Implementation Of Diabetes Prevention Programs Research Articles

Implementation of the Diabetes Prevention Program in Georgia Cooperative Extension According to RE-AIM and the Consolidated Framework for Implementation Research.

Increased dissemination of the CDC's Diabetes Prevention Program (DPP) is imperative to reduce type 2 diabetes. Due to its nationwide reach and mission to improve health, Cooperative Extension (Extension) is poised to be a sustainable DPP delivery system. However, research evaluating DPP implementation in Extension remains scant. Extension professionals delivered the DPP in a single-arm hybrid type II effectiveness-implementation study. Semi-structured interviews with Extension professionals were conducted at three time points. The Consolidated Framework for Implementation Research (CFIR) guided interview coding and analysis. Constructs were rated for magnitude and valence and evaluated as facilitators or barriers of RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) outcomes. The program reached 119 participants, was adopted by 92% (n = 12/13) of trained Extension professionals and was implemented according to CDC standards: all programs exceeded the minimum 22-session requirement (26 ± 2 sessions). The program was effective in achieving weight loss (5.0 ± 5.2%) and physical activity (179 ± 122min/week) goals. At post-intervention, eight professionals (67%) had begun or planned to maintain the intervention within the next 6months. Several facilitators were identified, including Extension leadership structure, organizational compatibility, and technical assistance calls. Limited time to recruit participants was the primary barrier. Positive RE-AIM outcomes, facilitated by contextual factors, indicate Extension is an effective and sustainable DPP delivery system. Extension and other DPP implementers should plan strategies that promote communication, the program's evidence-base, recruitment time, and resource access. Researchers should explore DPP implementation in real-world settings to determine overall and setting-specific best practices, promote intervention uptake, and reduce diabetes.

The national health service England diabetes prevention program—A narrative review

Abstract The National Health Service (NHS) Diabetes Prevention Program (DPP) is a comprehensive initiative in the United Kingdom aimed at preventing type 2 diabetes (T2DM) among individuals with prediabetes. The NHS DPP emphasizes early intervention and underscores the potential for preventing or delaying T2DM. Currently, it operates since 2015 at 44 geographically defined sites, serving an estimated annual volume of 200,000 patients. This narrative review evaluates the NHS DPP. A literature search, adhering to the Participants, Concept, and Context review framework, was conducted in various databases and sources, limited to the period from 2015 to 2023. Data were categorized based on publication date, study type, program indicators, and focus areas, forming the framework for the review discussion. The review search yielded a total of 18,357 articles, of which 45 were included, with a predominant focus on program effectiveness. The NHS DPP demonstrates strengths in risk reduction and cost-effectiveness but faces challenges related to fidelity and the needs of diverse populations. The review highlights the importance of evidence-based service delivery, stakeholder engagement, and digital innovation in future DPP programs. While a centralized approach provides structure, local flexibility is essential to cater to population-specific needs. This review underscores the importance of strategic planning, political support, partnerships, and robust data collection in DPP implementation. It recommends targeting high-risk individuals, intensive lifestyle interventions, and embracing digital solutions for program delivery. Ongoing research, including analysis of long-term data and user perspectives, will further enhance the evidence base for DPP programs worldwide.

Evaluating the Implementation of Digital and In-Person Diabetes Prevention Program in a Large, Integrated Health System: Natural Experiment Study Design.

Implementation of a Diabetes Prevention Program (DPP) in both in-person and digital health-care settings has been increasing. The purpose of this article is to describe the protocol of a mixed-methods, natural experiment study designed to evaluate the implementation of DPP in a large, integrated health system. Kaiser Permanente Northwest patients who were 19 to 75 years with prediabetes (hemoglobin A1c or glycated hemoglobin, 5.7-6.4) and obesity (body mass index ≥ 30 kg/m2) were invited, via the Kaiser Permanente Northwest patient portal, to participate in the digital (n = 4124) and in-person (n = 2669) DPP during 2016 through 2018. Primary (weight) and secondary (hemoglobin A1c or glycated hemoglobin level) outcome data will be obtained from electronic health records. A cost-effectiveness analysis as well as qualitative interviews with patients (enrolled and not enrolled in the DPP) and stakeholders will be conducted to examine further implementation, acceptability, and sustainability. The mixed-methods, natural experiment design we will use to evaluate Kaiser Permanente Northwest's implementation of the digital and in-person DPP builds on existing evidence related to the effectiveness of these two DPP delivery modes and will contribute new knowledge related to best practices for implementing and sustaining the DPP within large health systems over the long term.

Evaluation of a Diabetes Prevention Program Implementation in a Student-Run Free Clinic Setting

Introduction: The Diabetes Prevention Program (DPP) can prevent or delay the development of type 2 diabetes in at-risk individuals. Although low-resource and minority communities have higher rates of type 2 diabetes, these communities often have limited DPP participation due to cost and program accessibility. We evaluated whether a high-fidelity, reduced-cost 16-week DPP could feasibly be implemented by student volunteers and be effective in facilitating the target 5% weight loss goal among participants. 
 Methods: Uninsured, Spanish-speaking participants and their invited guests were recruited from Vanderbilt University Medical Center’s student-run clinic. Weekly DPP sessions were conducted using the CDC’s Prevent T2 curriculum in Spanish, delivered in-person for 6 weeks and virtually for the remaining 10 weeks due to the Coronavirus Disease 2019 pandemic. Participant attendance and weight data were collected. Pre- and post-program health-related quality of life was assessed using the EuroQoL 5D5L tool, and qualitative program feedback surveys were administered. Changes in weight and quality of life as a function of program session attendance and patient demographics were determined primarily using Wilcoxon tests.
 Results: Of the 17 participants actively engaged in the student-led DPP, 13 were clinic patients and 4 were invited guests. The median weight loss achieved by participants was 5.90% of their total body weight. 13 of the 17 participants (76.50%) achieved the 5% weight loss goal. Age, sex, pre-program body mass index, and English proficiency were not associated with the achievement of the 5% weight loss goal. Though not statistically significant, patients’ average self-scored general health rating (0-100) improved from 72.30 to 81.50 (p=0.12), and the greatest reductions in health limitations were reported with regards to pain (1.94 to 1.70, p=0.28) and daily activities (1.53 to 1.35, p=0.36).
 Conclusion: A student-run DPP implementation among low-resource participants is feasible and appears capable of achieving the target 5% weight loss.

O8 Translation of the National Diabetes Prevention Program into Cooperative Extension: Barriers and Facilitators

<h3>Background</h3> Translation of the Center for Disease Control's National Diabetes Prevention Program (DPP) from clinics to communities can reduce diabetes burden in the U.S. if more organizations adopt and maintain the intervention. Cooperative Extension offers a potentially powerful context for DPP implementation, with a capacity to reach large and diverse populations. There is a critical need to understand the impact of the DPP when implemented with fidelity in Extension, as well as implementation barriers and facilitators. <h3>Objective</h3> The objective of the present study was to evaluate barriers and facilitators of DPP implementation in Extension in Georgia. <h3>Study Design, Setting, Participants</h3> The present study was part of a 12-month, multi-site, hybrid type 2 effectiveness-implementation trial. The implementation evaluation utilized 3 qualitative semi-structured interviews (post-recruitment and mid- and post-implementation) with 12 Extension professionals implementing the DPP in 13 counties across all regions of Georgia. <h3>Measurable Outcome/Analysis</h3> The Consolidated Framework for Implementation Research (CFIR) was used to identify barriers and facilitators of DPP implementation in Extension. Interviews were coded deductively by 2 independent analysts based on CFIR constructs. Constructs were then rated (-2 to +2) to indicate their influence on implementation. Constructs with a strong influence on implementation were then evaluated for their influence on RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework domains. <h3>Results</h3> Preliminary analyses suggest that program length (Time [-2]) and the Intervention's Source (+2) from CDC had strong influences on Reach of the program; the DPP's Evidence Strength and Quality (+2) and the Tension for Change (+2) for more evidence-based Extension programming had strong positive influences on Adoption; and Networks and Communications (+2) had a strong positive influence on Implementation, especially during the COVID-19 pandemic. <h3>Conclusion</h3> Extension's infrastructure, culture, and need for evidence-based programming make it well-suited for DPP implementation. Results of this study can inform implementation strategies to improve the public health impact of DPP implementation in Extension in the future.

1097-P: Comparative Effectiveness of Diabetes Prevention Program Implementation Strategies

Background: In the US Diabetes Prevention Program (DPP) trial, a lifestyle intervention program focused on changes in diet and physical activity led to a 58% reduction in risk of developing type 2 diabetes. A variety of modifications to the DPP have been tested in clinical trials. We sought to compare the effects of different strategies for implementation of the US DPP on weight and other cardiometabolic outcomes. Methods: We conducted systematic searches of MEDLINE and Embase from January 2002 to August 2020. We included randomized controlled trials of adults that tested the effect of an intervention based on the US DPP on change in weight. Studies of at least 6 months duration were included. Two investigators independently extracted data. DPP implementation strategies were classified into eight different categories. Results: A total of 30 comparisons from 28 articles with 8,284 participants were included. Different strategies for implementing the DPP led to significant decreases in change in weight in the DPP compared with control arms during follow-up (Table). These strategies included intervention delivery through group sessions or combination of group and individual sessions. Additionally, interventions delivered by telehealth or by a combination of in-person and telehealth were effective. Conclusion: A number of different strategies for implementing the DPP lead to clinically meaningful decreases in weight. Disclosure K. S. Dorans: None. K. T. Mills: None. Y. Feng: None. A. A. Sethi: None. X. Li: None. J. He: None. Funding National Institute of General Medical Sciences (1P20GM109036-01A1)

Clinic- and Community-Based National Diabetes Prevention Programs in Los Angeles.

Clinics and community-based organizations (CBOs) are priority settings for implementing the evidence-based National Diabetes Prevention Program (DPP). Both program settings present theoretical advantages and disadvantages for engaging and helping populations most at risk for diabetes achieve lifestyle change goals. To date, few studies have compared implementation across them. The present study describes participant characteristics and lifestyle change outcomes across a sample of clinic- and community-based National DPPs which delivered services in Los Angeles during 2015 to 2018 (two clinics, two CBOs, combined n = 265 participants). Analyses examined participant gender, age, race/ethnicity, baseline body mass index, and program attributes such as screening method and language of instruction. Negative binomial regression models tested for differences in program attendance, mean weekly physical activity, and percent change in body weight by setting. Overall, participants were largely Hispanic/Latinx (81.51%) and female (90.19%). Programs operated by CBOs engaged other race/ethnic groups including Black participants more frequently than those operated by clinics (20.56% vs. 0%); the latter engaged more men (15.29% vs. 7.22%). Few participants in any setting met the National DPP's weight loss goal (clinic: 15.29%, CBO: 20.00%). Participating in a community-based program was initially associated with higher attendance and mean weekly physical activity, but associations were not significant after adjusting for covariates. Study results have practice implications for National DPP implementation and can help inform future efforts to scale and spread the program in Los Angeles and nationally.

Preventing Type 2 Diabetes in Women with Previous Gestational Diabetes: Reviewing the Implementation Gaps for Health Behavior Change Programs.

Gestational diabetes mellitus (GDM) places a woman at high risk of developing subsequent type 2 diabetes mellitus (T2DM), particularly in the first 5 years postpartum. Engaging women in health behavior change during this period is challenging and current diabetes prevention programs were developed for middle-aged adults, all of which have limited the evidence on successful implementation for this high-risk population. In this review, we will first summarize the effects of existing diabetes prevention programs in women with a history of GDM. Second, we suggest that the programs need to be modified according to the facilitators and barriers faced by this population. Third, we propose that improving program penetration, fidelity, and participation is critical for population-level success. Finally, we outline the research priorities to improve the implementation of diabetes prevention programs for postpartum women with a history of GDM.

Barriers and Facilitators to Real-world Implementation of the Diabetes Prevention Program in Large Healthcare Systems: Lifestyle Coach Perspectives.

Group-based lifestyle change programs based on the Diabetes Prevention Program (DPP) are associated with clinically significant weight loss and decreases in cardiometabolic risk factors. However, these benefits depend on successful real-world implementation. Studies have examined implementation in community settings, but less is known about integration in healthcare systems, and particularly in large, multi-site systems with the potential for extended reach. To examine the barriers and facilitators to successful DPP implementation in a large multi-site healthcare system. Semi-structured interviews, based on the RE-AIM framework, were conducted in person for 30-90min each. Past and present DPP lifestyle coaches in the healthcare system identified using purposive sampling. Thematic analysis of qualitative data to identify key factors influencing the success of DPP implementation. An iterative consensus process was used to model the relationships among factors. We conducted 33 interviews across 20 clinic sites serving 12 counties. Participants described six key factors as potential barriers or facilitators to implementation, including (1) Broader Context, including the surrounding physical and sociodemographic context; (2) Institutional Context, including finances, infrastructure, and personnel; (3) Program Provision, including curriculum, administration, cost, goals, and visibility; (4) Recruitment Process, including screening and referrals; (5) Lifestyle Coaches, including their characteristics, behaviors, and morale; and (6) Cohort, including group attrition/retention and interpersonal dynamics. These factors were both highly interconnected in their impact on implementation and widely variable across sites within the healthcare system, as illustrated in our multi-level conceptual framework. This study identified key factors that could serve as barriers or facilitators in the implementation of DPP in large healthcare systems, from the perspective of lifestyle coaches. With further examination, the conceptual model presented here may be used for planning and managing the implementation of group-based behavioral interventions in these settings.

899-P: Barriers and Facilitators to Implementation of the Group-Based Diabetes Prevention Program within a Large Health-Care System

Background: Lifestyle change programs based on the National Diabetes Prevention Program (DPP) are associated with clinically significant weight loss and decreases in cardiometabolic risk factors. However, these benefits depend on successful implementation in the real world. Studies have examined implementation in community settings, but less is known about integration in healthcare systems. We examined the barriers and facilitators to successful DPP implementation in a large multi-site healthcare system. Methods: Using purposive sampling, we conducted semi-structured interviews with past and present DPP lifestyle coaches in the healthcare system. Qualitative data were analyzed using deductive and inductive techniques to identify themes, which were organized into a conceptual framework using an iterative consensus process. Results: We conducted 33 interviews across 19 clinics serving 10 counties. Six interrelated themes and subthemes were identified: 1) Broader context, including the surrounding physical and demographic context; 2) Institutional setting, including finances, infrastructure, and personnel; 3) Program characteristics, including curriculum, administration, cost, goals, and visibility; 4) Participant recruitment, including screening and referrals; 5) Lifestyle coaches’ role, including their characteristics, behaviors, and morale; and 6) Participants’ characteristics, including attention, retention and group dynamics. Each theme and subtheme describes a key factor that served as a barrier and/or facilitator in the implementation process depending on the site-specific context and on each lifestyle coach’s approach to implementation. Conclusion: The study highlights the complexities associated with implementing a group-based DPP in a large healthcare system and emphasizes the key role of lifestyle coaches in overcoming site-specific barriers to implementation and adapting the program to the local context. Disclosure M. Halley: None. C. Nasrallah: None. N.K. Szwerinski: None. J.P. Petersen: None. R.J. Romanelli: None. K. Azar: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases

CDC releases diabetes prevention program action guide for pharmacies.

The Centers for Disease Control and Prevention (CDC) is urging the pharmacy profession to get involved in the national diabetes prevention program (DPP), which promotes a lifestyle intervention model for averting the onset of type 2 diabetes mellitus in patients at elevated risk for the condition. The DPP model uses a CDC-approved curriculum to help pharmacists and other healthcare professionals identify patients with prediabetes and encourage those patients to make healthier eating choices, exercise more, and manage stress. To facilitate peer support, DPP uses a group-coaching model, with at least 16 weekly sessions held during the first 6 months of program enrollment and monthly sessions held during months 7–12. Each DPP site must apply to CDC to become a recognized supplier of services and must regularly submit data to CDC and commit to enrolling at least 1 cohort of patients annually. According to CDC’s recently released DPP implementation guide for pharmacists, the program can be used in the ambulatory care setting “to maximize the unique skills and abilities of the pharmacy workforce.”

Prevalence of diabetes in three regions of Venezuela. The VEMSOLS study results

ObjectiveThe prevalence of diabetes in multiple regions of Venezuela is unknown. To determine the prevalence of diabetes in five populations from three regions of Venezuela. MethodsDuring 2006–2010, 1334 subjects ≥20years were selected by multistage stratified random sampling from all households from 3 regions of Venezuela. Anthropometric measurements and biochemical analysis were obtained. Statistical methods were calculated using SPSS 20 software. FindingsMean (SE) age was 44.8 years (0.39) and 68.5% were females. The prevalence of diabetes was 8.3% (95% CI, 6.9%–10.0%), higher in men than women (11.2% and 7.0% respectively; p=0.01). The prevalence adjusted by age and gender was 8.0% (95% CI, 6.9%–9.9%). This figure increased with age, with the lowest prevalence in the 20–29year old group (1.8% [95% CI, 0.6%–4.8%]) and the highest in the oldest group (26.8% [95% CI, 16.2%–40.5%]). Subjects with overweight or obesity had no increased risk of diabetes compared with those with normal weight. However, in women, the presence of abdominal obesity was associated with an increase of the risk of diabetes by 77% (OR 1.77 [95% CI, 1.1%–2.9%]). The prevalence of prediabetes was 14.6% (95% CI, 12.8%–16.7%), and only 48.2% were aware of their diabetes condition. ConclusionIn this study, 8.3% of the subjects had diabetes and 14.6% prediabetes. Less than half of the subjects with diabetes were aware of their condition. These results point to a major public health problem, requiring the implementation of diabetes prevention programs.

Lessons from Launching the Diabetes Prevention Program in a Large Integrated Health Care Delivery System: A Case Study.

There is urgent need for health systems to prevent diabetes. To date, few health systems have implemented the evidence-based Diabetes Prevention Program (DPP), and the few that have mostly partnered with community-based organizations to implement the program. Given the recent decision by the Centers for Medicare & Medicaid Services to reimburse for diabetes prevention, there is likely much interest in how such programs can be implemented within large health systems or how community partnerships can be expanded to support DPP implementation. Beginning in 2010, Montefiore Health System (MHS), a large health care system in the Bronx, NY, partnered with the Young Men's Christian Association (YMCA) of Greater New York to deliver the YMCA's DPP. Over 4 years, 1390 referrals to YMCA's DPP were made; 287 participants attended ≥3 classes, and average weight loss was 3.4%. Because of increased patient demand and internal capacity, MHS assumed responsibility for DPP implementation in May 2015. Fully integrating the program within the health system took 5–6 months, including configuring electronic health record templates/reports, hiring a coordinator, and creating clinical referral workflows/training guides. Billing workflows were designed for risk-based contracts. In the first 11 months of implementation, 1277 referrals were made, and referrals increased over time. Twenty-four class cycles were initiated, and 282 patients began attending classes. Average weight loss among 61 graduates from the Summer/Fall 2015 wave of MDPP classes was 3.8%. Additional opportunities for expansion include training allied health staff, providing patient incentives, increasing master trainer capacity, offering DPP to employees, and securing reimbursement.

Implementation findings from a hybrid III implementation-effectiveness trial of the Diabetes Prevention Program (DPP) in the Veterans Health Administration (VHA)

BackgroundThe Diabetes Prevention Program (DPP) is an effective lifestyle intervention to reduce incidence of type 2 diabetes. However, there are gaps in knowledge about how to implement DPP. The aim of this study was to evaluate implementation of DPP via assessment of a clinical demonstration in the Veterans Health Administration (VHA).MethodsA 12-month pragmatic clinical trial compared weight outcomes between the Veterans Affairs Diabetes Prevention Program (VA-DPP) and the usual care MOVE!® weight management program (MOVE!). Eligible participants had a body mass index (BMI) ≥30 kg/m2 (or BMI ≥ 25 kg/m2 with one obesity-related condition), prediabetes (glycosylated hemoglobin (HbA1c) 5.7–6.5% or fasting plasma glucose (FPG) 100–125 mg/dL), lived within 60 min of their VA site, and had not participated in a weight management program within the last year. Established evaluation and implementation frameworks were used to guide the implementation evaluation. Implementation barriers and facilitators, delivery fidelity, participant satisfaction, and implementation costs were assessed. Using micro-costing methods, costs for assessment of eligibility and scheduling and maintaining adherence per participant, as well as cost of delivery per session, were also assessed.ResultsSeveral barriers and facilitators to Reach, Adoption, Implementation, Effectiveness and Maintenance were identified; barriers related to Reach were the largest challenge encountered by site teams. Fidelity was higher for VA-DPP delivery compared to MOVE! for five of seven domains assessed. Participant satisfaction was high in both programs, but higher in VA-DPP for most items. Based on micro-costing methods, cost of assessment for eligibility was $68/individual assessed, cost of scheduling and maintaining adherence was $328/participant, and cost of delivery was $101/session.ConclusionsMulti-faceted strategies are needed to reach targeted participants and successfully implement DPP. Costs for assessing patients for eligibility need to be carefully considered while still maximizing reach to the targeted population.

A review of diabetes prevention program translations: use of cultural adaptation and implementation research.

The Diabetes Prevention Program (DPP) has been shown to prevent type 2 diabetes through lifestyle modification. The purpose of this study was to describe the literature on DPP translation, synthesizing studies using cultural adaptation and implementation research. A systematic search was conducted. Original studies evaluating DPP implementation and/or cultural adaptation were included. Data about cultural adaptation, implementation outcomes, and translation strategies was abstracted. A total of 44 were included, of which 15 reported cultural adaptations and 38 explored implementation. Many studies shortened the program length and reported a group format. The most commonly reported cultural adaptation (13 of 15) was with content. At the individual level, the most frequently assessed implementation outcome (n = 30) was adoption. Feasibility was most common (n = 32) at the organization level. The DPP is being tested in a variety of settings and populations, using numerous translational strategies and cultural adaptations. Implementation research that identifies, evaluates, and reports efforts to translate the DPP into practice is crucial.

The cost-effectiveness of diabetes prevention: results from the Diabetes Prevention Program and the Diabetes Prevention Program Outcomes Study.

BackgroundThe Diabetes Prevention Program (DPP) was a randomized, controlled clinical trial. It demonstrated that among high-risk individuals with impaired glucose tolerance, diabetes incidence was reduced by 58 % with lifestyle intervention and 31 % with metformin compared to placebo. During the Diabetes Prevention Program Outcomes Study (DPPOS), all DPP participants were unmasked to their treatment assignments, the original lifestyle intervention group was offered additional lifestyle support, the metformin group continued metformin, and all three groups were offered a group-implemented lifestyle intervention. Over the 10 years of combined DPP/DPPOS follow-up, diabetes incidence was reduced by 34 % in the lifestyle group and 18 % in the metformin group compared to placebo. The purpose of this article is to review and synthesize analyses published by the DPP/DPPOS Research Group that have described the cost-effectiveness of diabetes prevention.MethodsWe describe the resource utilization and costs of the DPP and DPPOS interventions, the costs of non-intervention-related medical care, the impact of the interventions on diabetes progression and quality-of-life, and the cost-effectiveness of the interventions from health system and societal perspectives. Cost-effectiveness analyses were performed with a 3-year time horizon using DPP data, a lifetime time horizon that simulated 3-year DPP data, and a 10-year time horizon using combined DPP/DPPOS data.ResultsAlthough more expensive than the placebo intervention, the greater costs of the lifestyle and metformin interventions were offset by reductions in the costs of nonintervention-related medical care. Every year after randomization, quality-of-life was better for participants in the lifestyle intervention compared to those in the metformin or placebo intervention. In both the simulated lifetime analysis and the 10-year within trial economic analysis, lifestyle and metformin were extremely cost-effective (that is, improved outcomes at a low incremental cost) or even cost-saving (that is, improved outcomes and reduced total costs) compared to the placebo intervention.ConclusionsThe implementation of diabetes prevention programs in high-risk individuals will result in important health benefits and represents a good value for money.Trial registration NCT00004992 (DPP) and NCT00038727 (DPPOS).Electronic supplementary materialThe online version of this article (doi:10.1186/s40842-015-0009-1) contains supplementary material, which is available to authorized users.

Implementation and evaluation of the VA DPP clinical demonstration: protocol for a multi-site non-randomized hybrid effectiveness-implementation type III trial

BackgroundThe Diabetes Prevention Program (DPP) study showed that lifestyle intervention resulted in a 58% reduction in incidence of type 2 diabetes among individuals with prediabetes. Additional large randomized controlled trials have confirmed these results, and long-term follow-up has shown sustained benefit 10–20 years after the interventions ended. Diabetes is a common and costly disease, especially among Veterans, and despite strong evidence supporting the feasibility of type 2 diabetes prevention, the DPP has not been widely implemented. The first aim of this study will evaluate implementation of the Veterans Affairs (VA) DPP in three VA medical centers. The second aim will assess weight and hemoglobin A1c (A1c) outcomes, and the third aim will determine the cost-effectiveness and budget impact of implementation of the VA DPP from a health system perspective.Methods/DesignThis partnered multi-site non-randomized systematic assignment study will use a highly pragmatic hybrid effectiveness-implementation type III mixed methods study design. The implementation and administration of the VA DPP will be funded by clinical operations while the evaluation of the VA DPP will be funded by research grants. Seven hundred twenty eligible Veterans will be systematically assigned to the VA DPP clinical demonstration or the usual care VA MOVE!® weight management program. A multi-phase formative evaluation of the VA DPP implementation will be conducted. A theoretical program change model will be used to guide the implementation process and assess applicability and feasibility of the DPP for VA. The Consolidated Framework for Implementation Research (CFIR) will be used to guide qualitative data collection, analysis, and interpretation of barriers and facilitators to implementation. The RE-AIM framework will be used to assess Reach, Effectiveness, Adoption, Implementation, and Maintenance of the VA DPP. Twelve-month weight and A1c change will be evaluated for the VA DPP compared to the VA MOVE! program. Mediation analyses will be conducted to identify whether program design differences impact outcomes.DiscussionFindings from this pragmatic evaluation will be highly applicable to practitioners who are tasked with implementing the DPP in clinical settings. In addition, findings will determine the effectiveness and cost-effectiveness of the VA DPP in the Veteran population.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-015-0250-0) contains supplementary material, which is available to authorized users.

Diagnosis and Medical Management of Gestational Diabetes

Gestational diabetes mellitus (GDM) is one of the most common medical complications during pregnancy. Both mother and baby are at increased risk of adverse pregnancy outcomes, as well as long-term metabolic effects such as diabetes. Diagnosing and treating GDM can reduce perinatal complications. The International Association of Diabetes and Pregnancy Study Groups (IADPSG) has proposed a new screening strategy for overt diabetes at the first prenatal visit and diagnostic criteria for GDM based on perinatal outcomes. However, controversies still exist and there is no international consensus about these issues. Regarding the management of GDM, individualized medical nutrition therapy is the cornerstone of treatment. If maternal glucose levels and/or fetal growth patterns show a sufficiently high risk of perinatal complications, insulin can be used to intensify treatment, and regimens should be tailored to meet glycemic targets. Postpartum screening for early detection of glucose intolerance and implementation of diabetes prevention programs are important for women with a history

Abstract P162: Lifestyle Intervention Improves Global Cardiovascular Health in Latinos with Prediabetes in Maracaibo, Venezuela

Introduction: The epidemics of obesity and hyperglycemia are associated with increased cardiovascular (CV) disease. There are limited data on the CV benefits of evidence-based lifestyle intervention strategies in developing countries. Aim: To assess impact o lifestyle intervention strategies based on the US Diabetes Prevention Program (DPP) on the global cardiovascular health. Methods: In a pilot clinical trial 140 Latino subjects (63.6% women) with prediabetes (ADA guidelines) were randomly assigned to receive either standard of care (SC, n=70) or group lifestyle (LS, n=70) intervention for 2 years in the healthcare system of Maracaibo, Venezuela. Ideal CV health behaviors (nonsmoking, achieving normal weight, enough physical activity, and a healthy diet) and ideal CV health factors (total cholesterol&lt;200 mg/dl, blood pressure&lt; 120/80 mmHg, and fasting blood glucose&lt;100 mg/dl) were evaluated at baseline and every 6 months. We calculated the American Heart Association (AHA) global CV health score assigning 1 to each ideal behavior and factor (for a maximum of 7) and 0 for poor status to each one. Results: Subjects were aged 48.1±11.8 years, had a BMI of 32.1±5.5kg/m² and a baseline score CV of 3.9 ±0.1 (i.e., 84.3% in SC and 88.6% in LS had poor to intermediate CV score). Larger improvements in the CV scores from baseline were obtained in the LS vs. SC (p&lt;0.0001) after 6 months (1.7±0.8 vs. 0.6±0.7), 12 months 2.3 ±0.8 vs. 1.2±0.8), 18 months (1.9±0.9 vs. 0.8±0.6) and 24 months (2.0±0.9 vs. 0.8±0.6) of intervention. At study end only 4.3% of LS and 47.1% of SC participants had poor-intermediate CV score (p&lt;0.01). Conclusions: Implementation of DPP- based lifestyle intervention leads to moderate improvements in overall CV health among Latinos with prediabetes in Venezuela. Achievement of the proposed 2020 AHA goal for better CV health seems feasible in this high-risk Latino population.

Implementation of diabetes prevention programs in rural areas: Montana and south‐eastern Australia compared

To identify the key elements that enabled the Greater Green Triangle Diabetes Prevention Project (GGT DPP) and the Montana Cardiovascular Disease and Diabetes Prevention (CDDP) programs successful establishment and implementation in rural areas, as well as identifying specific challenges or barriers for implementation in rural communities. Focus groups were held with the facilitators who delivered the GGT DPP in Australia and the Montana CDDP programs in the USA. Interview questions covered the facilitators' experiences with recruitment, establishing the program, the components and influence of rurality on the program, barriers and challenges to delivering the program, attributes of successful participants, and the influence of community resources and partnerships on the programs. Four main themes emerged from the focus groups: establishing and implementing the diabetes prevention program in the community; strategies for recruitment and retention of participants; what works in lifestyle intervention programs; and rural-centred issues. The results from this study have assisted in determining the factors that contribute to developing, establishing and implementing successful diabetes prevention programs in two rural areas. Recommendations to increase the likelihood of success of programs in rural communities include: securing funding early for the program; establishing support from community leaders and developing positive relationships with health care providers; creating a professional team with passion for the program; encouraging participants to celebrate their small and big successes; and developing procedures for providing post-intervention support to help participants maintain their success.