Diabetes Prevention Program Lifestyle Change Research Articles

A structural equation model of CFIR inner and outer setting constructs, organization characteristics, and national DPP enrollment

BackgroundThe National Diabetes Prevention Program (DPP) has made great strides in increasing accessibility to its year-long, evidence-based lifestyle change program, with around 3000 organizations having delivered the program. This large dissemination effort offers a unique opportunity to identify organization-level factors associated with program implementation and reach (enrollment) across diverse settings. The purpose of this study was to quantitatively examine the relationships among Consolidated Framework for Implementation Research (CFIR) Inner Setting and Outer Setting constructs and the implementation outcome of reach.MethodsThis study analyzed data from a 2021 cross-sectional online survey with 586 National DPP Staff (lifestyle coaches, master trainers, program coordinators) with information about their organization, implementation outcomes, and responses to quantitative CFIR Inner Setting and Outer Setting construct items. Structural equation modeling was used to test a hypothesized path model with Inner and Outer Setting variables to explore direct and indirect pathways to enrollment.ResultsThe CFIR items had good internal consistency and indicated areas of implementation strength and weakness. Eight variables included as part of the CFIR structural characteristics and one organization characteristic variable had significant direct relationships with enrollment. The length of delivery, number of lifestyle coaches, number of full-time staff, large organization size, and organizations delivering in rural, suburban, and/or urban settings all had positive significant direct relationships with enrollment, while academic organizations and organizations with only non-White participants enrolled in their National DPP lifestyle change programs had a negative association with enrollment.ConclusionsParticipant reach is an important implementation outcome for the National DPP and vital to making population-level decreases in diabetes incidence in the USA. Our findings suggest that to facilitate enrollment, program implementers should focus on organizational structural characteristics such as staffing. Strengths of this study include the use of adapted and newly developed quantitative CFIR measures and structural equation modeling. Health prevention programs can use the methods and findings from this study to further understand and inform the impact of organization factors on implementation outcomes.

333-OR: What Motivates People to Enroll in the National Diabetes Prevention Program Lifestyle Change Program

In 2021, the Centers for Disease Control and Prevention (CDC) began collecting data on what motivates people to enroll in the National Diabetes Prevention Program (National DPP) lifestyle change program (LCP). Upon enrolling in the LCP, participants are asked, “Who/what motivated you the most to sign up for this program?” Participants may choose health care professional, blood test results, prediabetes risk test, someone at a community-based organization (CBO), family/friends, current/past participant in the LCP, employer/employer’s wellness plan, health insurance plan, and media advertisements. By October 2022, these data had been collected on 128,116 eligible participants, of whom 25% reported that the prediabetes risk test motivated them the most, followed by their employer/employer’s wellness plan (23%), and health care professional (14%). Motivators were similar in men and women, with the prediabetes risk test and employer/employer’s wellness plan being the top 2 motivators. Across age groups, the prediabetes risk test and employer/employer’s wellness plan motivated adults aged 18-64 years the most, while health care professionals motivated individuals aged 65 years and over the most. Motivators varied across racial/ethnic groups, with family/friends, current/past participants, and someone at a CBO motivating some groups more than others. Though more participants were motivated by the prediabetes risk test, they did not stay in the program as long as those who were motivated by their employer/employer’s wellness plan, family/friends, or someone at a CBO (180 mean days vs. 278, 264, and 261 days, respectively). What might motivate participants to enroll in the LCP may not be what helps them stay in the program longer and may influence their risk reduction outcomes, including weight loss and engagement in physical activity. Understanding motivators can help organizations focus recruitment and enrollment efforts and support participants in achieving their goals. Disclosure M.Papalii: None. E.Ely: None.

547-P: Impact of the COVID-19 Public Health Emergency on Delivery of the National Diabetes Prevention Program Lifestyle Change Program

In January 2020, the Department of Health and Human Services (HHS) declared the COVID-19 pandemic to be a public health emergency (PHE). As a result of this declaration, organizations delivering the National DPP lifestyle change program (LCP) had to decide whether to hold program sessions virtually, in socially distanced spaces, or discontinue (temporarily or permanently). This analysis looks at how CDC-recognized organizations chose to deliver, or not deliver, the LCP during this time. As of data submitted by October 2022, 1,810 organizations had delivered at least one session since 2019, the year leading up to the PHE. At the start of 2020, 1,370 organizations were active: 1,251 in-person, 28 online, 44 distance learning, and 47 combination. The remaining 440 were either approved during the PHE or had gone inactive before the start of it. Of those active at the start of 2020, 219 (16%) had not submitted data on sessions held on or after this time, indicating a pause in delivery. Since the PHE began, 373 new organizations have been approved, 357 of which are still active. Of these new organizations, 241 have been mainly focused on delivery with at least one virtual component. Approval of new organizations in 2020 decreased for those delivering in-person, whereas approval of new online, distance learning, and combination organizations increased by 207%, 158%, and 122%, respectively. Data submitted by in-person organizations in 2020 and 2021 indicated that many of them delivered only virtual sessions during that time, which might explain the large increases in approval of virtual organizations. New enrollment after the start of 2020 among these organizations was 185,596 as of October 2022: 62,217 in in-person organizations, 99,688 in online, 14,859 in distance learning, and 8,832 in combination. As we move out of the PHE, we are mindful of the need to help organizations delivering the LCP adapt to more flexible delivery to accommodate participants’ evolving needs. Disclosure E.Ely: None.

690-P: Variation in Physical Activity and Weight Loss by Demographic Characteristics among Participants in the National Diabetes Prevention Program

The National Diabetes Prevention Program lifestyle change program aims to prevent type 2 diabetes by promoting behavioral changes such as increased physical activity and improved nutrition, with a goal of losing ≥5% of body weight. We analyzed data from 2012-2019 from participants who reported weekly physical activity (PA) minutes and weight and who participated either in-person (N=127,092) or online (self-paced, asynchronous interactions with coach) (N=196,670). Among those retained through the core phase (16 sessions), average weekly PA minutes were higher among men than women (228 vs. 182 in-person and 277 vs. 204 online), higher for older than younger participants (210 vs. 187 vs. 164 in-person and 248 vs. 233 vs. 191 online for ≥65, 45-64, and 18-44 years), higher for those with lower BMI (213 vs. 184 in-person and 244 vs. 215 online for 23-29 BMI and ≥30 BMI) and varied by race/ethnicity (187 in-person and 183 online for non-Hispanic Black participants, 183 in-person and 207 online for Hispanic participants, and 198 in-person and 227 online for non-Hispanic White participants). Percent weight loss by session 16 was greater for men than women (6.0 vs. 5.2 in-person and 5.5 vs. 4.2 online), greater for older than younger participants (5.8 vs. 5.3 vs. 4.6 in-person and 5.5 vs. 4.7 vs. 4.0 online for ≥65, 45-64, and 18-44 years), greater for those with higher BMI (5.2 vs. 5.4 in-person and 4.4 vs. 4.6 online for 23-29 BMI and ≥30 BMI) and varied by race/ethnicity (3.8 in-person and 3.7 online for non-Hispanic Black participants, 4.4 in-person and 4.0 online for Hispanic participants, and 5.9 in-person and 4.8 online for non-Hispanic White participants). We found that participants with different demographic characteristics experience program successes differently despite similar time in the program, suggesting a need to understand the reasons for these differences and customize program delivery strategies to address them. Disclosure M.Cannon: None. B.Ng: None. E.Ely: None.

Use and Impact of Type 2 Diabetes Prevention Interventions

RCTs have found that type 2 diabetes can be prevented among high-risk individuals by metformin medication and evidence-based lifestyle change programs. The purpose of this study is to estimate the use of interventions to prevent type 2 diabetes in real-world clinical practice settings and determine the impact on diabetes-related clinical outcomes. The analysis performed in 2020 used 2010‒2018 electronic health record data from 69,434 patients aged ≥18 years at high risk for type 2 diabetes in 2 health systems. The use and impact of prescribed metformin, lifestyle change program, bariatric surgery, and combinations of the 3 were examined. A subanalysis was performed to examine uptake and retention among patients referred to the National Diabetes Prevention Program. Mean HbA1c values declined from before to after intervention for patients who were prescribed metformin (-0.067%; p<0.001) or had bariatric surgery (-0.318%; p<0.001). Among patients referred to the National Diabetes Prevention Program lifestyle change program, the type 2 diabetes postintervention incidence proportion was 14.0% for nonattendees, 12.8% for some attendance, and 7.5% for those who attended ≥4 sessions (p<0.001). Among referred patients to the National Diabetes Prevention Program lifestyle change program, uptake was low (13% for 1‒3 sessions, 15% for ≥4 sessions), especially among males and Hispanic patients. Findings suggest that metformin and bariatric surgery may improve HbA1c levels and that participation in the National Diabetes Prevention Program may reduce type 2 diabetes incidence. Efforts to increase the use of these interventions may have positive impacts on diabetes-related health outcomes.

48-LB: Retention in the National Diabetes Prevention Program Lifestyle Change Program by Participant-Level Factors

Retention is closely linked to clinical outcomes in the National Diabetes Prevention Program (National DPP) lifestyle change program (LCP) . We examined retention, defined as the number of sessions attended, using data collected by the CDC Diabetes Prevention Recognition Program, the quality assurance component of the National DPP. We evaluated participants who enrolled in in-person lifestyle change programs from March 2018 to November 2020 and had the opportunity to complete at least 9 months of the 12-month program. To control for programmatic changes due to COVID-19, we divided enrollment into 3 cohorts: 1) 3/1/2018 - 5/31/2019 (before) , 2) 6/1/2019-2/29/2020 (mixed) , and 3) 3/1/2020-11/30/2020 (during COVID-19 pandemic) . Mean sessions attended was lower in cohort 3 (10.8, p<0.05) than in cohorts 1 (12.9) and 2 (12.6) . As shown in Table 1, across the 3 cohorts the following factors were associated with lower mean number of sessions attended: younger age, Hispanic ethnicity and non-White race, lower educational attainment, and Medicaid as a payer source. Our findings highlight that new strategies could be useful to improve retention among some demographic and socioeconomic groups (e.g., younger adults, Hispanic individuals, individuals with lower educational attainment, and Medicaid recipients) in the National DPP. Disclosure X. Zhang: None. M. Cannon: None. E. Ely: None. B. Smith: None. Funding CDC

Using Community Health Workers to Address Barriers to Participation and Retention in Diabetes Prevention Program: A Concept Paper.

The PreventionLink of Southern Maryland is a 5-year project to eliminate barriers to participation and retention in the National Diabetes Prevention Program (DPP) lifestyle change program to prevent or delay the onset of type 2 diabetes in adults with prediabetes. This is the study to identify the obstacles to participation and retention in the DPP lifestyle change program among high burden populations and learn how CHWs have reduced the identified barriers to participation and retention for high burden populations. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) to conduct this literature review. We have used the Scopus and PubMed, including all types of studies and peer-reviewed documents published in English between 2010 and 2020. From 131 identified articles, 18 articles were selected for qualitative synthesis. The reviewed literature documented following as main barriers to participate in a DPP lifestyle change program: time, cost, lack of transportation, cost of transportation, commute distance, technology access, access to facilities and community programs, caregiver responsibilities, lack of health literacy and awareness, and language. CHWs can address these barriers to participation and retention, they were involved in educating and supporting roles; they worked as bridges between healthcare providers and participants and as intervention team members. Diabetes prevention program participants with social determinant risk factors who most need CHW services are unlikely to have financial resources to pay for CHW services out-of-pocket. Hence, the public and private health plans that pay for their prediabetes care should consider paying for these CHW services and there is a need to trust more to CHW and have them as a "community health teams" member.

Health Care Providers' Knowledge, Attitudes, and Practices and the Association With Referrals to the National Diabetes Prevention Program Lifestyle Change Program.

PurposeTo examine how health care providers’ knowledge, attitudes, and practices affect their referrals to the National Diabetes Prevention Program.DesignCross-sectional, self-report data from DocStyles—a web-based surveySettingUSASamplePracticing family practitioners, nurse practitioners, pharmacists, and internists, n = 1,503.MeasuresQuestions regarding health care providers’ knowledge, attitudes, and practices and their referrals to the National Diabetes Prevention Program.AnalysisBivariate and multivariate analyses were used to calculate predictive margins and the average marginal effect.ResultsOverall, 15.2% of health care providers (n = 1,503) reported making a referral to the National Diabetes Prevention Program. Health care providers were more likely to make referrals if they were familiar with the program (average marginal effect = 36.0%, 95% CI: 29.1%, 42.8%), reported knowledge of its availability (average marginal effect=49.1%, 95% CI: 40.2%, 57.9%), believed it was important to make referrals to the program (average marginal effect = 20.7%, 95% CI: 14.4%, 27.0%), and used electronic health records to manage patients with prediabetes (average marginal effect = 9.1%, 95% CI: 5.4%, 12.7%). Health care providers’ demographic characteristics had little to no association with making referrals.ConclusionMaking referrals to the National Diabetes Prevention Program was associated with health care providers’ knowledge of the program and its reported availability, their attitudes, and their use of the electronic health record system to manage patients with prediabetes.

Implementation of Diabetes Prevention in Health Care Organizations: Best Practice Recommendations.

Approximately 1 in 3 American adults has prediabetes, a condition characterized by blood glucose levels that are above normal, not in the type 2 diabetes ranges, and that increases the risk of developing type 2 diabetes. Evidence-based treatments can be used to prevent or delay type 2 diabetes in adults with prediabetes. The American Medical Association (AMA) has collaborated with health care organizations across the country to build sustainable diabetes prevention strategies. In 2017, the AMA formed the Diabetes Prevention Best Practices Workgroup (DPBP) with representatives from 6 health care organizations actively implementing diabetes prevention. Each organization had a unique strategy, but all included the National Diabetes Prevention Program lifestyle change program as a core evidence-based intervention. DPBP established the goal of disseminating best practices to guide other health care organizations in implementing diabetes prevention and identifying and managing patients with prediabetes. Workgroup members recognized similarities in some of their basic steps and considerations and synthesized their practices to develop best practice recommendations for 3 strategy maturity phases. Recommendations for each maturity phase are classified into 6 categories: (1) organizational support; (2) workforce and funding; (3) promotion and dissemination; (4) clinical integration and support; (5) evaluation and outcomes; (6) and program. As the burden of chronic disease grows, prevention must be prioritized and integrated into health care. These maturity phases and best practice recommendations can be used by any health care organization committed to diabetes prevention. Further research is suggested to assess the impact and adoption of diabetes prevention best practices.

459-P: An Examination of Introductory Sessions Offered by CDC-Recognized National Diabetes Prevention Program Lifestyle Change Programs

The Centers for Disease Control and Prevention (CDC)’s National Diabetes Prevention Program (National DPP) lifestyle change program (LCP) is effective in preventing or delaying type 2 diabetes among people with prediabetes. Increasing enrollment in the National DPP LCP remains a priority. Some LCPs attempt to increase enrollment by offering introductory sessions, pre-enrollment sessions that aim to recruit, engage, and enroll participants based on emerging evidence linking introductory sessions with increased enrollment. As part of a national survey of CDC-recognized organizations offering the National DPP LCP, we examined the content and characteristics of introductory sessions currently offered. Of the 544 organizations who reported offering introductory sessions, the majority provide essential information by overviewing the organization’s LCP (98%) and providing information about type 2 diabetes prevention (79%) during the session. Most provide social support by offering an opportunity to meet the coach (86%) and for program staff and participants to mingle (69%), but only 36% offer light refreshments. Most assess eligibility and readiness to change by offering participants an opportunity to take a risk test to determine eligibility (74%), assess their readiness to join (63%), and to enroll in the program, if interested (71%). Only 34% provide resources for participants not eligible for the program. Session characteristics intended to overcome behavioral barriers to enrollment as identified in prior studies are less common: 39% conduct activities to help participants feel that they can be successful, 38% include testimonials from successful program participants, and 26% assess how soon a participant plans to enroll. There is room for improvement in incorporating behavioral science principles in introductory sessions. Future work will examine associations between specific introductory session characteristics and enrollment. Disclosure P. Williams: None. W. Elkins: None. K. Proia: None. Z. Tayebali: None. K. Axelrod: None. N. S. Esquivel: None. A. Smith: None. D. Porterfield: None.

Educational Attainment, Decision-Making Preferences, and Interest in Evidence-Based Diabetes Prevention among Women with a History of Gestational Diabetes Mellitus

Background: The Diabetes Prevention Program (DPP) showed that lifestyle change or metformin is equally efficacious in preventing diabetes in women who have had gestational diabetes mellitus (GDM). Few studies have investigated the relationship between education and willingness to engage in either intervention and between education and preferred decision-making style.Methods: Within a large health system, we surveyed insured women 18–64 years old with a history of GDM, identified through the electronic health record. We estimated preference for decision-making style and interest in DPP lifestyle change and/or metformin by educational level, using multivariate logistic regression models controlling for age, race, and ethnicity.Results: Our sample (n = 264) was 36% Latino, 29% Asian, 28% non-Latino white, and 5% African American, with a mean age of 37 years. In terms of education, 31% had a postgraduate degree, 41% were college graduates, and 29% did not graduate from college. In multivariate analyses, willingness to engage in either intervention did not vary by education. Women who did not graduate from college were more likely to leave medical decisions to their provider (p = 0.004) compared to women with a college or postgraduate degree. However, regardless of education, over 80% of women preferred to make medical decisions themselves or jointly with their provider.Conclusions: Most women prefer to play an active role in their own medical decisions and have an interest in both evidence-based diabetes prevention strategies. This suggests that shared decision-making is appropriate for many women with a history of GDM and different levels of educational attainment.

Retention Among Participants in the National Diabetes Prevention Program Lifestyle Change Program, 2012-2017.

To assess retention in the National Diabetes Prevention Program (DPP) lifestyle change program, which seeks to prevent type 2 diabetes in adults at high risk. We analyzed retention among 41,203 individuals who enrolled in Centers for Disease Control and Prevention (CDC)-recognized in-person lifestyle change programs at organizations that submitted data to CDC's Diabetes Prevention Recognition Program during January 2012-February 2017. Weekly attrition rates were typically <1-2% but were between 3.5% and 5% at week 2 and at weeks 17 and 18, where session frequency typically transitions from weekly to monthly. The percentage of participants retained through 18 weeks varied by age (45.9% for 18-29 year olds, 53.4% for 30-44 year olds, 60.2% for 45-54 year olds, 66.7% for 55-64 year olds, and 67.6% for ≥65 year olds), race/ethnicity (70.5% for non-Hispanic whites, 60.5% for non-Hispanic blacks, 52.6% for Hispanics, and 50.6% for other), mean weekly percentage of body weight lost (41.0% for ≤0% lost, 66.2% for >0% to <0.25% lost, 72.9% for 0.25% to <0.5% lost, and 73.9% for ≥0.5% lost), and mean weekly physical activity minutes (12.8% for 0 min, 56.1% for >0 to <60 min, 74.8% for 60 to <150 min, and 82.8% for ≥150 min) but not by sex (63.0% for men and 63.1% for women). Our results demonstrate the need to identify strategies to improve retention, especially among individuals who are younger or are members of racial/ethnic minority populations and among those who report less physical activity or less early weight loss. Strategies that address retention after the first session and during the transition from weekly to monthly sessions offer the greatest opportunity for impact.

804-P: How Barriers Affect Primary Care Providers’ Referral to the National Diabetes Prevention Program Lifestyle Change Program

Primary care providers’ (PCP) referral of participants to the National Diabetes Prevention Program lifestyle change program (National DPP LCP) needs to be amplified or increased. Using data from 2016, 2017, and 2018 DocStyles surveys, we examined how barriers affect PCPs’ referral and how their practice patterns change over time. Barriers were measured by survey questions regarding PCPs’ perspectives on the importance of 1) claim adjudication processes/payment for the service; 2) interconnectivity of electronic health records (EHRs) with other systems; 3) incentives for referrals; and 4) awareness of prediabetes and National DPP LCP. A logistic model was used to analyze the trend, and the full model controlled for age, gender, practice type, and practice regions. Our analytic cohorts consist of PCPs who were selected repeatedly in two years. The 2016-2018 cohort had 502 PCPs, and the 2017-2018 cohort had 462 PCPs. In the first cohort, the referral rate decreased by 38.5%, from 23.3% in 2016 to 14.3% in 2018 (P&amp;lt;0.05). In the second cohort, the rate decreased by 37.8%, from 24.0% in 2017 to 14.9% in 2018 (P&amp;lt;0.05). Not realizing the importance of the above 4 barriers contributed significantly to the decreased referral rate. Referral rates for those who did not realize barriers 1 and 2 in 2016 did not differ significantly from those who did; however, by 2018 those who did not realize the barriers had lower referral rates (odds ratio (OR) 2.26 (95% confidence interval: 1.31-3.91) for barrier 1 and 1.78 (1.05-3.00) for barrier 2). Similarly, for barriers 3 and 4 differences were not significant in 2017, but ORs increased to 1.89 (1.02-3.51) and 2.91 (1.62-5.20) in 2018. Our findings suggest that lack of realizing the importance of claim/payment, EHR usage, incentives for referrals, and awareness of National DPP LCP discouraged PCP referral practice and the negative effect amplified over time. Future interventions need to focus on how to overcome these barriers. Disclosure X. Zhang: None. M. Cannon: None. K. Nhim: None. T. Khan: None.

622-P: Systematic Screening and Assessment of Diabetes Prevention and Self-Management Programs That Utilize Telehealth Technology

Background: Remote delivery of health care services through telehealth technology holds promise for expanding access to and engaging individuals in underserved communities. Systematic Screening and Assessment and Evaluability Assessment methods were used to identify and evaluate promising CDC-recognized National Diabetes Prevention Program Lifestyle Change and Diabetes Self-Management Education and Support (DSMES) programs utilizing telehealth technology. Objective: To describe how 8 Lifestyle Change and DSMES programs utilize telehealth technologies effectively to expand access to services in underserved communities. Methods: Eight effective programs were selected to participate in an in-depth study. Information was gathered to understand activities, adaptations, and implementation challenges through in-depth interviews with stakeholders and on-site observation. Results: In all program sites, telehealth technology seamlessly integrated into existing program models to increase patient engagement and experience. Programs offered various tailored products based on the curriculums to reinforce prevention and self-management education. Automation of several program processes reduced burden on health coaches and diabetes educators, and improved data quality and analysis capabilities. Bi-directional communication between providers and programs was key to gaining provider buy-in and increasing referrals. Understanding activities being implemented by effective programs is crucial for expanding use of telehealth technologies. Conclusion: This project provides valuable practice-based evidence for planning and implementing diabetes prevention and management interventions. Disclosure Y. Mensa-Wilmot: None. T. Bonner: None. M.M. Ayala-Perales: None. A. Mensa-Kwao: None. S. Bowen: None. M. Greenberg: None. N. Dawkins-Lyn: None. G.E. Rutledge: None.

2239-PUB: Best Practices for Implementing Diabetes Prevention in Health Care Settings

One in 3 adults in the U.S. has prediabetes and 90 percent don’t even know they have it. If left untreated or treated with usual care, many will go on to develop type 2 diabetes. The Centers for Disease Control and Prevention’s National Diabetes Prevention Program (DPP) was created in 2010 to address the increasing burden of prediabetes and type 2 diabetes in the United States. Despite the demonstrated effectiveness of an intensive lifestyle invention program, there are still millions of undiagnosed and untreated individuals with prediabetes. Identification of prediabetes and referral of eligible adults to a lifestyle change program is recommended in both the ADA and USPSTF clinical guidelines and standards of care. However, only a minority of clinicians are systematically addressing prediabetes in their patient population or referring their patients to a lifestyle change program. Although existing research has evaluated the uptake of clinical guidelines regarding diabetes prevention and the availability of coverage for lifestyle change programs, there is a gap in collecting and sharing best practices for building a diabetes prevention strategy that includes the CDC’s National DPP lifestyle change program. The AMA convened a diverse group of leading health care organizations that were successful in establishing system-based strategies. This session will describe a best practice implementation framework for health systems to consider when establishing or expanding a diabetes prevention strategy and engaging with clinical champions to improve identification and treatment of patients with prediabetes. Disclosure J. Williams: None. N. Sachdev: None. T. Moin: None. O. Duru: None.

855-P: The Relationship between Primary Care Providers’ Perceptions of Patient Motivation and Their Referral Practices for the National Diabetes Prevention Program Lifestyle Change Program

Previous studies indicate that primary care providers’ (PCP) clinical decision making is affected by their perceptions of patient motivation. However, it is unclear how these perceptions affect PCP’s decisions to refer patients to community-based programs, such as the National Diabetes Prevention Program lifestyle change program (National DPP LCP), a structured, evidence-based, year-long lifestyle change program to prevent or delay onset of type 2 diabetes in adults with prediabetes or at risk of developing type 2 diabetes. Using data from the DocStyles 2018 web-based cross-sectional survey, we examined the relationship between PCP perceptions and referral practices. The following questions were asked to ascertain PCP perceptions and referral practices respectively: 1) “I need to make sure that my patients are motivated and ready to succeed in the National DPP LCP”; and 2) “Have you referred your patients with prediabetes to the in-person or online National DPP LCP to prevent or delay type 2 diabetes?” We analyzed the data using logistic regression analysis, with the final adjusted model controlling for PCP’s age, gender, practice years, PCP practitioner type, practice setting, and region. Our study sample included 1253 PCPs (46.3% female), with a mean age of 48.4 years and a mean practice duration of 17.4 years. We found that PCPs who realized the importance of patient motivation and readiness for their referral decision were more likely to refer their patients to the National DPP LCP, in both unadjusted (odds ratio [OR]=2.59, 95% confidence interval [CI]=1.85, 3.65) and adjusted (OR=2.58, 95% CI= 1.83, 3.64) models. Our findings highlight the importance of PCPs’ perceptions of patient motivation in their referral practices, suggesting that patient motivation and their PCP’s awareness of this motivation may need to be addressed to increase referrals to and enrollment in the National DPP LCP. Disclosure X. Zhang: None. M. Cannon: None. A. Lanza: None. T. Khan: None. M.C. Jackson: None. K. Nhim: None.

The Diabetes Prevention Impact Tool Kit: An Online Tool Kit to Assess the Cost-Effectiveness of Preventing Type 2 Diabetes.

The National Diabetes Prevention Program lifestyle change program demonstrated health benefits and potential for health care cost-savings. For many states, employers, and insurers, there is a strong business case for paying for type 2 diabetes prevention, which will likely result in medical and nonmedical cost-savings as well as improved quality of life after a few years. Using an iterative feedback process with multiple stakeholders, the Centers for Disease Control and Prevention developed the Diabetes Prevention Impact Tool kit, https://nccd.cdc.gov/toolkit/diabetesimpact, which forecasts the cost impact the lifestyle change program can have for states, employers, and health insurers. We conducted key informant interviews and a qualitative analysis to evaluate the tool kit. We found that end users recognized its utility for decision making. They valued the detail of the tool kit's underlying calculations and appreciated the option of either using the default settings or revising assumptions based on their own data. The Diabetes Prevention Impact Tool kit can be a helpful tool for organizations that wish to forecast the economic costs and benefits of implementing or covering the National Diabetes Prevention Program lifestyle change program.

Linking Postpartum and Parenting Women With a National Diabetes Prevention Program: Recruitment Efforts, Challenges, and Recommendations.

IN BRIEF Women with a history of gestational diabetes mellitus (GDM) are at higher risk for type 2 diabetes. This project piloted the National Diabetes Prevention Program lifestyle change program in cohorts of women with a history of GDM. The article describes recruitment efforts, challenges, and study participation and provides recommendations for future program implementation.

Behavior Change of Participants in Group vs. Individual DPP Weight Loss Interventions—The SHINE Study

Objective: To compare change in physical activity (PA) and dietary fat intake (DFI) in the SHINE (Support, Health Information, Nutrition and Exercise) Study. SHINE was a randomized, controlled weight loss trial (n=257) of 2 telephone (to increase reach) translations of the Diabetes Prevention Program (DPP) lifestyle change intervention, delivered at 5 diverse healthcare sites. Methods: Participants (metabolic syndrome, no diabetes) were randomized to the DPP lifestyle change program, participating individually (solo; n=129) or in a group conference call (group; n=128). The 16-session DPP curriculum was delivered in year-1 by trained primary care staff and coaches, with continued contact in year-2. Participants: mean age= 51.8 years, 74.3% female, 85.6% white, 44.1% employed, 36.9% annual income &amp;lt;$30K, mean BMI= 39.3 kg/m2, mean PA = 2428.0 mets/week, mean DFI = 33.5% of total calories. We previously reported that both group and solo arms lost significant weight, but solo participants regained. Here we look at change in PA (International Physical Activity Quest.) and DFI (NCI Fat Screener). Mixed linear models compared mean change from baseline in PA and DFI, within and between arms, at 6, 12 and 24 mos. for this longitudinal dataset. Results: Compared to baseline, the group arm increased PA at 6, 12 and 24 mos. (71.0, 139.5, 255.0 mets/week), the solo arm only improved at 24 mos. (102.0 mets/week). Compared to baseline, the group arm showed decreased DFI at 6, 12 and 24 mos. (1.4%, 1.4%, 1.4%); the solo arm improved at 6 and 12 mos. (2.6%, 2.9%) but not at 24 mos. There were no differences between arms in means for PA or DFI. Conclusions: Primary care staff can be trained to deliver a telephonic DPP translation that is effective to achieve significant PA and DFI behavior change. Despite anecdotal concerns that group contact may be less tailored to individuals and thus less effective, we found that group may be more effective than solo contact in achieving activity and diet changes associated with weight loss. Disclosure P.M. Trief: Research Support; Self; National Institute of Diabetes and Digestive and Kidney Diseases. L.M. Delahanty: Consultant; Self; Janssen Pharmaceuticals, Inc., Akcea Therapeutics, Nutrisystem, Inc.. Advisory Panel; Self; Jana Care Inc., Omada Health, Inc.. D.A. Cibula: None. R.S. Weinstock: Research Support; Self; Medtronic MiniMed, Inc., Mylan, Kowa Pharmaceuticals America, Inc., Diasome Pharmaceuticals, Inc., Calibra Medical, Dexcom, Inc., Ultradian Diagnostics LLC., JAEB Center For Health Research, JDRF, National Institute of Diabetes and Digestive and Kidney Diseases.

Primary Care Providers’ Prediabetes Screening, Testing, and Referral Behaviors

Introduction:Intensive behavioral counseling is effective in preventing type 2 diabetes, and insurance coverage for such interventions is increasing. Although primary care provider referrals are not required for entry to the Centers for Disease Control and Prevention (CDC)–recognized National Diabetes Prevention Program lifestyle change program, referral rates remain suboptimal. This study aims to assess the association between primary care provider behaviors regarding prediabetes screening, testing, and referral and awareness of the CDC-recognized lifestyle change program and the Prevent Diabetes STAT: Screen, Test, and Act Today™ toolkit. Awareness of the lifestyle change program and the STAT toolkit, use of electronic health records, and the ratio of lifestyle change program classes to primary care physicians were hypothesized to be positively associated with primary care provider prediabetes screening, testing, and referral behaviors.Methods:Responses from primary care providers (n= 1,256) who completed the 2016 DocStyles cross-sectional web-based survey were analyzed in 2017 to measure self-reported prediabetes screening, testing, and referral behaviors. Multivariate logistic regression was used to estimate the effects of primary care provider awareness and practice characteristics on these behaviors, controlling for provider characteristics.Results:Overall, 38% of primary care providers were aware of the CDC-recognized lifestyle change program, and 19% were aware of the STAT toolkit; 27% screened patients for prediabetes using a risk test; 97% ordered recommended blood tests; and 23% made referrals. Awareness of the lifestyle change program and the STAT toolkit was positively associated with screening and referring patients. Primary care providers who used electronic health records were more likely to screen, test, and refer. Referring was more likely in areas with more lifestyle change program classes.Conclusions:This study highlights the importance of increasing primary care provider awareness of and referrals to the CDC-recognized lifestyle change program.