Diabetes Prevention Program Research Articles

Lifestyle Coach Perceptions of Barriers and Facilitators to Participation and Lifestyle Change Among Black and Latinx National Diabetes Prevention Program Participants

ABSTRACT Background Despite the disproportionate impact of type 2 diabetes on racial/ethnic marginalized groups, interventions have not effectively engaged and retained these populations. To effectively meet the needs of these groups, a better understanding of barriers and facilitators to lifestyle change and participation in interventions is needed. Purpose The social determinants of health (SDOH) framework was utilized to examine barriers and facilitators in the National Diabetes Prevention Program (DPP) from the perspective of Lifestyle Coaches delivering the intervention to Black or Latinx participants. Method Using an online survey, coaches reported on barriers observed among participants and strategies to facilitate engagement and retention in the National DPP. We qualitatively coded and summarized responses. Results Black and Latinx participant-serving coaches shared five of the seven most endorsed barriers. Both groups of coaches shared the same four most endorsed facilitators. Discussion Results illustrate the impact SDOH have on one’s ability to participate in diabetes prevention and enact lifestyle change, suggesting that an adapted approach may help to reach Black and Latinx participants. Translation to Health Education Practice This project informs future National DPP implementation. Competencies in the following areas are addressed: Assessment of Needs and Capacity (I), Evaluation and Research (IV), and Advocacy (V).

Metformin in the Diabetes Prevention Program 3-year trial: The cost-effectiveness that never was.

To highlight oversimplified quality-adjusted life year (QALY) calculations and incremental cost-effectiveness ratios (ICERs) regarding lifestyle metformin and placebo as flaws in the trial-based (Diabetes Prevention Program) cost-effectiveness analysis. We revised the QALY calculations to conform to convention and calculated appropriate ICERs using both original and revised QALYs results. We used several additional health economics tools to present results, showing the consistency of each method and the added value of each. We presented net monetary benefits, assessed decision uncertainty and calculated net losses. We also used graphics, making correct interpretation clearer and allowing illustration and calculation of technical and economic inefficiencies of treatments that were not cost-effective. ICERs with either QALY calculation indicated that metformin was technically and economically inefficient and not cost-effective. There was virtually no decision uncertainty. All methods employed pointed to an identical conclusion. In contrast to original claims, although lifestyle was cost-effective in diabetes prevention, metformin was not, and acting otherwise imposes significant monetary and health costs. Various available tools of economic evaluation would probably have prevented the original misinterpretation by the authors had they been used. The varied tools implemented here illustrate with a common example their consistency and value to the field, showing how to depict the results in various ways.

Recruitment and Retention in the National Diabetes Prevention Program Lifestyle Change Program in Two Federally Qualified Health Centers in Rural Hawai'i.

Prediabetes disproportionately affects racial and ethnic minority groups in Hawai'i. The National Diabetes Prevention Program lifestyle change program (National DPP LCP) decreases the risk of developing diabetes. However, enrolling and retaining participants is a challenge for program providers. This evaluation aimed to understand factors that influence racial and ethnic minority groups in Hawai'i to enroll in and complete the program. From 2018 through 2023, two federally qualified health centers (FQHCs) in rural Hawai'i administered 6 year-long cohorts. Trained lifestyle coaches, who were FQHC staff members, recruited participants and facilitated the evidence-based curriculum. In 2023, the evaluation team conducted semistructured interviews with 14 of the 40 enrolled participants (35%), all of whom were women aged 25 to 74 years. Six participants identified as Native Hawaiian or Other Pacific Islander and 3 as Filipino. Eight participants reported completing the program. We used qualitative methodology to analyze transcripts. We identified themes around motivators, barriers, facilitators, and suggestions for improvement. Recruitment by trusted individuals in their communities motivated participants to enroll. Caregiving and work obligations were attendance barriers for early withdrawers and graduates. Social support from lifestyle coaches and enrolled friends and family were facilitators for program completion. Suggestions included improving class availability and incorporating culturally relevant recipes. Barriers experienced by Native Hawaiian or Other Pacific Islander and Filipino participants were similar to those reported by racial and ethnic groups in other studies. Program providers in rural communities should use trusted individuals as lifestyle coaches and recruit family and friends, regardless of National DPP LCP eligibility, to reduce caregiving barriers and engage critical support systems to facilitate completion.

Identification and optimisation of a risk stratified cohort of patients with type 2 diabetes through the delivery of a enhanced pharmacist-led service

Abstract Introduction Cardio-renal metabolic (CRM) diseases are each associated with significant morbidity and mortality, and due to their shared pathology, the benefit of managing these diseases holistically is becoming increasingly evident. The East Belfast Federation practices have sought to review patients living with type 2 diabetes (T2D), prioritising those not meeting their 3 Treatment Targets (3TT, HbA1c, blood pressure [BP] and cholesterol) to optimise treatment through a pharmacist-led model of care. Aims and Objectives 1. Improve adherence to latest update of NICE T2D [NG28, 2022], with a focus on patients with Cardiovascular Disease (CVD) & Chronic Kidney Disease (CKD). 2. Upskill diabetes teams, to create a legacy effect and ensure improved holistic management will continue beyond the project period. 3. Use a clinical audit tool to identify, stratify and optimise T2D patients not meeting their 3TTs. 4. Improve identification, coding and recall of patients with non-diabetic hyperglycaemia (NDH) as per QOF Indicator NDH001NI [QOF 2022/23]. 5. Enhanced focus on review of sulphonylureas (SU) in relation to frailty and risk of hypoglycaemia [Strain, 2021]. Method Patients not meeting their 3TTs (HbA1c>58 mmol/mol, BP>140/80mmHg, total cholesterol>5mmol/L) were identified from October 2022 to July 2023. Primary care based clinics created which we tailored to the specific needs of the practices with a focus on optimising patients with CVD & CKD co-morbidities. Dedicated specialist education and clinical support was provided to existing diabetes teams in CRM patient management. Additional searches were created and patients identified to review patients experiencing NDH and on a SU. Results At 9 months from baseline, there was a statistically significant improvement of 8.9% in patients achieving all 3TTs (n=373, P=0.013). This was accompanied by an increase in the number of patients optimised for CV risk reduction, with a 39% and 42% increase in patient receiving sodium glucose co-transporter-2 (SGLT2) inhibitors (n=542) and Glucagon-like peptide-1 receptor agonists (GLP1RA) (n=190), respectively. A 5.5% (n=28) reduction in the number of patients on a SU was observed, as well as a 44% (n=76) increase in the number of referrals into the Diabetes Prevention Programme (DPP). 151 statins and 51 BP medications were started/optimised. Discussion and Conclusion The project further exemplifies the feasibility of a pharmacist-led T2D service in a primary care setting. In addition to improvement in established T2D markers, the role promoted collaboration and facilitated best-practice sharing across multiple diabetes teams. This approach allows for more co-ordinated care for patients who may otherwise be referred to multiple specialists, which often results in fragmented care. Future work should focus on promoting CRM protection as early as possible to reduce disease progression and improve outcomes.Number of patients on antidiabetic meds% attainment of 3TT

Moving Diabetes Prevention Programs to the Workplace: A Qualitative Exploration of Barriers and Facilitators to Participant Engagement When Implemented by an Employer-Based Clinic.

The Diabetes Prevention Program (DPP), an effective evidence-based strategy to reduce the incidence of type 2 diabetes, has been widely implemented in various locations, including workplaces. However, most people do not remain engaged in the program for the recommended full year. Limited qualitative research exists around participant engagement in the workplace DPP. Our study aimed to explore participant engagement in the DPP delivered through the employer-based clinic (EBC) at a large technology company. The DPP was implemented through the EBC at a large technology company in Southern California, beginning in September 2019 by using in-person and virtual synchronous group classes before and during the COVID-19 pandemic. Virtual focus groups with DPP participants from 2 inaugural cohorts were conducted via Zoom from October 2020 to February 2021. Data were analyzed by using inductive thematic analysis. Five focus groups with 2 to 3 participants in each (total n = 12) were conducted, 2 focus groups per cohort and 1 focus group with the group instructors. Barriers and facilitators to engagement in the DPP were grouped into thematic domains: Individual Drivers, Small Group Community, Workplace Setting, Integrated EBC, and the COVID-19 Pandemic. Results showed that prepandemic workplace demands (ie, meetings, travel) affected DPP participation, yet the group setting provided social support in the workplace to engage in and maintain healthy habits. With the move to a virtual synchronous offering during the pandemic, participants valued the group setting but expressed a preference for in-person meetings. Collectively, participant engagement was bolstered by shared buy-in and collaboration between the employer and the EBC. Our findings suggest that engagement in a workplace DPP can be supported by addressing workplace-specific barriers and gaining buy-in from employers. Delivering the DPP, in person and virtually, through an EBC has the potential to engage employees who have prediabetes.

Learning by Doing: The Potential for Experiential Education in Health Promotion

Background: Rural populations face significant health disparities (e.g., high rates of chronic diseases) and unique accessibility barriers (e.g., limited healthcare facilities). Training higher education students to serve as facilitators for chronic disease prevention programs may address rural health promotion needs. Purpose: The purpose of this pilot, exploratory study was to create an experiential learning opportunity for students and examine their experiences. Methodology/Approach: Project leaders completed a Diabetes Prevention Program Lifestyle Coach training and, based on their experiences, created training program goals, content, and schedule. Undergraduate students in health-related programs or courses were recruited to participate. Four students completed a 4-week experiential training program and, at the end of the program, participated in an individual qualitative interview for researchers to understand their experiences. Findings/Conclusions: Data were analyzed through a qualitative-descriptive approach. The main theme, experiential learning, branched into two subthemes: (a) professional development and (b) program implementation and future program directions. Students’ experiential learning influenced their personal and programmatic views of prevention training. Implications: The benefits of experiential learning in prevention will enhance students’ education and future employment experiences. Future studies should improve upon training delivery and examine the acceptability of this method of delivery in the rural population.

Is Weight Loss the Most Effective Method for the Prevention of Type 2 Diabetes? A Discussion in View of Evidence from Landmark Studies

Type 2 Diabetes mellitus (T2DM) and obesity are a continuum and intertwined in a complex way. Both these chronic conditions pose a significant challenge to the global health system, if the current trend continues, it is estimated that by 2045 the number of people affected globally will increase by almost 700 million. Considering the above, effective strategies have to be implemented to tackle this global pandemic. The main strategies discussed in the literature are lifestyle intervention (ESI) with or without weight loss and medication. This article looked at the evidence from the various landmark studies which include the Diabetes Prevention Program (DPP) and Diabetes Prevention Study (DPS) Outcomes of these studies suggest that ELSI with loss is superior to ELSI without weight loss and metformin in risk reduction of T2DM. The evidence from the Swedish obese subject study also concludes that weight loss achieved through bariatric surgery reduces the risk. Lifestyle modification programmes even without weight loss have greater health benefits but as far as risk reduction for T2DM the evidence is not conclusive. This review article concludes that reducing weight is paramount for preventing T2DM, especially in high-risk individuals, compliance plays a vital role in overcoming these challenges and stresses the importance of tailored strategies for person-to-person characteristics to overcome those challenges.

Case Report: Medicare Diabetes Prevention Program in an Academic Medical Center

Case Report: Medicare Diabetes Prevention Program in an Academic Medical Center

Facilitators and barriers to implementing the Diabetes Prevention Program in rural church settings: A qualitative study using the Consolidated Framework for Implementation Research.

The CDC's Diabetes Prevention Program (DPP) is an effective lifestyle intervention to prevent type 2 diabetes (T2D). However, DPP implementation in rural areas is limited. This study sought to address this gap by implementing DPP in rural church settings through a community-academic partnership and identifying implementation facilitators and barriers. This was a cross-sectional qualitative study. Semistructured interviews guided by the Consolidated Framework for Implementation Research (CFIR) assessed church leaders' and lifestyle coaches' perceptions of implementing DPP in rural churches. Thematic analysis was used to identify key themes through an inductive approach; then, these emergent themes were deductively linked to CFIR constructs. COREQ guidelines were used to report study findings. Twenty-five stakeholders participated. Facilitators to implementing DPP included its evidence-based effectiveness in preventing T2D, as well as support from the academic partner in terms of funding, training, and communication. Additionally, DPP's alignment with community needs, along with the active engagement of pastors in participant recruitment, supported implementation. Several barriers hindered DPP implementation, including transportation and childcare issues, as well as program participants' medical conditions/disabilities limiting their participation. Furthermore, rural residents' reluctance to adopt lifestyle changes and loyalty to family churches posed challenges to their engagement in DPP. This study identified contextual factors influencing DPP implementation in rural communities. Findings highlight the importance of tailored strategies that leverage facilitators while proactively addressing barriers, including rural residents' reluctance to attend programs outside their church, resistance to lifestyle changes, and transportation issues to ensure successful DPP implementation in rural areas.

Implementation lessons learned from the University of California’s Diabetes Prevention Program Initiative

BackgroundThe University of California’s Diabetes Prevention Program (UC DPP) Initiative was implemented systemwide to address diabetes and obesity risk on all 10 campuses. As little is known about implementing lifestyle change programs in university settings, we examined implementation partners’ (i.e., UC DPP leaders and campus leads) perceptions of factors influencing program success on UC campuses.MethodsWe conducted qualitative interviews with UC DPP leaders and campus leads to examine challenges and opportunities with university-based DPP delivery models. Interviews were recorded, professionally transcribed, and reviewed in detail by the research team. Transcripts were analyzed using rapid qualitative analysis (RQA). The study was approved by the UCLA Institutional Review Board. All implementation partners provided verbal informed consent.ResultsTwenty-six implementation partners (8 UC DPP leaders and 18 campus leads) completed interviews in 2021. Seven themes were identified as critical for implementation, including (1) marketing and recruitment (i.e., market and recruit broadly through established channels as well as target at-risk populations); (2) enrollment (i.e., offer the program during convenient times and let participants know what to expect); (3) use an adaptable, evidence-based program; (4) secure funding for the program, participants, lifestyle coaches, and space; (5) hire experienced and dedicated staff and lifestyle coaches; (6) ensure leadership support; and (7) utilize campus linkages and resources. Perceptions of challenges faced with respect to these themes are also described.ConclusionsThis is one of the first studies to examine the challenges and opportunities of delivering an intensive lifestyle change program across 10 university sites. Understanding factors that enhance success of university-based diabetes prevention programs can facilitate UC DPP efforts and help inform delivery strategies of health and wellness programs across other university settings more broadly.

Evaluation of a Workplace Diabetes Prevention Program Delivered via Distance Learning: A Qualitative Study.

Little is known about how distance learning impacts delivery of the National Diabetes Prevention Program (DPP) despite a rapid shift to this platform during the coronavirus disease 2019 (COVID-19) public health emergency. We explored how a workplace DPP, delivered via distance learning, impacted knowledge, motivation, and behavioral skills of participants throughout the program. We conducted repeated qualitative interviews with distance learning participants at baseline, 6 months, and 12 months from September 2020 to July 2022. Three study team members coded interview data using individual responses as the unit of analysis. We used a thematic approach, using the information-motivation-behavioral skills framework, to analyze responses and generate understanding of the program's impact. The 27 individuals who participated in the interviews (89% women, mean age 56 years) reported the distance learning platform was effective in changing their behavior. The program's focus on food logging and setting limits on specific types of caloric intake was perceived as essential. Education on ideal levels of fat and sugar consumption, lessons on how to read food labels, and dissemination of recipes with healthy food substitutions allowed participants to initiate and sustain healthy decision-making. Strategies to increase physical activity, including breaking up exercise throughout the day, made reaching their goals more feasible. Participants reported food logging and weight reporting, as well as group support during sessions, either sustained or increased their motivation to adhere to the program over time. A workplace DPP delivered via distance learning successfully prompted improvements in the knowledge, motivation, and behavioral skills necessary to increase healthy eating and physical activity among participants.

Gestational diabetes mellitus: ensuring healthy futures

Gestational diabetes mellitus is the most common medical condition in pregnancy, disproportionately affecting overweight or obese women and those from non-White populations. The lack of standardised screening and diagnostic consensus contributes to varying prevalence. Conventional risk factor-based screening can leave women undiagnosed, leading to increased risk of harm. If diet and lifestyle modifications fail to achieve glycaemic targets, prompt treatment should be initiated to manage glucose levels. A planned birth is crucial to ensure the best outcomes. Postpartum, women need screening for type 2 diabetes and other cardiometabolic risk factors, enrollment in diabetes prevention programmes, and counselling on the increased risk of future cardiometabolic disease for themselves and their offspring, highlighting the importance of ongoing prevention and management strategies.

National health and economic impact of a lifestyle program to prevent type 2 diabetes mellitus in Germany: a simulation study

IntroductionTo examine the long-term health and economic impact of a lifestyle diabetes prevention program in people with high risk of developing type 2 diabetes in Germany.Research design and methodsWe assessed...

The Underutilization of National Diabetes Prevention Program Among Women With a History of Gestational Diabetes Mellitus: An In-Depth Focus Group Analysis

IntroductionGestational Diabetes Mellitus (GDM) significantly increases the risk of developing Type 2 Diabetes Mellitus (T2DM) in women. However, the National Diabetes Prevention Program (NDPP), effective in reducing T2DM incidence, is underutilized among women with a history of GDM. This study aims to explore the factors contributing to this underutilization and propose strategies to increase NDPP's usage. MethodsA qualitative study with narrative methodology was employed, involving focus group discussions with 18 women ages between 29-43, who had a history of GDM. Participants were recruited from a GDM registry through University of California, San Diego's(UCSD) online platform. The discussions were aimed at understanding their awareness of T2DM risk post-GDM and their knowledge about the NDPP. ResultsThematic analysis of the discussions revealed four key themes: 1) Challenges in navigating health information post-GDM, 2) Perceived facilitators for NDPP participation, including peer support, personalized guidance, and virtual options, 3) Perceived barriers, such as time constraints, childcare responsibilities, and financial considerations, and 4) Insights into patient perspectives on GDM care. Despite awareness of their increased T2DM risk, there was a notable gap in knowledge about the NDPP among participants. ConclusionsThe study highlights the critical need for improved communication regarding post-GDM diabetes risk and the NDPP. Addressing communication gaps, offering personalized support, and accommodating the unique challenges faced by women with a history of GDM can enhance NDPP participation. The significance of a patient-centric approach in diabetes prevention is underscored, emphasizing that such an approach could significantly impact T2DM prevention in this high-risk population.

Abstract B053: A pilot study of a digital weight loss program for cancer prevention among obese individuals from four diverse cohorts

Abstract Background: Obesity and physical inactivity increase the risk of many types of cancer. Effective weight management, healthy diet, and physical activity are critical to reduce cancer risk. This pilot study of a technology-based weight loss program evaluated the program feasibility, weight loss, and improvement of healthy behaviors and quality of life among minority and medically underserved participants with obesity for cancer prevention. Methods: Participants in this pilot study were included from four cohorts: 1) Mano a Mano Mexican American Cohort (MAC; family dyads) 2) Project CHURCH (African-American men), 3) High- Risk Breast Cohort (HRBC; women), and 4) Mammography Cohort (women who participated in mammography screening). A 16-week weight loss program using the Diabetes Prevention Program was provided for healthy eating, physical activity, and portion control. Participants received program materials, text messages, Fitbit, and Wi-Fi connected scale. Weight, physical activity, dietary intake, weight-related health behaviors, and quality of life were assessed at baseline and follow-up. Program feasibility including retention and satisfaction were assessed after the program. Changes in outcomes from pre- to post- program were examined using paired t-tests and chi-squared tests. Results: Among 48 enrolled participants, 37 participants completed the program (total=77%; MAC=59%; Project CHURCH=90%; HRBC=90%; Mammography=90%). During the program, 46% participants measured and recorded their weights at least one day per week (MAC=17%; Project CHURCH=60%; HRBC=80%; Mammography=50%); 65% wore the Fitbit at least 2 days per week (MAC=44%; Project CHURCH=90%; HRBC=80%; Mammography=60%); 77% responded to text messages 15 out of 30 times (MAC=61%; Project CHURCH=90%; HRBC=90%; Mammography=80%); and 92% were satisfied with the program (MAC=100%; Project CHURCH=100%; HRBC=78%; Mammography=89%). After the program, we observed about 2% weight loss in average (self- report: p=0.009; scale measured: p=0.010). There were significant improvements in weight- related eating behaviors (routine restraint: +0.55, p=0.001; compensatory restraint: +0.49, p=0.001; susceptibility to external cues: -0.41, p=0.026; and emotional eating: -0.57, p=0.001). Stage of change for weight control showed significant shifts from action to maintenance stage (p=0.012). Furthermore, dietary habits significantly changed after the intervention with decreased 30% of total energy intake (p<0.001), increased 14% protein intake (p=0.044), and decreased 56% added-sugar intake (p<0.001). Conclusions: This digital weight loss program was determined as feasible and effective for weight loss and improving eating behaviors and dietary intake among minority and medically underserved individuals with obesity. The MAC showed a higher drop-out rate and less engaged in the program compared to other cohort, and therefore, this cohort may need adapted and more support that a low touch digital weight loss program can provide to improve the feasibility. Citation Format: Che Young Lee, Thuan Le, Carrie R Daniel, Larkin L. Strong, Scherezade K Mama, Lorna H McNeill, Abenaa Brewster, Samir Hanash, Karen Basen-Engquist. A pilot study of a digital weight loss program for cancer prevention among obese individuals from four diverse cohorts [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B053.

Longitudinal associations between microRNAs and weight in the diabetes prevention program.

Circulating microRNAs show cross-sectional associations with overweight and obesity. Few studies provided data to differentiate between a snapshot perspective on these associations versus how microRNAs characterize prodromal risk from disease pathology and complications. This study assessed longitudinal relationships between circulating microRNAs and weight at multiple time-points in the Diabetes Prevention Program trial. A subset of participants (n=150) from the Diabetes Prevention Program were included. MicroRNAs were measured from banked plasma using a Fireplex Assay. We used generalized linear mixed models to evaluate relationships between microRNAs and changes in weight at baseline, year-1, and year-2. Logistic regression was used to evaluate whether microRNAs at baseline were associated with weight change after 2 years. In fully adjusted models that included relevant covariates, seven miRs (i.e., miR-126, miR-15a, miR-192, miR-23a, and miR-27a) were statistically associated with weight over 2 years. MiR-197 and miR-320a remained significant after adjustment for multiple comparisons. Baseline levels of let-7f, miR-17, and miR-320c were significantly associated with 3% weight loss after 2 years in fully adjusted models. This study provided evidence for longitudinal relationships between circulating microRNAs and weight. Because microRNAs characterize the combined effects of genetic determinants and responses to behavioral determinants, they may provide insights about the etiology of overweight and obesity in the context or risk for common, complex diseases. Additional studies are needed to validate the potential genes and biological pathways that might be targeted by these microRNA biomarkers and have mechanistic implications for weight loss and disease prevention.

The challenges and lessons from a formative process and value-based evaluation of the wave 1 roll-out of the all Wales Diabetes Prevention Programme

BackgroundThe All Wales Diabetes Prevention Programme (AWDPP) is a Wales wide, public health initiative designed to systematically identify adults at risk of developing type 2 diabetes and offer a 30-minute person-centred lifestyle conversation focused on diet and physical activity. An independent formative process and value-based evaluation was commissioned to examine the implementation of this programme in 14 primary care cluster areas across Wales during the initial roll-out.MethodsThis evaluation was undertaken to ascertain the views on early implementation of the programme from service users, health care professionals and key stakeholders. The evaluation was informed by the Medical Research Council Framework for Process Evaluation and Wales Prudent Healthcare principles. As part of the value-based assessment, a preliminary cost-consequence analysis was conducted to understand the short-term economic impact of the implementation of the programme.ResultsService users who took part in the evaluation highly valued the programme and nearly half had been previously unaware that they were at risk of developing type 2 diabetes. Delivering the programme presented challenges but there was significant enthusiasm and support from all stakeholders. Overall, the programme was being delivered as intended albeit with evidence of some variation in the application of the programme eligibility criteria.ConclusionsIn Wave 1 of the AWDPP roll-out, the intent to deliver the programme in line with Prudent Healthcare was successful and promising in terms of demonstrating value. Opinions expressed by service users suggest the AWDPP matters to them; raising awareness, promoting knowledge and capacity to change behaviours and motivate and raise confidence.

Testosterone and the prevention of type 2 diabetes mellitus: therapeutic implications from recent trials.

Type 2 diabetes (T2D) is increasing to epidemic proportions and frequently associated with obesity and a low serum testosterone concentration in men. This review valuates recent randomized controlled trials (RCTs) investigating the effect of testosterone treatment on glycemic control and T2D prevention. The 2-year Testosterone for the Prevention of Type 2 diabetes Trial (T4DM) study showed that in men aged 50 years and over with visceral obesity and impaired glucose tolerance, testosterone treatment on the background of a lifestyle intervention reduced T2D risk by 40%. The Testosterone Effects on Atherosclerosis Progression in Aging Men and Testosterone Trials demonstrated modest improvements in insulin sensitivity and body composition. However, the Testosterone Replacement Therapy for Assessment of Long-Term Vascular Events and Efficacy Response in Hypogonadal Men trial found no significant glycemic benefits over 2 years. Recent data from the Diabetes Prevention Program Outcome Study support the cost efficacy and durability of metformin. In men at high risk of T2D, treatment with testosterone prevents the disease; however, there are caveats to its use and other approaches may be more applicable. Differences in trial designs, age groups, and outcome measures contribute to varying results. HbA1C is a suboptimal outcome measure. Future research should explore potential synergies between testosterone and GLP-1 receptor agonists in T2D management, while considering cost-effectiveness.

The Impact of Public Health on Disease Prevention

Public health plays an important role in preventing diseases by supporting measures that prioritise the well-being of entire populations over individuals. This study investigates the history of public health, the approaches used in illness prevention, and the difficulties encountered in executing these tactics. Public health strategies, such as immunisation programs and lifestyle modifications, are critical in combating communicable and non-communicable diseases. Case studies like the Diabetes Prevention Program and REACH U.S. demonstrate the effectiveness of public health efforts. The paper also discusses current difficulties, such as limited resources, misinformation, and increasing dangers, as well as possible future strategies for improving public health systems through innovation, research, and community participation. Keywords: Public Health, Disease Prevention, Vaccination, Health Promotion, Preventive Healthcare.

Behavioral Weight Management Interventions for Hispanic Men in the United States: A Systematic Review.

Hispanic men have the highest prevalence of obesity relative to other racial and ethnic subgroups; however, this population is consistently underrepresented in weight management interventions. This systematic review aims to provide an overview of behavioral weight management interventions adapted for Hispanic men and describe their tailoring strategies and efficacy. Six online databases were selected for their abundant collection of high-quality, peer-reviewed literature and searched for studies which evaluated and reported weight outcomes for a cohort of adult (>18 years) Hispanic men. Of 6,508 unique publications screened, 12 interventions met inclusion criteria, the majority of which were published in the past 10 years. Only one study regarding an intervention tailored for Hispanic men was a randomized controlled trial adequately powered to assess a weight-based outcome; the remaining assessed feasibility or utilized quasi-experimental methods. Intervention characteristics and tailoring strategies varied considerably, but content was most frequently based on the Diabetes Prevention Program. Tailoring strategies commonly focused on improving linguistic access and incorporating social or family support. Follow-up varied from 1 month to 30 months and mean change in weight, the most common outcome, ranged from 0.6 to -6.3 kg. Our findings reveal a need for more fully powered randomized controlled trials evaluating the efficacy of interventions systematically tailored specifically for Hispanic men. Although the majority were not fully powered, these interventions showed some efficacy among their small cohorts for short-term weight loss. Future directions include exploring how to tailor goals, concepts, and metaphors included in interventions and comparing individual to group delivery settings.