Looking back and forward from the Diabetes Prevention Program (DPP): A commentary on the importance of research aimed at intervention optimization.

Abstract

This article discusses the Diabetes Prevention Program (DPP). DPP was an extremely successful clinical trial that demonstrated the efficacy of lifestyle intervention in the prevention of type 2 diabetes in those at increased risk. Many have asked how this study came to be. The author presents a historical perspective on the DPP trial, stressing both the many years of research that preceded and permitted this successful study and its impact on both clinical approaches and subsequent research directions. The author discusses the tension that seems to exist between two important types of research-conducting systematic research aimed at optimizing an intervention to ensure that it will successfully change the targeted behavior versus moving more rapidly to clinical trials testing the health benefits derived from changing the targeted behavior. Today studies that propose to conduct programmatic research related to intervention optimization are criticized for not also testing if these interventions produce clinically important health outcomes. It is not cost-effective to seek answers to questions about health outcomes before developing and demonstrating the efficacy of the intervention on changing the behavioral targets. There are many examples of large clinical trials examining the effect of changing a behavior on an important health outcome that have failed to achieve significant differences in health outcomes because the intervention was not successful in changing the behavior relative to the control condition. (PsycInfo Database Record (c) 2022 APA, all rights reserved).