Abstract
BackgroundThe National Diabetes Prevention Program (National DPP) is rapidly expanding in an effort to help those at high risk of type 2 diabetes prevent or delay the disease. In 2012, the Centers for Disease Control and Prevention funded six national organizations to scale and sustain multistate delivery of the National DPP lifestyle change intervention (LCI). This study aims to describe reach, adoption, and maintenance during the 4-year funding period and to assess associations between site-level factors and program effectiveness regarding participant attendance and participation duration.MethodsThe Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework was used to guide the evaluation from October 2012 to September 2016. Multilevel linear regressions were used to examine associations between participant-level demographics and site-level strategies and number of sessions attended, attendance in months 7–12, and duration of participation.ResultsThe six funded national organizations increased the number of participating sites from 68 in 2012 to 164 by 2016 across 38 states and enrolled 14,876 eligible participants. By September 2016, coverage for the National DPP LCI was secured for 42 private insurers and 7 public payers. Nearly 200 employers were recruited to offer the LCI on site to their employees. Site-level strategies significantly associated with higher overall attendance, attendance in months 7–12, and longer participation duration included using self-referral or word of mouth as a recruitment strategy, providing non-monetary incentives for participation, and using cultural adaptations to address participants’ needs. Sites receiving referrals from healthcare providers or health systems also had higher attendance in months 7–12 and longer participation duration. At the participant level, better outcomes were achieved among those aged 65+ (vs. 18–44 or 45–64), those who were overweight (vs. obesity), those who were non-Hispanic white (vs. non-Hispanic black or multiracial/other races), and those eligible based on a blood test or history of gestational diabetes mellitus (vs. screening positive on a risk test).ConclusionsIn a time of rapid dissemination of the National DPP LCI the findings of this evaluation can be used to enhance program implementation and translate lessons learned to similar organizations and settings.
Highlights
The National Diabetes Prevention Program (National DPP) is rapidly expanding in an effort to help those at high risk of type 2 diabetes prevent or delay the disease
According to the American Diabetes Association (ADA), prediabetes is defined as blood glucose levels that are elevated, though not high enough to be diagnosed as type 2 diabetes [3]
We present data on program adoption, implementation, and maintenance as well as information on program reach to participants and program effectiveness regarding site-level factors associated with participant overall attendance, attendance in months 7–12, and duration of participation
Summary
The National Diabetes Prevention Program (National DPP) is rapidly expanding in an effort to help those at high risk of type 2 diabetes prevent or delay the disease. The Diabetes Prevention Program (DPP) randomized clinical trial, initiated in 1996, found that a yearlong intensive lifestyle intervention aimed at reducing risk through healthy eating, physical activity, and stress reduction helped participants lose 5–7% of their body weight and reduce the risk of developing type 2 diabetes by 58% among high risk adults aged ≥ 25 and 71% for those aged ≥ 60 [10]. Since the DPP research study, many translational studies have shown that the structured lifestyle intervention is effective and feasible in community settings to prevent or delay the incidence of type 2 diabetes among people at high risk [11,12,13,14,15,16,17,18]. In order to do this, a coordinated national effort was needed to increase the supply of quality programs, demand for the program among people at risk, referrals from healthcare providers, and coverage among public and private payers [19]
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