to teach participants to follow a very low-carbohydrate diet (VLCD), which can directly reduce post-prandial glycemia and facilitate weight loss by reducing circulating insulin and enabling lipolysis. To date, there have been no high-quality, randomized controlled trials to test whether a VLCD can prevent progression to T2DM among individuals with prediabetes. The aim of this study is to test the effectiveness of a VLCD version the NDPP (VLC-NDPP) versus the standard NDPP. We hypothesize the VLC-NDPP will demonstrate greater improvements in weight loss and glycemic control.MethodsWe propose to conduct a 12-month, 1:1, randomized controlled trial that will assign 300 adults with overweight or obesity and prediabetes to either the NDPP or VLC-NDPP. The primary outcome will be glycemic control as measured by change in hemoglobin A1c (HbA1c) from baseline to 12 months. Secondary outcomes will include percent body weight change and changes in glycemic variability, inflammatory markers, lipids, and interim HbA1c. We will evaluate progression to T2DM and initiation of anti-hyperglycemic agents. We will conduct qualitative interviews among a purposive sample of participants to explore barriers to and facilitators of dietary adherence. The principal quantitative analysis will be intent-to-treat using hierarchical linear mixed effects models to assess differences over time.DiscussionThe NDPP is the dominant public health strategy for T2DM prevention. Changing the program’s dietary advice to include a carbohydrate-restricted eating pattern as an alternative option may enhance the program’s effectiveness. If the VLC-NDPP shows promise, this trial would be a precursor to a multi-site trial with incident T2DM as the primary outcome.Trial registrationNCT05235425. Registered February 11, 2022.

The National Diabetes Prevention Program (DPP) promotes lifestyle changes to prevent diabetes. However, only one-third of DPP participants achieve weight loss goals, and changes in diet are limited. Continuous glucose monitoring (CGM) has shown potential to raise awareness about the effects of diet and activity on glucose among people with diabetes, yet the feasibility of including CGM in behavioral interventions for people with prediabetes has not been explored. This study assessed the feasibility of adding a brief CGM intervention to the Arizona Cooperative Extension National DPP. Extension DPP participants were invited to participate in a single CGM-based education session and subsequent 10-day CGM wear period, during which participants reflected on diet and physical activity behaviors occurring prior to and after hyperglycemic events. Following the intervention, participants completed a CGM acceptability survey and participated in a focus group reflecting on facilitators and barriers to CGM use and its utility as a behavior change tool. A priori feasibility benchmarks included opt-in participation rates ≥ 50%, education session attendance ≥ 80%, acceptability scores ≥ 80%, and greater advantages than disadvantages of CGM emerging from focus groups, as analyzed using the Key Point Summary (KPS) method. Thirty-five DPP members were invited to participate; 27 (77%) consented, and 24 of 27 (89%) attended the brief CGM education session. Median survey scores indicated high acceptability of CGM (median = 5, range = 1-5), with nearly all (n = 23/24, 96%) participants believing that CGM should be offered as part of the DPP. In focus groups, participants described how CGM helped them make behavior changes to improve their glucose (e.g., reduced portion sizes, increased activity around eating events, and meditation). In conclusion, adding a single CGM-based education session and 10-day CGM wear to the DPP was feasible and acceptable. Future research will establish the efficacy of adding CGM to the DPP on participant health outcomes and behaviors.

IntroductionLow and middle-income countries like South Africa are experiencing major increases in burden of non-communicable diseases such as diabetes and cardiovascular conditions. However, evidence-based interventions to address behavioural factors related...

Introduction: The National Diabetes Prevention Program (NDPP) is a widely-disseminated lifestyle intervention. Retention in the NDPP is problematic and leads to suboptimal weight loss, especially among racial/ethnic minority participants. We report results of implementing a novel “pre-session” protocol to support engagement among a diverse sample of NDPP participants. Methods: The NDPP was delivered in a safety net healthcare system. As of September 2016, pre-sessions were offered prior to NDPP attendance and focused on (1) education on diabetes risks, (2) motivational interviewing to participate in the NDPP, and (3) problem-solving barriers to engagement. We compared NDPP attendance and weight loss outcomes between 75 pre-session participants and a historical control group of 42 individuals who were not offered a pre-session prior to their beginning the NDPP in July 2016. This comparator group was selected to reduce potentially confounding effects of other prior modifications to NDPP dissemination over time. Results: The majority of participants in this analysis were female (78.3%), low-income (51.1%), and Hispanic (57.6%). Mean age was 46.6 (SD=12.7) with a mean baseline BMI of 35.9 (SD=5.7). There were no significant baseline differences in characteristics between NDPP participants who received a pre-session and historical controls. Pre-session participants attended 5.3 (SD=1.4) more NDPP sessions (p<.001) and stayed in the program 96.4 (SD=24.6) days longer (p<.001) than historical controls. Pre-session participants achieved 1.8% (SD=0.8) greater weight loss (p=.039) and were 2.4 times more likely to achieve ≥5% weight loss in the NDPP as historical controls; p=.044, 95% CI [1.0-5.8]. Conclusions: By improving engagement and weight loss, findings suggest pre-sessions may be a promising strategy to improve NDPP effectiveness and mitigate health disparities in program outcomes. Disclosure N. Ritchie: None. P.G. Kaufmann: None. M. Gritz: None. J.S. Holtrop: None.

In the National Diabetes Prevention Program (DPP) developed by the CDC, participants receive health-coach facilitated education on lifestyle modification to develop better eating and exercise habits with the goal of losing 5-7% weight over the course of a year. Incorrect assumptions about weight loss can lead to reduced participation and low outcomes in DPP. This study aims to determine the truth of common assumptions about weight loss and the impact that such assumptions have on the effectiveness of DPP. A common assumption observed is that women of menopausal age (45-60) find it more difficult to lose weight and we hypothesized that women at the menopausal age will achieve the weight loss goal at a slower rate compared to younger women of pre-menopausal age (18-44) . Weight loss is defined as the difference between initial and final weight as a percentage of initial weight; a positive value indicates weight loss. Effectiveness is defined as the percentage of participants who achieve a specific weight loss threshold. The data used was the number of days until each participant achieved the weight loss goal of 5%. This was divided into two groups: 641 women aged 45-60) , and 278 women aged 18-44. A Students t-test was then performed on the data sets to measure the effect of assumptions about menopause and weight loss. Contrary to the hypothesis, we found that menopausal women to be just as likely to achieve the 5% weight loss goal as pre-menopausal women in the same amount of time. This indicates that the assumption is untrue, however it is a useful assumption in the sense that it can encourage menopausal women to lose weight. Disclosure M.Ottur: None. G.Cooke: None. S.Rajan: None.

The National Diabetes Prevention Program (NDPP) offers lifestyle change education to adults at risk for diabetes across the United States, but its reach is curbed due, in part, to limitations of traditional in-person programs. Diabetes Prevention Programs (DPPs) that are fully digital may increase reach by overcoming these barriers. The aim of this research was to examine the reach of Lark's DPP, a fully digital artificial-intelligence-powered DPP. This study assessed geographic features and demographic characteristics of a sample of Lark DPP commercial health plan members with complete data (N = 16,327) and compared several demographic features with a large composite sample of members from DPPs across the nation (NDPP; N = 143,489) and a National Health Interview Survey (NHIS) sample of prediabetic adults in the United States (NHIS; N = 2118). Examination of the Lark DPP sample revealed that 24.4% of members lived in rural areas, 30.8% lived in whole county health professional shortage areas, and only 7.6% of members lived in a zip code with an in-person DPP. When comparing the Lark sample with the NDPP and NHIS samples, Lark DPP enrollees tended to be younger and have a higher body mass index (BMI) (p's < 0.001). Lark provides convenient access to a DPP for individuals living in hard-to-reach areas who may face barriers to participating in in-person or telephonic DPPs or who prefer a digital program. Compared with the NDPP sample, Lark is also reaching younger and higher BMI users, who are traditionally difficult to enroll and have a high need for intervention.

Lifestyle Modification for the Management of Obesity

BackgroundThe evidence-based National Diabetes Prevention Program (NDPP) is now widely disseminated, yet strategies to increase its effectiveness are needed, especially for underserved populations. The yearlong program promotes lifestyle changes for weight loss and can be offered in-person, online, via distance learning, or a combination of modalities. Less is known about which delivery features are optimal and may help address disparities in outcomes for subgroups. We previously demonstrated the efficacy of a stand-alone text messaging intervention based on the NDPP (SMS4PreDM) in a randomized controlled trial in a safety net health care system. Upon broader dissemination, we then showed that SMS4PreDM demonstrated high retention and modest weight loss at a relatively low cost, suggesting the potential to improve in-person NDPP delivery.ObjectiveIn this study, we aim to compare the effectiveness of in-person NDPP classes with and without supplementary SMS4PreDM on attendance and weight loss outcomes to determine whether text messaging can enhance in-person NDPP delivery for a safety net patient population.MethodsFrom 2015 to 2017, patients with diabetes risks were identified primarily from provider referrals and enrolled in NDPP classes, SMS4PreDM, or both per their preference and availability. Participants naturally formed three groups: in-person NDPP with SMS4PreDM (n=236), in-person NDPP alone (n=252), and SMS4PreDM alone (n=285). This analysis compares the first two groups to evaluate whether supplemental text messaging may improve in-person NDPP outcomes. Outcomes for SMS4PreDM-only participants were previously reported. NDPP classes followed standard delivery guidelines, including weekly-to-monthly classes over a year. SMS4PreDM delivery included messages promoting lifestyle change and modest weight loss, sent 6 days per week for 12 months. Differences in characteristics between intervention groups were assessed using chi-square and t tests. Differences in NDPP attendance and weight loss outcomes were analyzed with multivariable linear and logistic regressions.ResultsThe mean age was 50.4 years (SD 13.9). Out of a total of 488 participants, 76.2% (n=372) were female and 59.0% (n=288) were Hispanic. An additional 17.2% (n=84) were non-Hispanic white and 12.9% (n=63) were non-Hispanic black. A total of 48.4% (n=236) of participants elected to receive supplemental text message support in addition to NDPP classes. Participants who chose supplemental text message support were on average 5.7 (SD 1.2) years younger (P<.001) than the 252 participants who preferred in-person classes alone. Relatively more women and Hispanic individuals enrolled in the NDPP with supplemental text messages than in NDPP classes alone, 83.9% (n=198) vs 69.0% (n=174, P<.001) and 68.6% (n=162) vs 50.0% (n=126, P=.001), respectively. Attendance and weight loss outcomes were comparable between groups.ConclusionsDespite its appeal among priority populations, supplemental text messaging did not significantly increase attendance and weight loss for the in-person NDPP. Further research is needed to identify optimal strategies to improve the effectiveness of the NDPP.

IntroductionDifferences in eligibility criteria and intervention characteristics have limited the generalizability of findings from studies of worksite translations of the National Diabetes Prevention Program (DPP). The objective of our study was to identify factors associated with achievement of the DPP’s 5% weight-loss goal in the Vanderbilt University Medical Center (VUMC) Faculty and Staff Health and Wellness DPP from 2014 to 2017.MethodsWe analyzed data from a DPP worksite translation that adhered to national standards for program quality and intervention fidelity. We compared baseline characteristics and program metrics for participants who did and did not achieve the program’s 5% weight-loss goal, and we developed a multivariable logistic regression model to identify independent predictors of achieving this goal.ResultsOf the 165 employees enrolled in the DPP from 2014 to 2017, 43.6% (n = 72) met the 5% weight-loss goal. Mean (standard deviation) percentage weight loss for the program was 5.2% (6.0%), or 4.8 (6.0) kg. The median (interquartile range) body mass index at baseline was lower among participants who achieved the 5% weight-loss goal than among those who did not (31.6 [29.4–37.4] vs 34.7 [31.5–39.2], P = .009), and participants who achieved the goal reported more physical activity minutes per week (166.0 [135.2–223.0] min vs 128.5 [83.2–169.8] min, P < .001). Session attendance was greater for participants achieving the 5% weight-loss goal (23 [21–25]) sessions vs 18 [12–21] sessions, P < .001). In the adjusted analysis, physical activity and session attendance remained significant predictors of achieving the 5% weight-loss goal.ConclusionSession attendance and physical activity independently predicted achievement of the 5% weight-loss goal in this worksite translation of the DPP. Strategies designed to improve these metrics may increase DPP success rates.

The PreventionLink of Southern Maryland is a 5-year project to eliminate barriers to participation and retention in the National Diabetes Prevention Program (DPP) lifestyle change program to prevent or delay the onset of type 2 diabetes in adults with prediabetes. This is the study to identify the obstacles to participation and retention in the DPP lifestyle change program among high burden populations and learn how CHWs have reduced the identified barriers to participation and retention for high burden populations. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) to conduct this literature review. We have used the Scopus and PubMed, including all types of studies and peer-reviewed documents published in English between 2010 and 2020. From 131 identified articles, 18 articles were selected for qualitative synthesis. The reviewed literature documented following as main barriers to participate in a DPP lifestyle change program: time, cost, lack of transportation, cost of transportation, commute distance, technology access, access to facilities and community programs, caregiver responsibilities, lack of health literacy and awareness, and language. CHWs can address these barriers to participation and retention, they were involved in educating and supporting roles; they worked as bridges between healthcare providers and participants and as intervention team members. Diabetes prevention program participants with social determinant risk factors who most need CHW services are unlikely to have financial resources to pay for CHW services out-of-pocket. Hence, the public and private health plans that pay for their prediabetes care should consider paying for these CHW services and there is a need to trust more to CHW and have them as a "community health teams" member.