Solving the Puzzle to Lasting Impact of the National Diabetes Prevention Program.

Abstract

To address the burden of type 2 diabetes, the Centers for Disease Control and Prevention (CDC) launched the National Diabetes Prevention Program (National DPP) in 2010 (1). The program promotes weight loss through lifestyle change, based on remarkable findings of 58% reduced cumulative incidence over 3 years in an efficacy trial (2). Major successes include reaching hundreds of thousands of at-risk individuals nationwide, robust outcomes, and widespread insurance coverage (1,3), but more work is needed to ensure lasting impact, and retention plays a critical part. This Commentary briefly reviews the new retention study by Cannon et al. (4), linkage to other critical pieces, and future directions. In considering solutions to a complex national problem, I seek to contribute my uniquely broad experience with the National DPP working as a lifestyle coach, securing funding, overseeing delivery, reaching disadvantaged populations, serving on state workgroups, rate setting, becoming a Medicare supplier, advocating to payers and legislators, and authoring over 20 peer-reviewed articles on the program. Beginning with doctoral training on a preceding translational study (5), I now lead a large pragmatic trial a decade later to improve retention with presessions to the National DPP (6). I am also ashamedly familiar with diabetes risks and lost over 50 pounds in my own personal journey with lifestyle change. With rigorous analysis of 41,203 participants across 581 organizations, Cannon et al. show incremental attrition that leaves only a third (32%) remaining by month 10 of the yearlong intervention (data not presented for months 11–12) (4). Racial/ethnic minority and younger individuals, and those lacking successful lifestyle change, drop out disproportionately more. The findings help replicate my early studies on retention gaps for these groups (7–9 …