Introduction: An increase in the prevalence of Diabetes Mellitus is expected in the upcoming years, both in Portugal and worldwide. A significant concern is the high number of individuals who are unaware of their condition or who are at risk of developing it, reflecting a critical public health issue. Type 2 Diabetes Mellitus (T2DM) can be prevented in high-risk individuals targeting lifestyle modifications, which may reverse modifiable risk factors. The National Diabetes Program created the “More Health, Less Diabetes – Type 2 Diabetes diagnosis and prevention Program”, a community-based lifestyle intervention program, consisting of educational sessions aiming to improve health literacy, leading to habits change. Objective: to evaluate the Program, validate the effectiveness of its interventions and assess its outcomes, facilitating its nationwide implementation. Methods: 23 participants at moderate or high risk of developing T2DM were included and underwent a 12-month educational intervention. Anthropometric data and responses to the FINDRISC, EQ-5D-5L, PREDIMED, and adapted IPAQ questionnaires were evaluated at the beginning and end of the Program. Results: After 12 months in this program, there were statistically significant reductions in body weight (from 81.9kg to 78.8kg, p<0.001), BMI (31.2kg/m² to 30.0kg/m², p<0.001), and waist circumference (104.5cm to 100.17cm, p<0.001) and significant improvements in the risk of developing T2DM (p=0.001), physical activity levels (p=0.035), adherence to the Mediterranean diet (p=0.035) and Anxiety/Depression levels (p=0.007). Conclusion: This Program proved effectiveness reducing the risk of developing T2DM, showing potential for national implementation, in primary health care settings. Its major advantage is the emphasis on the primary prevention of a highly prevalent, chronic disease with significant healthcare costs.

The Caribbean region suffers from a high burden of diabetes and diabetes-associated mortality. Despite the evidence for diabetes prevention programs, there have been very few such initiatives in the region. To address this gap, we describe the effectiveness and implementation of the Lifestyle Intervention and Metformin Escalation (LIME) Clinical Trial in reducing the risk of diabetes among individuals with pre-diabetes in the Caribbean. LIME is a quasi-experimental pre-post study that took place between 2018 and 2021. LIME recruited individuals with high-risk pre-diabetes (hemoglobin A1c (HbA1c) between 6.0 and 6.4%) across clinical sites in Barbados, Trinidad and Tobago, Puerto Rico, and the US Virgin Islands. Eligible participants were enrolled in a 6-week lifestyle modification workshop. Six months later, individuals who did not lose at least 5% of their bodyweight or had an HbA1c of 6% or higher were prescribed metformin medication. The primary outcome was a change in HbA1c at 6- and 12-months. Paired t-test and McNemar's test were used to examine change in primary outcome. Implementation outcomes of reach, adoption, and implementation fidelity were assessed using programmatic data. Of 914 individuals screened, 211 (23%) had high-risk pre-diabetes. Of those, 114 enrolled in the study (54% Reach). At the 6-month follow-up, there was a significant reduction in average HbA1c from 6.19% to 5.95% (p < 0.001), average weight from 86.7kg to 85kg (p < 0.001), with a reduction in added sugar intake from 7.3 tsp/day to 3.8 tsp/day (p < 0.0001) but no significant change in physical activity level or fruit and vegetable intake. Reduction in HbA1c (6.19% to 5.67%, p < 0.0001) and weight (85.1kg to 83.7kg, p = 0.0149) was maintained at 12 months. Trained facilitators variably engaged in leading workshops (adoption 25%-100%), and were 100% adherent to the protocol (fidelity). LIME is an effective diabetes prevention intervention for individuals with pre-diabetes in the Caribbean. Future work should investigate approaches to improve reach (eligible participant engagement) and adoption (participation of trained facilitators), and report on cost-effectiveness to inform scale-up of the intervention. clinicaltrials.gov NCT03258723 (23/08/2017).

To examine whether age at type 2 diabetes onset affects disease progression, assessed by changes in glycemic control and clinical biomarkers during follow-up. Participants in the Kerala Diabetes Prevention Program (K-DPP) and U.S. Diabetes Prevention Program (US-DPP) who developed type 2 diabetes during the trial were analyzed. Data on fasting plasma glucose (FPG), hemoglobin A1c (HbA1c), triglycerides (TGs), HDL, LDL, BMI, blood pressure, and estimated glomerular filtration rate (eGFR) were collected at diabetes onset and end of follow-up. Linear and mixed-effects regressions assessed the association and rate of biomarker change by age at onset. We included 802 US-DPP (mean age 52.6 years) and 146 K-DPP participants (mean age 47.7 years). Younger-onset participants had a higher BMI at onset and end of follow-up (mean follow-up 7.9 and 7.6 years for US-DPP and K-DPP, respectively), with a relatively small BMI change over time in US-DPP participants. In fully adjusted models, FPG and HbA1c at onset were not associated with age at onset. Both measures increased faster in younger-onset participants, although the association was not significant in K-DPP participants. In US-DPP participants, younger age at onset was associated with higher eGFR and lower HDL and systolic blood pressure (SBP); similar directions were seen in K-DPP participants, but the association with HDL was nonsignificant. SBP fell slightly in older-onset US-DPP participants during follow-up but not in younger-onset participants. Younger-onset diabetes was associated with greater adiposity, lower HDL, and better SBP and eGFR at onset, with differences largely persisting during follow-up. During follow-up, glycemia increased slightly faster in individuals with younger-onset diabetes.

Background: Cardiovascular disease (CVD) is the leading cause of death in Black men, contributing to the shortest life expectancy among U.S. race/sex groups. Black men have the lowest attainment of the American Heart Association’s (AHA) Life Essential 8 (LE8) metrics and high levels of psychosocial stress, which are critical for attainment of ideal cardiovascular health. Research Question/Hypothesis: This study aims to evaluate the impact of a community-based intervention on cardiovascular health and psychosocial stress in Black men. Specifically, we hypothesize Black Impact will improve LE8 and psychosocial stress compared to usual care. Methods/Statistical Analysis: Black Impact is a 24-week community-based lifestyle intervention focused on physical activity, health education, and addressing social needs. Participants meet weekly in teams for 90 minutes at community recreation and parks sites. The Black Impact curriculum is adapted from the Diabetes Prevention Program and AHA Check, Change, Control Program. Health coaches deliver the curriculum weekly, along with physical fitness trainers, to emphasize attainment of ideal LE8 health behaviors and related factors. Black Impact also addresses social needs via support from community health workers. LE8 and perceived stress are assessed at baseline, 12 and 24 weeks. The LE8 score is an average of the scores for the eight individual metrics: blood pressure, blood glucose, cholesterol, body mass index, nicotine exposure, diet, physical activity, and sleep and ranges from 0-100, with a higher number being better. The perceived stress scale score has a range of 0-40, with a lower number being better. Changes from baseline to 24 weeks were calculated using linear mixed-effects models in the overall cohort without accounting for randomization as this is an ongoing waitlist-controlled randomized clinical trial. Results/Data: Among 198 Black men in Black Impact, the mean age was 54 years. Baseline LE8 and perceived stress scores were 63.5 (SD 11.9) and 12.6 (SD 6.7), respectively. At week 24 LE8 increased by 3.3 points (95% CI: 2.1, 4.6) and perceived stress scores decreased by 1.9 points (95%CI: -2.7, -1.2). Conclusion(s): Black Impact is an intervention aimed at improving cardiovascular health and perceived stress in Black men. The non-randomized findings support potential improvements in cardiovascular health and perceived stress, and we look forward to sharing full intervention vs. control findings in Fall 2026.

RECOMMENDATIONS 1. We recommend that PHPs identify PLWO, and initiate patient-centred, health-focused conversations with them (Level 3, Grade C).2. We recommend that PHPs ensure that they ask PLWO for their permission prior to discussing weight or taking anthropometric measurements (Level 3, Grade C). 3. Primary care interventions should be used to increase health literacy in individuals’ knowledge about and skills in weight management as an effective intervention to manage weight (Level 1a, Grade A). 4. PHPs should refer PLWO to primary care multi-component programmes with personalised obesity management strategies as an effective way to support obesity management (Level 1b, Grade B). 5. PHPs can use collaborative deliberation with motivational interviewing to tailor action plans to individuals’ life context in a way that is manageable and sustainable to support improved physical and emotional health, and weight management (Level 2b, Grade C). Features of primary care and primary healthcare community-based interventions for PHPs and developers: 6. Interventions that target a specific ethnic group should consider the diversity of psychological and social practices with regard to excess weight, food and physical activity as well as socioeconomic circumstances, as they may differ across and within different ethnic groups (Level 1b, Grade B). 7. Longitudinal primary care interventions should focus on incremental, personalised, small behaviour changes (the ‘Small Changes’ approach) to be effective in supporting people to manage their weight (Level 1b, Grade B). 8. Primary care multi-component programmes should consider personalised obesity management strategies as an effective way to support PLWO (Level 1b, Grade B). 9. Primary care interventions that are behaviour based (nutrition, exercise, lifestyle), alone or in combination with pharmacotherapy, should be utilised to manage PLWO (Level 1a, Grade A). 10. Group-based nutrition and physical activity sessions informed by the Diabetes Prevention Program and the Look AHEAD (Action for Health in Diabetes) programme should be used as an effective management option for PLWO (Level 1b, Grade A). 11. Interventions that use technology to increase reach to larger numbers of people asynchronously should be a potentially viable lower-cost method in a community-based setting (Level 1b, Grade B). Educational recommendations to support development of obesity management skills in the primary healthcare clinical workforce: 12. Educators in undergraduate, graduate and continuing education programmes for PHPs should provide courses and clinical experiences to address the gaps in skills, knowledge of the evidence, and attitudes necessary to confidently and effectively support PLWO (Level 1a, Grade A).[20]

Revising the Sustainability Plan for the National Diabetes Prevention Program.

Abstract Aim: This study is a cross-sectional study that aimed to assess the frequency of type 2 diabetes (T2D) risk variables among Egyptian college students. The Finnish Diabetes Risk Score (FINDRISC), originally used in middle-aged groups, was used in a college (young-aged) student group to identify early risk behaviors. Materials and Methods: We assessed the risk of T2D in 377 college students aged 18 to 22 years old. Inquiries were made about family history, personal history, and lifestyle patterns. Laboratory tests, blood pressure readings, and anthropometric data were also gathered. Results: A total of 61% of participants were female, mean body weight was 71.6 ± 14.4 kg, and mean body mass index was 25 ± 4.5 kg/m 2 . The average FINDRISC for the entire group was 6.5 ± 3.7. Fifty-two percent belonged to the low-risk (LR) group, and 48% to the greater-risk (GR) group. The GR group was further separated into three risk categories: significantly elevated risk (9.8%), highly elevated risk (1.9%), and slightly elevated risk (36.3%). HDL-C, VLDL-C, triglycerides, fasting serum insulin, fasting plasma glucose, and homeostatic model assessment for insulin resistance (HOMA-IR) did not differ between the two groups; however, the GR group had significantly greater total cholesterol ( P &lt; 0.01) and LDL-cholesterol ( P &lt; 0.05) than the LR group. The GR group consumed fast food more frequently ( P &lt; 0.05). Social stress was an independent predictor of worsening FINDRISC ( β = −1.04, P &lt; 0.01) and was substantially higher in GR compared to LR ( P &lt; 0.05). Conclusion: The increased risk of T2D in this population is alarming and warrants implementing a diabetes prevention program.

Prediabetes is common, yet evidence-based lifestyle interventions are underutilized. To determine whether referral to an exclusively artificial intelligence (AI)-led lifestyle intervention based on the Diabetes Prevention Program (DPP) is noninferior to referral to a human-led DPP in achieving recommended thresholds for weight loss, hemoglobin A1c (HbA1c) reduction, and weekly physical activity among adults with prediabetes and overweight or obesity. This phase 3, parallel-group, pragmatic, noninferiority randomized clinical trial was conducted from October 11, 2021, to December 16, 2024 (last follow-up) at 2 US clinical sites in Baltimore, Maryland, and Reading, Pennsylvania. Adults 18 years or older with prediabetes and overweight or obesity were enrolled. Participants were randomized in a 1:1 ratio to receive either a referral to an AI-powered DPP lifestyle intervention delivered via a mobile app and Bluetooth-enabled digital scale or a referral to a human coach-led DPP lifestyle intervention delivered remotely. Both interventions were delivered independently of the study team over a 12-month period. The primary outcome was a composite of maintaining an HbA1c less than 6.5% throughout the study and achievement of at least 5% weight loss, at least 4% weight loss plus at least 150 minutes of weekly physical activity (assessed with actigraphy), or an absolute reduction in HbA1c of at least 0.2 percentage points at 12 months. Noninferiority of referral to the AI-led DPP compared with referral to the human-led DPP was prespecified to be determined if the 1-sided 95% CI lower boundary of the risk difference did not cross -15%. A total of 368 participants were included (median [IQR] age, 58 [50-65] years; 71% were female, 27% were Black, 6% were Hispanic, and 61% were White; median [IQR] BMI, 32.3 [28.5-37.1]). After referral, 171 of 183 participants (93.4%) initiated the AI-led DPP and 153 of 185 (82.7%) initiated the human-led DPP. The primary outcome was achieved by 58 of 183 participants (31.7%) in the AI-led DPP group and 59 of 185 (31.9%) in the human-led DPP group (risk difference, -0.2% [1-sided 95% CI, -8.2%]), meeting the criterion for noninferiority. Findings were consistent across individual components of the composite end point and in sensitivity analyses. Among adults with prediabetes and overweight or obesity, referral to a fully automated AI-led DPP was noninferior to referral to a human-led DPP in achieving a composite outcome based on weight reduction, physical activity, and HbA1c. ClinicalTrials.gov Identifier: NCT05056376.

Disclosure: R. Ali: None. A. Dixit: None. T. Jain: None. A.J. Augustine: None. P.R. Patel: None. S. Iftikhar: None. B. Padamati: None. G. Palaniswamy: None. V.A. Mendpara: None. N. Koduri: None.Background: Type 2 Diabetes Mellitus (T2DM) is a growing global health challenge, affecting over 537 million adults worldwide. While lifestyle factors like poor diet and lack of exercise are well-documented contributors, the role of alcohol consumption in increasing diabetes risk is often overlooked. Chronic alcohol use can lead to insulin resistance, obesity, and liver dysfunction, all of which heighten the likelihood of developing diabetes. Despite these metabolic effects, alcohol is rarely a focal point in diabetes prevention efforts. This study examines long-term trends in alcohol-related diabetes burden, focusing on mortality rates (ASMR), Disability (DALYs), and Future projections. Methods: This study analyses Global Burden of Disease (GBD) data from 1990 to 2021, tracking diabetes cases attributed to alcohol consumption. Time-series forecasting models (ARIMA and Exponential Smoothing) are used to predict trends through 2031. A Pearson correlation analysis (r = 0.85, p < 0.001) assesses the relationship between alcohol intake and diabetes burden over time. Additionally, a Vector Auto Regression (VAR) model evaluates the influence of alcohol taxation, obesity rates, and GDP per capita on diabetes prevalence. Results: The findings indicate a consistent rise in alcohol-related diabetes burden, with prevalence increasing from 0.015% in 1990 to 2.92% in 2021. Projections suggest this trend will continue, with alcohol-attributable diabetes burden expected to reach 1.7% by 2031 if no interventions are made. The Age-Standardized Mortality Rate (ASMR) due to alcohol-related diabetes increased from 4.59 in 1990 to 7.88 per 100,000 population in 2021, marking a 71.7% rise in diabetes-related deaths linked to alcohol consumption. Similarly, Disability-Adjusted Life Years (DALYs) due to alcohol-related diabetes increased from 4.45 million in 1990 to 7.72 million in 2021, a 73.4% rise, reflecting a growing impact on disability and reduced quality of life. Economic factors also play a key role—higher alcohol taxation is associated with lower diabetes rates while rising obesity levels and economic growth contribute to an increasing diabetes burden. Conclusions: The evidence points to alcohol consumption as a significant but often underestimated factor driving type 2 diabetes rates, impacting both mortality and disability. Without effective policy measures, the alcohol-related diabetes burden is projected to grow significantly in the coming years. Strategies such as higher alcohol taxes, public awareness campaigns, and integrating alcohol reduction into diabetes prevention programs could help mitigate these risks. Future research should focus on regional variations and long-term policy impacts to develop more effective interventions for reducing alcohol-related metabolic risks.Presentation: Monday, July 14, 2025

The incidence of type 2 diabetes (T2D) is increasing in low- and middle-income countries. Effective, culturally tailored interventions are needed for diabetes prevention. To evaluate the effectiveness of a 12-month, mosque-based, faith-integrated lifestyle intervention in reducing T2D incidence among adults with prediabetes in rural Bangladesh. This parallel-group, cluster randomized clinical trial (RCT) was conducted from April 2022 to April 2023 across 8 rural mosque clusters in 5 districts of Bangladesh, with a 12-month follow-up. Adults (aged 25-65 years) were screened using a validated diabetes risk score. Individuals with high risk scores underwent oral glucose tolerance testing, and those with prediabetes (fasting blood glucose of 6.1-6.9 mmol/L, 2-hour blood glucose of 7.8-11.0 mmol/L [to convert to milligrams per deciliter, multiply by 18], or both, according to World Health Organization criteria) were included in this trial. Participants were randomized (1:1) by mosque cluster to the intervention or the control. After baseline assessments, participants who completed the 12-month follow-up were included in the intention-to-treat analysis. The intervention group attended monthly mosque-based sessions integrating Islamic teachings with structured guidance on diet, physical activity, and behavior modification delivered by imams and trained female assistants. The control group received usual care (standard health advice including a health leaflet and referral to local health services) at enrollment. The primary outcome was the 12-month cumulative incidence of T2D. Secondary outcomes included changes in weight, body mass index (BMI), glycemic markers, lipid profiles, blood pressure, diabetes-related knowledge, physical activity, and quality of life. Of the 799 participants (mean [SD] age, 46.2 [11.6] years; 424 women [53.1%]) randomized, 641 completed the 12-month follow-up and were included in the intention-to-treat analysis: 341 (n = 4 mosques) in the intervention group and 300 (n = 4 mosques) in the control group. The intervention group had a significantly lower 12-month cumulative T2D incidence (9.8% [95% CI, 7.1%-13.5%]) vs the control group (17.1% [95% CI, 13.4%-21.6%]), with an absolute risk reduction of 7.3 percentage points (95% CI, 5.2-10.6 percentage points), a relative risk reduction of 42.5% (95% CI, 15.0%-70.0%), and a number needed to treat of 14 (95% CI, 9-39). In Cox proportional hazards regression adjusted for clustering, the hazard ratio was 0.75 (95% CI, 0.60-0.95; P = .02), corresponding to a 25.0% reduction in diabetes risk. Secondary outcomes including weight, BMI, fasting glucose, 2-hour blood glucose, hemoglobin A1c, lipid profiles, diabetes-related knowledge, physical activity, and quality of life also improved significantly more in the intervention group compared with the control group. In this cluster RCT involving adults with prediabetes, a culturally adapted, mosque-based lifestyle intervention significantly reduced T2D incidence over 12 months in rural Bangladesh. These results demonstrate the potential for scalable and cost-effective diabetes prevention programs in low-resource, Muslim-majority communities. ISRCTN Registry Identifier: ISRCTN91564707.

The aim of this study was to identify shared and distinct metabolite profiles prospectively associated with nephropathy, retinopathy and neuropathy at 15years' follow-up among 1947 participants in the Diabetes Prevention Program Outcomes Study, the long-term follow-up of the Diabetes Prevention Program (DPP). We applied bootstrapped LASSO to 353 annotated metabolites to identify metabolites associated with one or more complication. For these metabolite hits, we tested for an interaction with DPP treatment arm, and ran multivariable models for the pooled sample or within treatment group as appropriate. At follow-up, 572 participants had one or more complication (n=277 nephropathy, n=194 retinopathy, n=212 neuropathy). Of 105 metabolites that predicted any complication, 74 predicted one, 27 predicted two, and four predicted all three. In a pooled analysis of 69 metabolites without treatment arm interactions, histidine predicted lower odds of nephropathy (OR 0.75; 95% CI 0.69, 0.88), and serine predicted lower odds of nephropathy (OR 0.69; 95% CI 0.58, 0.82) and neuropathy (OR 0.68; 95% CI 0.56, 0.84). Of 36 metabolites that interacted with treatment arm, higher N-carbamoyl-β-alanine predicted greater odds of nephropathy (OR 1.99; 95% CI 1.38, 2.99) and C22:0-sphingomyelin predicted lower odds of neuropathy (OR 0.54; 95% CI 0.37, 0.77) in the metformin arm. In the lifestyle intervention arm, quinolinic acid predicted greater odds of neuropathy (OR 1.64; 95% CI 1.24, 2.19). These estimates accounted for sex, race, baseline age, BMI and smoking, and time elapsed during follow-up. Further adjustment for HbA1c during follow-up, incident diabetes and eGFR did not change the results. The existence of distinct metabolite profiles associated with single microvascular complications highlights the importance of characterising pathophysiological mechanisms specific to each complication, in addition to studying shared mechanisms across multiple complications.

This article describes and evaluates a multipronged strategy to expand use of the Diabetes Prevention Program (DPP) and diabetes self-management education and support (DSMES) services across a large academic health system. Strategies included streamlining referral processes, embedding diabetes educators in primary care, leveraging consistent leadership messaging, and building partnerships with community organizations. These interventions led to substantial increases in referrals, with 10.8% of 4,397 patients enrolling in DPP and 35.9% of 10,210 enrolling in DSMES. Coordinated, multilevel interventions can effectively increase engagement in these underutilized, evidence-based diabetes care programs.

We aimed to synthesise global prevalence estimates of type 2 diabetes among Indigenous youth aged under 25 years, and examine age- and gender-specific differences and secular trends. We searched MEDLINE, Embase, CINAHL and Cochrane, and bibliographies of included studies, from 1 January 1980 to 14 September 2024. We included cross-sectional observational studies that reported diabetes point prevalence estimates (per 1000) and prevalence trends in Indigenous youth aged under 25 years from all regions. Age- and gender-specific analysis and secular trends were reported. Study quality was assessed using a modified Newcastle-Ottawa Scale adapted for Indigenous health research. From 2342 records and 27 additional references, 49 studies were retained for data extraction. Total type 2 diabetes prevalence, reported in 33 of 49 studies from 36 distinct populations across six countries and two self-governing states, varied widely (0-44 per 1000), with 75% (27/36) of the populations reporting a prevalence of over 1 per 1000. Age-specific data, available in 44 studies, showed increased prevalence with age: 0-4 per 1000 at age <10 years; 0-44 per 1000 at age 10-19 years; and 0-64 per 1000 at age 15-25 years. Of 22 studies with gender-specific data, 77% showed a female predominance. Secular trends, examined in 12 studies since 1981, showed a rising prevalence in young adults (aged 15-25 years) in eight of ten studies, and in youth aged under 15 years in six of nine studies. Heterogeneity in study design, diagnostic criteria, and incomplete age- and gender disaggregation precluded meta-analysis. Youth type 2 diabetes prevalence in Indigenous populations is very high, particularly in young adulthood, and among the female sex. Prevalence has increased over time. Future research should stratify data by age and pubertal status, and identify both protective and risk factors to inform targeted prevention strategies. Indigenous-led, community-specific approaches that actively engage youth are critical in the development and implementation of diabetes surveillance, prevention and management programmes. PROSPERO registration no. CRD42021278418.

A history of gestational diabetes mellitus (GDM) can have significant implications for women's long-term health. Despite these risks, primary care rates for postnatal screening are low. A service improvement project (SIP) was implemented as part of an MSc in advanced diabetes care undertaken at Birmingham City University. Its aims were to improve postnatal follow-up care for women with GDM and reduce their risk of developing type 2 diabetes, enhancing their long-term health. A key success of the SIP was improved knowledge of the importance of postnatal screening among staff and women. The number of women being correctly coded and offered postnatal screening also increased, highlighting the importance of healthcare integration for better patient outcomes. Work continues to improve referral rates and attendance of the National Diabetes Prevention Programme with the roll-out of an electronic care pathway.

To determine the effects of first-degree family history of diabetes on diabetes incidence in Diabetes Prevention Program (DPP) and Diabetes Prevention Program Outcomes Study (DPPOS) participants. In the DPP, adults with prediabetes were randomized to an intensive lifestyle intervention, metformin, or placebo and followed for incident diabetes. On study completion 88% of eligible DPP participants reenrolled in DPPOS for long-term follow-up. The present analysis includes all 3,072 participants with family history information through DPPOS, with a median follow-up of 21 years (1,975 had parental history of diabetes [PH] [312 biparental, 947 maternal, 716 paternal], 226 had only sibling history [SH], and 871 denied any family history). The primary outcome is incident diabetes based on American Diabetes Association criteria, with adjustment for demographic and clinical variables, DPP randomization arm, and polygenic risk score (PRS). Adjusted hazard ratio (HR) was 1.21 (95% CI 1.06, 1.38) for any family history, 1.19 (1.04, 1.35) for PH, and 1.15 (0.91, 1.44) for SH. Biparental history conferred greater hazard (HR 1.44 [95% CI 1.22, 1.69]) than maternal (1.22 [1.08, 1.38]) or paternal (1.22 [1.08, 1.39]) diabetes history alone. PRS explained 32% of the association of any family history with diabetes risk. PH increased type 2 diabetes risk after DPP treatment group was controlled for. That effect was only partially explained by PRS, suggesting that rare gene variants, familial, and environmental factors may contribute to type 2 diabetes risk in people with prediabetes.

Facilitators and barriers affecting the implementation of diabetes prevention programs in primary care settings: A qualitative meta-synthesis from a multi-stakeholder perspective.

Applying the RE-AIM framework to evaluate a diabetes prevention intervention delivered through a food bank.

PurposeTo evaluate the real-world effectiveness of a longstanding community-based National Diabetes Prevention Program (DPP) on participation and weight-loss for Latino(a) adults.DesignRetrospective cohort analysis.SettingThe yearlong program was delivered in an urban area of Colorado by a team of Latino(a) community health workers in partnership with a safety-net healthcare organization.SubjectsNational DPP participants between January 2014 and December 2023.MeasuresOutcome measures included National DPP sessions attended and achievement of ≥5% weight loss. Covariates included demographics, body mass index, self-reported physical activity, and health status.AnalysisDescriptive statistics and multivariable logistic regression analyses evaluated associations between demographic and program-related characteristics with program attendance and ≥5% weight loss.Results2377 participants were included; median age 44 years (IQR 37, 52), 86.1% female, 89.8% Latino(a), and 82.0% Spanish speakers. Among 1988 participants who attended ≥8 of 20 sessions within 6 months and had 2 or more weight values, 31.6% achieved ≥5% weight loss. Weight loss of ≥5% was associated with male sex, attendance of ≥16 of 26 sessions, participation in later cohorts, ≥20% sessions with ≥150 minutes per week physical activity, and high self-reported health status.ConclusionCommunity-based National DPP programs can be an effective strategy for increasing program participation and supporting weight loss among Latino(a) adults. Ongoing efforts to engage Latino men in such programs are needed.

The Diabetes Prevention Program (DPP) was a 3-year randomized clinical trial (RCT) with evaluation of lifestyle and metformin interventions compared with placebo for diabetes prevention in high-risk adults. Both interventions significantly reduced diabetes incidence, prompting the long-term Diabetes Prevention Program Outcomes Study (DPPOS) to assess the progression of diabetes and its complications over 22 years. During follow-up, departures from the original metformin or placebo assignment occurred primarily because of development of diabetes that, by protocol, was managed by clinicians outside the study, after participants developed diabetes with HbA1c ≥7.0%. Diabetes development led to changes in metformin treatment and addition of other glucose-lowering therapies. Using statistical methods designed to estimate intervention effects despite these deviations, we consistently found that metformin reduced diabetes incidence. However, using these methods to evaluate whether use of metformin for prediabetes confers continued benefits after diabetes diagnosis did not substantially change the conclusions from those of the simpler intention-to-treat analysis that did not account for treatment changes. All of the analytic methods used resulted in similar metformin effect estimates with 95% CIs for hazard ratios including 1.0 (no effect) for all outcomes except for diabetes incidence. Elucidating metformin's long-term role in mitigating diabetes-related complications beyond its effects on diabetes prevention is challenging.

The effect of virtual versus in-person delivery on behavior changes among adults enrolled in the Diabetes Prevention Program in the Rio Grande Valley, Texas: A secondary analysis