Diabetes Prevention Program Interventions Research Articles

334-OR: Implementation of a Modified Diabetes Prevention Program in WIC Clinics—A Pilot Study

Background: The aim of this study was to pilot implementation of a postpartum 8-week Diabetes Prevention Program (DPP)-like intervention in Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) clinics. Methods: Participants had gestational diabetes mellitus in their most recent pregnancy, delivered 6 weeks-12 months prior to recruitment, and used WIC services in the New Orleans region. The following implementation strategies were tested: partnership with and buy-in from WIC, intervention tailoring, variety of health coaches, and combining in-person and online delivery with tracking tools. Results: We enrolled 20 women; 18 completed the study. Health coaches delivering the intervention included a community dietitian, a WIC nutritionist, and a WIC health educator. Average participant age was 31.5 years, 55% of participants were Black and 30% were Hispanic/Latina. Session attendance was high and most participants liked the idea of joining a 1-year DPP program and thought it would be feasible (Table). Average 2-month changes in clinical outcomes were -1.5 kg (95% CI: -3.9, 0.8 kg) for weight, 0.02% (95% CI: -0.10, 0.14%) for hemoglobin A1c, and -4.9 mg/dL (95% CI: -11.3, 1.4 mg/dL) for fasting glucose. Conclusion: Based on these findings, we are conducting a cluster randomized trial to test different implementation strategies for delivering a 1-year postpartum DPP intervention in WIC clinics. Disclosure K.S.Dorans: None. M.M.Salles: None. B.Schoonenberg: None. G.I.Uwaifo: None. A.N.Bazzano: None. E.Harville: None. M.E.Schultheis: None. C.Bridgeforth: None. F.Alvarado: None. E.Dandridge: None. T.Dobson: None. J.He: None. C.Martin: None. K.T.Mills: None. Funding National Heart, Lung, and Blood Institute (OT2HL158287); National Institute of General Medical Sciences (P20GM109036)

332-OR: Association of Perceived Stress and Weight Loss in the National Diabetes Prevention Program (DPP)

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.

Cost-effectiveness analysis of a digital Diabetes Prevention Program (dDPP) in prediabetic patients.

To assess the cost-effectiveness of a digital Diabetes Prevention Program (dDPP) in preventing type 2 diabetes mellitus among prediabetic patients from a health system perspective over a 10-year time horizon. A Markov cohort model was constructed to assess the cost-effectiveness of dDPP compared to a small group education (SGE) intervention. Transition probabilities for the first year of the model were derived from two clinical trials on dDPP. Transition probabilities for longer-term effects were derived from meta-analyses on lifestyle and Diabetes Prevention Program interventions. Cost and health utilities were derived from published literature. Partial completion of interventions was incorporated to provide a robust prediction of a real-world deployment. Parameter uncertainties were assessed using univariate and probabilistic sensitivity analyses. Cost-effectiveness was measured by an incremental cost-effectiveness ratio (ICER) between dDPP and SGE from a health system perspective over a 10-year time horizon. The dDPP dominated the SGE at the $50,000, $100,000, and $150,000 willingness-to-pay thresholds per quality-adjusted life years (QALYs). The base case analysis at the $100,000 willingness-to-pay threshold (WTP) revealed a dominated ICER, with the SGE costing $1332 more and accruing an average of 0.04 fewer QALYs. Probabilistic sensitivity analysis showed that the dDPP was preferred in 64.4% of simulations across the $100,000 WTP thresholds. The findings comparing a dDPP to an SGE suggest that a dDPP can be cost-effective for patients with a high risk of developing type 2 diabetes.

Evaluation of feasibility and acceptability of a web-based diabetes prevention program (DPP) for diabetes risk reduction in Chinese Americans in New York City.

Intensive lifestyle intervention remains an effective modality to reduce diabetes incidence and delay the progression to type 2 diabetes. The primary aim of this study was to pilot-test the feasibility and acceptability of a culturally and linguistically tailored web-based DPP intervention among Chinese Americans with prediabetes living in New York City. Thirteen Chinese American participants with prediabetes were recruited to complete a 1-year web-based Diabetes Prevention Program (DPP) lifestyle intervention. Quantitative and qualitative measures such as retention rate and data collected from web-based questionnaires and focus groups were collected and analyzed to assess study feasibility and acceptability. Participants were receptive to the program through high engagement, retention and satisfaction. Retention rate was 85%. 92% of participants completed at least 16 sessions out of 22 sessions. Post-trial surveys indicated high satisfaction of 27.2/32 based on Client Satisfaction Questionnaire (CSQ-8) score. Participants expressed the program increased their knowledge and methods to prevent onset of type 2 diabetes such as incorporating healthy eating habits and increasing physical activities. Although not a primary outcome, there was a significant weight reduction of 2.3% at the end of month 8 of the program (p < 0.05). The culturally and linguistically adapted DPP via online platform successfully demonstrated feasibility and acceptability among Chinese Americans with prediabetes. Further evaluation of the web-based Chinese Diabetes Prevention Program in a larger trial is warranted.

Adaptation of diabetes prevention program for Chinese Americans – a qualitative study

BackgroundStudies have demonstrated that a culturally and linguistically tailored Diabetes Prevention Program (DPP) can be effective in reducing diabetes risk in Chinese Americans. The purpose of this study was to explore the cultural and linguistic acceptability of the Centers for Disease Control and Prevention’s Prevent T2 curriculum in an online format in the Chinese American community in New York City (NYC).MethodsThree focus groups among a total of 24 Chinese Americans with prediabetes and one community advisory board (CAB) meeting with 10 key stakeholders with expertise in diabetes care and lifestyle interventions were conducted. Each focus group lasted approximately 1 to 1.5 h. All groups were moderated by a bilingual moderator in Chinese. The sessions were audiotaped, transcribed and translated to English for analysis. Using Atlas.ti software and open coding techniques, two researchers analyzed transcripts for thematic analysis.ResultsFive key themes were identified: barriers to behavioral changes, feedback on curriculum content and suggestions, web-based intervention acceptability, web-based intervention feasibility, and web-based intervention implementation and modifications. Participants with prediabetes were found to have high acceptability of web-based DPP interventions. Suggestions for the curriculum included incorporating Chinese American cultural foods and replacing photos of non-Asians with photos of Asians. Barriers included lack of access to the internet, different learning styles and low technology self-efficacy for older adults.ConclusionAlthough the acceptability of web-based DPP in the Chinese American community in NYC is high, our focus group findings indicated that the major concern is lack of internet access and technical support. Providing support, such as creating an orientation manual for easy online program access for future participants, is important.

An Electronic Health Record–Compatible Model to Predict Personalized Treatment Effects From the Diabetes Prevention Program: A Cross-Evidence Synthesis Approach Using Clinical Trial and Real-World Data

ObjectiveTo develop an electronic health record (EHR)-based risk tool that provides point-of-care estimates of diabetes risk to support targeting interventions to patients most likely to benefit. Patients and MethodsA risk prediction model was developed and validated in a large observational database of patients with an index visit date between January 1, 2012, and December 31, 2016, with treatment effect estimates from risk-based reanalysis of clinical trial data. The risk model development cohort included 1.1 million patients with prediabetes from the OptumLabs Data Warehouse (OLDW); the validation cohort included a distinct sample of 1.1 million patients in OLDW. The randomly assigned clinical trial cohort included 3081 people from the Diabetes Prevention Program (DPP) study. ResultsEleven variables reliably obtainable from the EHR were used to predict diabetes risk. This model validated well in the OLDW (C statistic = 0.76; observed 3-year diabetes rate was 1.8% (95% confidence interval [CI], 1.7 to 1.9) in the lowest-risk quarter and 19.6% (19.4 to 19.8) in the highest-risk quarter). In the DPP, the hazard ratio (HR) for lifestyle modification was constant across all levels of risk (HR, 0.43; 95% CI, 0.35 to 0.53), whereas the HR for metformin was highly risk dependent (HR, 1.1; 95% CI, 0.61 to 2.0 in the lowest-risk quarter vs HR, 0.45; 95% CI, 0.35 to 0.59 in the highest-risk quarter). Fifty-three percent of the benefits of population-wide dissemination of the DPP lifestyle modification and 73% of the benefits of population-wide metformin therapy can be obtained by targeting the highest-risk quarter of patients. ConclusionThe Tufts–Predictive Analytics and Comparative Effectiveness DPP Risk model is an EHR-compatible tool that might support targeted diabetes prevention to more efficiently realize the benefits of the DPP interventions.

Evaluation of the University of California Diabetes Prevention Program (UC DPP) Initiative

BackgroundType 2 diabetes can negatively impact long term health outcomes, healthcare costs and quality of life. However, intensive lifestyle interventions, including the Diabetes Prevention Program (DPP), can significantly lower risk of incident type 2 diabetes among overweight adults with prediabetes. Unfortunately, the majority of adults in the US who are at risk of developing diabetes do not engage in DPP-based lifestyle change programs. Increased adoption of evidence-based obesity and diabetes prevention interventions, such as the DPP, may help large employers reduce health risks and improve health outcomes among employees. In 2018, the University of California Office of thePresident (UCOP) implemented the UC DPP Initiative, a novel, multi-component program to address diabetes and obesity prevention across the UC system.MethodsThe goal of our study is to conduct a multifaceted evaluation of the UC DPP Initiative using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Our evaluation will integrate unique and diverse UC data sources, including electronic health record (EHR) data, administrative claims, campus-based DPP cohort data, qualitative interviews and site visits. Our primary outcome of interest is the mean percent weight change among three groups of overweight/obese UC beneficiaries at risk for diabetes at 12-month follow-up. Secondary outcomes include mean percent weight change at 24-month follow-up, barriers and facilitators associated with implementatio, as well as the degree of program adoption and maintenance.DiscussionOur study will help inform diabetes and obesity prevention efforts across the UC system. Findings from this evaluation will also be highly applicable to universities and large employers, as well as community organizers, healthcare organizations and insurers implementing the DPP and/or other health promotion interventions.

Impact of Maintenance Session Attendance and Early Weight Loss Goal Achievement on Weight Loss Success in a Community-Based Diabetes Prevention Program Intervention.

The purpose of this study was to examine how maintenance session attendance and 6-month weight loss (WL) goal achievement impacted 12-month 5% WL success in older adults participating in a community-based Diabetes Prevention Program (DPP) lifestyle intervention. Data were combined from 2 community trials that delivered the 12-month DPP-based Group Lifestyle Balance (GLB) to overweight/obese adults (mean age = 62 years, 76% women) with prediabetes and/or metabolic syndrome. Included participants (n = 238) attended ≥4 core sessions (months 0-6) and had complete data on maintenance attendance (≥4 of 6 sessions during months 7-12) and 6- and 12-month WL (5% WL goal, yes/no). Multivariate logistic regression was used to estimate the odds of 12-month 5% WL associated with maintenance attendance and 6-month WL. Associations between age (Medicare-eligible ≥65 vs <65 years) and WL and attendance were examined. Both attending ≥4 maintenance sessions and meeting the 6-month 5% WL goal increased the odds of meeting the 12-month 5% WL goal. For those not meeting the 6-month WL goal, maintenance session attendance did not improve odds of 12-month WL success. Medicare-eligible adults ≥65 years were more likely to meet the 12-month WL goal (odds ratio = 3.03, 95% CI, 1.58-5.81) versus <65 years. The results of this study provide important information regarding participant attendance and WL for providers offering DPP-based lifestyle intervention programs across the country who are seeking Medicare reimbursement. Understanding Medicare reimbursement-defined success will allow these providers to focus on and develop strategies to enhance program effectiveness and sustainability.

Better Me Within Randomized Trial: Faith-Based Diabetes Prevention Program for Weight Loss in African American Women.

Previous DPP translations in African American women have been suboptimal. This trial evaluated a community-based participatory research developed faith-based diabetes prevention program (DPP) to improve weight loss in African American women. This cluster randomized trial allocated churches to faith-based (FDPP) or standard (SDPP) DPP interventions. Setting. African American churches. Subjects. Eleven churches with 221 African American women (aged 48.8 ± 11.2 years, BMI = 36.7 ± 8.4) received the FDPP (n = 6) or SDPP (n = 5) intervention. FDPP incorporated 5 faith-based components, including pastor involvement, into the standard DPP curriculum. The SDPP used the standard DPP curriculum. Lay health leaders facilitated interventions at church sites. Weight and biometrics were collected by blinded staff at baseline, 4- and 10-months. A multilevel hierarchical regression model compared the FDPP and SDPP groups on outcomes. FDPP and SDPP churches significantly lost weight at 10-months (overall -2.6%, p < .01). Women in FDPP churches who attended at least 15 sessions lost an additional 6.1 pounds at 4-months compared to SDPP corresponding to a 5.8% reduction at 10-months (p < .05). Both groups had significant improvements in health behaviors and biometrics. Faith-based and standard DPP interventions led by lay health leaders successfully improved weight, health behaviors, and chronic disease risk. However, the faith-based DPP when fully implemented met the CDC's recommendation for weight loss for diabetes prevention in African American women.

Physical fitness and activity changes after a 24-week soccer-based adaptation of the U.S diabetes prevention program intervention in Hispanic men

PurposeOne third of the U.S. adult population is estimated to have prediabetes. Hispanics have a 50% higher type 2 diabetes (T2DM) death rate compared to non-Hispanic whites, yet low participation in lifestyle change programs, making this subgroup an important target for prevention efforts. The purpose of this study was to determine the effects of an exercise intervention implementing the Center for Disease Control and Prevention National Diabetes Prevention Program (NDPP) plus recreational soccer (RS) in Hispanic men. MethodsOverweight and obese Hispanic men, aged 30–57 years with prediabetes at screening were recruited from the community. Trained soccer coaches led 30-min facilitated discussion of the NDPP modules after each RS session, with two weekly sessions delivered over 12 wks, then once a wk until 24 wks. The 1-h RS sessions followed the Football Fitness curriculum structure. Standardized study assessments included objectively measured physical activity via fitness tracker, physical fitness via validated field tests, global positional system soccer specific metrics and behavior change questionnaires. Mixed models assessed the outcomes as a function of time and cohort and incorporated an unstructured covariance structure to examine the difference between baseline, 12 and 24 wks. All analyses were conducted as intent-to-treat and generated using SAS v 9.4. RESULTS: Hispanic males (n = 41; mean age 41.9 [6.2 SD] years) were obese at baseline (mean BMI 32.7, standard error [0.7]). After 24 wks of the NDPP+RS intervention, there were significant beneficial changes in vertical jump (2.8 [1.3] cm; p = 0.048), agility and lower extremity muscular power (figure 8-run) at 12 wks (−4.7% change; p = 0.001) and 24 wks (−7.2% change; p < 0.0001), predicted VO2 max (12 wks: 1.9%; p = 0.007; 24 wks 1.0%; p = 0.036), modified push-ups increased 22% (p < 0.0001) at 12 wks and 31% (p < 0.0001) at 24 wks, dynamic sit-ups increased 10% (p = 0.005) at 12 wks and 15% (p < 0.0001) at 24 wks. CONCLUSION: Among middle-aged Latino men, broad-ranging significant improvements in physical fitness were observed after 24 wks participating in lifestyle education plus RS in a single arm feasibility trial.

Reducing metabolic syndrome through a community-based lifestyle intervention in African American women

Background and aimsMetabolic syndrome (MetS) increases the risk of cardiovascular disease and type 2 diabetes. Despite a higher prevalence of MetS in African American (AA) women, little is known about the effectiveness of lifestyle interventions in improving metabolic markers in this high-risk group. This study investigated the effectiveness of a community-based lifestyle intervention delivered by lay health coaches in reducing MetS among AA women. Methods and resultsA cluster-randomized diabetes prevention program (DPP) was implemented in 11 churches utilizing a community-based participatory research (CBPR) approach to develop and deliver the interventions. A total of 221 adults, AA women who were overweight or obese, and did not have diabetes were included in this study. The prevalence of MetS was 42.08% before receiving the DPP intervention and 31.22% after the intervention that represented a 10.86% absolute reduction and a 25.81% relative reduction from baseline. The adjusted odds ratio (OR) of being free from MetS at post-intervention in contrast to baseline was 2.14 (p = 0.02). Factors that increased the odds of being free from MetS were younger age, reduction in intake of total calories, total fat, saturated and trans-fat, and dietary sodium. ConclusionA faith adapted lifestyle intervention held in church settings and delivered by minimally trained lay health coaches reduced the prevalence of MetS in AA women who were overweight or obese. Findings from this study can be used to translate evidence into public health programs at the community level for the prevention of type 2 diabetes and cardiovascular disease. Clinical trial registration numberNCT 04082702 (www.clinicaltrials.gov).

PARTNERING WITH NUTRITION SERVICES PROGRAM PROVIDERS TO DISSEMINATE EVIDENCE-BASED PROGRAMS USING TELE-HEALTH

Among adults ≥ age 65, 48% have prediabetes and are eligible to participate in the Medicare-covered Diabetes Prevention Program (DPP). We conducted a six-week pilot study to evaluate the feasibility and acceptability of a telehealth-adapted DPP for Nutrition Services Program (NSP) older adult meal program recipients. We enrolled NSP recipients (n=16) from a New York City senior center. These DPP participants attended weekly interactive DPP webinars and completed questionnaires covering lifestyle, physical activity, quality of life, and food records, and wore physical activity trackers. Retention was 75%; attendance averaged 80%; and weight loss was 2.9% (p=0.001). Our six-week pilot data suggest that a tele-adapted DPP intervention can achieve the Medicare reimbursement goals for attendance and 5% weight loss. We are surveying NSP recipients, who receive home-delivered meals, to evaluate the acceptability and feasibility of conducting a larger scale tele-adapted DPP intervention trial among NSP participants.

900-P: Long-Term Effectiveness of a DPP for Prediabetic Hispanic Women

The prevalence of type 2 diabetes(T2DM) in Hispanic Americans, at 22.6%, is twice that of non-hispanic whites. The NIDDK Diabetes Prevention Program (DPP) showed that an intensive lifestyle intervention can reduce the incidence of T2DM by 58% in many ethnic/racial groups. The DPP at Fair Haven Community Heath Care (FHCHC) in New Haven, CT is a modified NIDDK/CDC DPP which aims to promote weight loss, physical activity and reduced incidence of T2DM among Hispanic patients. A previous randomized controlled study showed that female participants in this DPP benefited with decreased weight, lower glucose excursions and improved fasting insulin one year after enrolling compared to controls. The purpose of this follow-up study is to assess the long-term effectiveness of the FHCHC DPP. Methods: This study took place at FHCHC after obtaining IRB approval. A retrospective chart review was conducted comparing participants randomly assigned to the DPP with those assigned to control group. Measures abstracted included fasting glucose, 2-hour OGTT, HbA1c, lipids, blood pressure, BMI and medications from all medical visits between the date of enrollment and October 2018. Results: All 66/66 original subjects in the DPP intervention group as well as 66/66 controls had clinical data beyond 1 year. An average of over 7 years follow-up was available for analysis. ANCOVA test comparing change of weight from baseline to specific time periods showed a significant difference between groups in change from baseline to year 1 of 20.86 lbs. (p=.001), change to year 2 and 3 of 13.8 lbs. (p=.004), but not year 4 and 5 of 11.3 lbs. (p=.067) or year 6+ 10. 0 lbs. (p=.163). There was no statistically significant difference between the two groups in fasting glucose, two-hour glucose tolerance test, or HbAlc. Conclusion: Weight loss shown after 1 year of the FHCHC DPP was sustained at years 2 and 3 but not at years 4 through 7. HbA1C, two-hour glucose, and fasting glucose were not significantly different between groups after the first 1 year. Disclosure P.D. Shah: None. R. Feinn: None. J. Rockfeld: None. A.W. Camp: None.

Development of a Videoconference-Adapted Version of the Community Diabetes Prevention Program, and Comparison of Weight Loss With In-Person Program Delivery.

IntroductionEffective, standardized, and easily accessible weight management programs are urgently needed for military beneficiaries. Videoconference interventions have the potential for widespread scaling, and can provide both real time interaction and flexibility in delivery times regardless of location, but there is little information on their effectiveness and acceptability.Materials and MethodsThis study as part of a larger weight loss trial describes the videoconference adaption of Group Lifestyle Balance (GLB) program, a community group-based Diabetes Prevention Program intervention, and provides a comparison of weight loss and meeting attendance between in-person and videoconference delivery modes over 12 weeks in adult family members of military service members. Forty-three participants were enrolled from two military installations and received either the videoconference-adapted or an in-person GLB program in a non-randomized trial design. Differences in program attendance and percent weight lost at 12 weeks were compared by independent samples t-tests and nonparametric methods. Group differences in the percentage of weight lost over the 12-week period were analyzed using a linear mixed model.ResultsAll GLB intervention components were successfully delivered by videoconference with minor adaptations for the different delivery mechanism. Participant retention was 70% and 96% in the in-person and videoconference groups, respectively (p = 0.04). Completing participants in both groups lost a significant percent body weight over the 12 week intervention (p < 0.001) and there was no difference in percent body weight after 12 weeks of intervention (6.2 ± 3.2% and 5.3 ± 3.4% for in-person and videoconference at 12 weeks, respectively; p = 0.60).ConclusionThis study describes the first videoconference adaption of the GLB program for use in military families. Attrition was lower in the videoconference group, and there were a similar levels of weight loss in both groups regardless of delivery modality. Videoconference weight loss interventions are effective and feasible for scaling to support healthy weight management in military as well as civilian populations.

How stakeholder engagement influenced a randomized comparative effectiveness trial testing two Diabetes Prevention Program interventions in a Marshallese Pacific Islander Community

BackgroundMarshallese face significant health disparities, with particularly high rates of type 2 diabetes. Engaging stakeholders in the research process is essential to reduce health inequities.MethodsA community- and patient-engaged research approach was used to involve community Marshallese stakeholders in a randomized comparative effectiveness trial testing two Diabetes Prevention Program interventions.ResultsThe article outlines the engagement process and the specific influence that stakeholders had on the research planning and implementation, discussing the areas of agreement and disagreement between community and patient stakeholders and academic investigators and documenting changes to the research protocol.ConclusionThe article provides an example of methods that can be used to design and conduct a randomized controlled trial testing with a population who has been underrepresented in research and suffered significant historical trauma.

Results From a Trial of an Online Diabetes Prevention Program Intervention

Online Diabetes Prevention Programs (DPPs) can be scaled up and delivered broadly. However, little is known about real-world effectiveness and how outcomes compare with in-person DPP. This study examined online DPP weight loss and participation outcomes and secondarily compared outcomes among participating individuals with parallel in-person interventions. A large non-randomized trial supplemented by a comparative analysis of participating individuals from a concurrent trial of two parallel in-person programs: in-person DPP and the Veterans Administration's standard of care weight loss program (MOVE!). Obese/overweight Veterans with prediabetes enrolled in online DPP (n = 268) between 2013 and 2014. Similar eligibility criteria were used to enroll in-person participants between 2012 and 2014 (n = 273 in-person DPP, n = 114 MOVE!) within a separate trial. Online DPP included a virtual group format, live e-coach, weekly modules delivered asynchronously, and wireless home scales. In-person programs included eight to 22 group-based, face-to-face sessions. Weight change at 6 and 12 months using wirelessly uploaded home scale data or electronic medical record weights from clinical in-person visits. Outcomes were analyzed between 2015 and 2017. From 1,182 invitations, 268 (23%) participants enrolled in online DPP. Among these, 158 (56%) completed eight or more modules; mean weight change was -4.7kg at 6 months and -4.0kg at 12 months. In a supplemental analysis of participants completing one or more sessions/modules, online DPP participants were most likely to complete eight or more sessions/modules (87% online DPP vs 59% in-person DPP vs 55% MOVE!, p < 0.001). Online and in-person DPP participants lost significantly more weight than MOVE! participants at 6 and 12 months; there was no significant difference in weight change between online and in-person DPP. An intensive, multifaceted online DPP intervention had higher participation but similar weight loss compared to in-person DPP. An intensive, multifaceted online DPP intervention may be as effective as in-person DPP and help expand reach to those at risk.

Association of Intensive Lifestyle Intervention and Metformin with Frailty in the Diabetes Prevention Program (DPP) Outcomes Study (DPPOS)

Objective: To examine whether odds of frailty differ by DPP intervention arms (intensive lifestyle intervention [ILS], metformin [MET], placebo [PLB] after long-term follow-up in the DPPOS. Methods: DPP, a randomized trial of individuals at high risk of diabetes, lasted 2.8 years, after which there was a 13-month bridge period in which 16 sessions of group ILS was offered to all participants. During DPPOS, ILS was offered lifestyle reinforcement semi-annually and MET received unmasked metformin. Frailty was measured initially in DPPOS Year 8 in 2385 participants and repeated in 2264 of these in Year 10 (12 and 14 years after randomization). Using Fried criteria, presence of 3 of 5 characteristics (slow walking speed, weak grip strength, unintentional weight loss, low physical activity, and exhaustion) was classified as frail, 1 or 2 pre-frail, and 0 non-frail.: GEE models adjusting for visit year were employed with repeated measures pooled from Years 8 and 10 to estimate pairwise odds ratios between ILS, MET and PLB for the outcomes of frail and pre-frail vs. non-frail. Results: Odds of frailty vs. non-frailty were 37% lower in ILS compared to PLB (Table) and MET (OR=0.629, CI= 0.420-0.942, p=0.024). There were no significant treatment group differences in odds of pre-frailty. Conclusion: ILS intervention in persons at high risk of diabetes may reduce frailty in later life.12 years Post-randomization14 years post-randomizationOdds of Frailty vs. Non-Frailty Pooled over both examsTreatment GroupPrevalencePrevalence OR (95% CI) compared with placeboP-valuePre-FrailtyFrailtyPre-FrailtyFrailtyPlacebo42.8%5.7%43.7%5.4%1 (referent)n/aMetformin45.8%5.4%42.5%5.3%0.994 (0.694-1.424)0.976Lifestyle46.8%3.0%46.3%3.6%0.625 (0.419-0.934)0.022 Disclosure H.P. Hazuda: None. Q. Pan: None. J.P. Crandall: None. H. Florez: Advisory Panel; Self; Sanofi. J.A. Luchsinger: None. E.M. Venditti: None. A. Kriska: None. S. Golden: None. G. Bray: Advisory Panel; Self; Herbalife International of America, Inc., Novo Nordisk A/S. D. Research Group: None.

A Latino Patient-Centered, Evidence-Based Approach to Diabetes Prevention.

Cultural tailoring of evidence-based diabetes prevention program (DPP) interventions is needed to effectively address obesity and its related chronic diseases among Latinos in primary care. This article describes the patient-centered process used to adapt the DPP and reports cultural adaptations. We used a 2-stage formative research process to culturally adapt an evidence-based DPP intervention in the context of primary care. The first stage involved 5 focus groups of Latino patients and interviews with 5 stakeholders (3 with primary care physicians and 2 with medical directors) to inform a first round of adaptations. The second stage included pretesting the stage I-adapted intervention with a Latino patient advisory board to complete a second round of adaptations. Key stakeholders involved in this 2-stage adaptation process included 34 Latino patients who participated in 5 focus groups and 5 physicians and medical directors who participated in key informant interviews during stage I and 11 patients who attended the 16 advisory board meetings and their family members who attended 1 of the meetings during stage II. Using this patient-centered stakeholder-engaged approach, we found the original intervention was largely congruent with the cultural values of the study population. To further strengthen the cultural relevance of the intervention, salient cultural values emphasized by patients and stakeholders underscored the importance of family and community support for behavior change. Accordingly, key adaptations were made to (1) invite family members to the orientation session and at 2 other key timepoints to facilitate family support, (2) provide participants support from the coach and each other via smartphone applications, and (3) provide healthy, easy, low-cost culturally appropriate meals at each group session. The 2-stage approach actively engaging patients, family members, providers, and health care system leaders reinforced the cultural congruence of the existing intervention while further strengthening it with adaptations promoting Latino family and community support.

A Review of Technology-Assisted Interventions for Diabetes Prevention.

The high prevalence of prediabetes and success of the diabetes prevention program (DPP) has led to increasing efforts to provide readily accessible, cost-effective DPP interventions to the general public. Technology-assisted DPP interventions are of particular interest since they may be easier to widely distribute and sustain as compared to traditional in-person DPP. The purpose of this article is to provide an overview of currently available technology-assisted DPP interventions. This review focuses on studies that have examined the use of mobile phone text messaging, smartphone/web-based apps, and telehealth programs to help prevent or delay the onset of incident type 2 diabetes. While there is variability in the results of studies focused on technology-assisted DPP and weight loss interventions, there is evidence to suggest that these programs have been associated with clinically meaningful weight loss and can be cost-effective. Patients who are at risk for diabetes can be offered technology-assisted DPP and weight loss interventions to lower their risk of incident diabetes. Further research should determine what specific combination of intervention features would be most successful.

Cardiometabolic Risk Factor Changes Observed in Diabetes Prevention Programs in US Settings: A Systematic Review and Meta-analysis.

BackgroundThe Diabetes Prevention Program (DPP) study showed that weight loss in high-risk adults lowered diabetes incidence and cardiovascular disease risk. No prior analyses have aggregated weight and cardiometabolic risk factor changes observed in studies implementing DPP interventions in nonresearch settings in the United States.Methods and FindingsIn this systematic review and meta-analysis, we pooled data from studies in the United States implementing DPP lifestyle modification programs (focused on modest [5%–7%] weight loss through ≥150 min of moderate physical activity per week and restriction of fat intake) in clinical, community, and online settings. We reported aggregated pre- and post-intervention weight and cardiometabolic risk factor changes (fasting blood glucose [FBG], glycosylated hemoglobin [HbA1c], systolic or diastolic blood pressure [SBP/DBP], total [TC] or HDL-cholesterol). We searched the MEDLINE, EMBASE, Cochrane Library, and Clinicaltrials.gov databases from January 1, 2003, to May 1, 2016. Two reviewers independently evaluated article eligibility and extracted data on study designs, populations enrolled, intervention program characteristics (duration, number of core and maintenance sessions), and outcomes. We used a random effects model to calculate summary estimates for each outcome and associated 95% confidence intervals (CI). To examine sources of heterogeneity, results were stratified according to the presence of maintenance sessions, risk level of participants (prediabetes or other), and intervention delivery personnel (lay or professional).Forty-four studies that enrolled 8,995 participants met eligibility criteria. Participants had an average age of 50.8 years and body mass index (BMI) of 34.8 kg/m2, and 25.2% were male. On average, study follow-up was 9.3 mo (median 12.0) with a range of 1.5 to 36 months; programs offered a mean of 12.6 sessions, with mean participant attendance of 11.0 core sessions. Sixty percent of programs offered some form of post-core maintenance (either email or in person). Mean absolute changes observed were: weight -3.77 kg (95% CI: -4.55; -2.99), HbA1c -0.21% (-0.29; -0.13), FBG -2.40 mg/dL (-3.59; -1.21), SBP -4.29 mmHg (-5.73, -2.84), DBP -2.56 mmHg (-3.40, 1.71), HDL +0.85 mg/dL (-0.10, 1.60), and TC -5.34 mg/dL (-9.72, -0.97). Programs with a maintenance component achieved greater reductions in weight (additional -1.66kg) and FBG (additional -3.14 mg/dl).Findings are subject to incomplete reporting and heterogeneity of studies included, and confounding because most included studies used pre-post study designs.ConclusionsDPP lifestyle modification programs achieved clinically meaningful weight and cardiometabolic health improvements. Together, these data suggest that additional value is gained from these programs, reinforcing that they are likely very cost-effective.