An Examination of Gender Differences in the National Diabetes Prevention Program’s Lifestyle Change Program

Jackson, Matt; Dai, Shifan; Skeete, Renée A.; Owens-Gary, Michelle; Cannon, Michael J.; Smith, Bryce D.; Jabrah, Rajai; Masalovich, Svetlana; Soler, Robin

doi:10.1177/0145721720964585

Cited by 18 publications

(10 citation statements)

References 15 publications

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“…One of these studies compared population estimates of eligibility to actual enrollment and found that adults who were eligible, but did not enroll in the National DPP during the first 5 years of its nationwide implementation were more likely to be younger or older (relative to middle aged), Hispanic (relative to non-Hispanic), and male (relative to female). 16 Over this same time frame, individuals who enrolled inbut did not completethe National DPP were more likely to be younger and racial/ethnic minority participants. 19 Qualitative studies have identified barriers to enrollment and retention, including childcare, transportation, and scheduling, 10 , 15 length of the year-long program, and discomfort with the group modality.…”

Section: Discussionmentioning

confidence: 99%

“…11,14 Just one known study of the National DPP, focused on women of childbearing age, includes in-depth interviews with patients from within a health system. 15 Given women's higher engagement with the National DPP to date, 16 there is substantial opportunity for qualitative study in this group. This study extends the research with a qualitative analysis of barriers and facilitators to enrollment and retention within a health system from the perspectives of (1) women referred to the National DPP and (2) referring clinicians.…”

Section: Introductionmentioning

confidence: 99%

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Barriers and Facilitators to Enrollment and Retention in the National Diabetes Prevention Program: Perspectives of Women and Clinicians Within a Health System

Baucom

Pershing

Dwenger

et al. 2021

Women's Health Reports

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Background: More than 10% of US adults are living with type 2 diabetes. The Centers for Disease Control and Prevention established the National Diabetes Prevention Program (National DPP) in 2010 in an effort to delay or prevent this disease among individuals at high risk. Unfortunately, enrollment and retention rates are low. This qualitative study aims to understand barriers and facilitators to enrolling and completing the National DPP among women, and to provide recommendations for improvement. Methods: Semistructured interviews were conducted with the following: (1) women who were eligible for the National DPP, but declined to enroll (n = 11); (2) women who enrolled in the National DPP, but did not complete the program (n = 12); and (3) clinicians who treat women eligible for the National DPP (n = 12). Transcripts of the interviews were coded using content analysis. Results: The 35 interviews (23 patients and 12 clinicians) provided further insight into known barriers, such as the cost of the program, the time that it takes, and inconvenient locations. The study also identified previously undiscovered barriers, including the program not meeting participants' expectations and facilitating referrals. Furthermore, improved communication between clinicians, patients, and National DPP staff could ensure that both clinicians and National DPP staff are aware of patients' goals and their individual barriers to success. Conclusions: Enrollment and retention in the National DPP may be improved with additional communication, more training for National DPP staff to work more closely with participants, adding better incentives to participation, and making the program more accessible through flexibility in time and/or locations.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Barriers and Facilitators to Enrollment and Retention in the National Diabetes Prevention Program: Perspectives of Women and Clinicians Within a Health System

Baucom

Pershing

Dwenger

et al. 2021

Women's Health Reports

View full text Add to dashboard Cite

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“…Although equivalent weight loss yielded greater reduction in risk factors for type 2 diabetes for men than their women counterparts, 27 women are over three times as likely to enroll in the NDPP lifestyle change program. 28 In the DPP Outcomes Study, coronary calcium score severity was less in men receiving metformin versus placebo, an effect not seen in women. 29 In a meta-analysis, no sex-specific differences in the reduction in incidence of type 2 diabetes was appreciated in both lifestyle and pharmacological interventions.…”

Section: Discussionmentioning

confidence: 99%

Use of metformin following a population-level intervention to encourage people with pre-diabetes to enroll in the National Diabetes Prevention Program

Hurst

McEwen

Joiner

et al. 2021

BMJ Open Diab Res Care

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IntroductionThe National Diabetes Prevention Program (NDPP) and metformin are interventions to slow progression from pre-diabetes to type 2 diabetes. When coverage for the NDPP was offered by a public research university’s health insurance plan, proactive strategies were used to combat historically low enrollment. Although not specifically targeted by these strategies, metformin use was higher than expected, leading to this evaluation.Research design and methodsWe used insurance enrollment, claims, pharmacy, and laboratory data for 64 131 adult employees, dependents, and retirees to identify individuals with pre-diabetes and invite them to enroll in the NDPP at no out-of-pocket cost. The characteristics of individuals with pre-diabetes who used metformin before and after their invitation were compared with NDPP enrollees.Results8131 individuals with pre-diabetes were identified. Of these, 776 (9.5%) enrolled in a NDPP and 802 (9.9%) used metformin. Metformin users were younger, had higher body mass index, were more likely to have comorbidities, and had higher baseline hemoglobin A1c levels than non-users. Timing of metformin use varied with 107 (13%) discontinuing, 426 (53%) continuing, and 269 (34%) initiating metformin use after their NDPP invitation. Of NDPP enrollees, 13 (2%) discontinued, 56 (7%) continued, and 34 (4%) initiated metformin use when they enrolled.ConclusionsDespite no active encouragement, use of metformin was similar to the rate of enrollment in the NDPP. Metformin use was higher for individuals with higher likelihood of responding. With the proven cost-effectiveness of metformin, targeted strategies to increase metformin use in individuals with pre-diabetes who are likely to respond, but not willing to enroll in a lifestyle intervention, are needed.

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“…Although some older participants may be reluctant to adopt new technologies, virtual delivery approaches have shown promise with this age group [ 24 ]. Online organizations enrolled a somewhat higher proportion of men than in-person organizations and thus may be an important avenue for increasing the relatively low proportion of men who enroll in the National DPP lifestyle change program [ 13 ]. The organizations with no in-person component (i.e., online and distance learning) enrolled lower proportions of participants who were Hispanic/Latino or non-White, suggesting that in order to reduce health disparities, these delivery modes need to be made more accessible and appealing to minority racial and ethnic groups [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

Delivering the National Diabetes Prevention Program: Assessment of Enrollment in In-Person and Virtual Organizations

Cannon

Lloyd

et al. 2022

Journal of Diabetes Research

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The aim of the US Centers for Disease Control and Prevention’s (CDC) National Diabetes Prevention Program (National DPP) is to make an evidence-based lifestyle change program widely available to the more than 88 million American adults at risk for developing type 2 diabetes. The National DPP allows for program delivery using four delivery modes: in person, online, distance learning, and combination. The objective of this study was to analyze cumulative enrollment in the National DPP by delivery mode. We included all participants who enrolled in CDC-recognized organizations delivering the lifestyle change program between January 1, 2012, and December 31, 2019, and whose data were submitted to CDC’s Diabetes Prevention Recognition Program. During this time, the number of participants who enrolled was 455,954. Enrollment, by delivery mode, was 166,691 for in-person; 269,004 for online; 4,786 for distance-learning; and 15,473 for combination. In-person organizations enrolled the lowest proportion of men (19.4%) and the highest proportions of non-Hispanic Black/African American (16.1%) and older (65+ years) participants (28.2%). Online organizations enrolled the highest proportions of men (27.1%), younger (18-44 years) participants (41.5%), and non-Hispanic White participants (70.3%). Distance-learning organizations enrolled the lowest proportion of Hispanic/Latino participants (9.0%). Combination organizations enrolled the highest proportions of Hispanic/Latino participants (37.3%) and participants who had obesity (84.1%). Most in-person participants enrolled in organizations classified as community-centered entities (41.4%) or medical providers (31.2%). Online and distance-learning participants were primarily enrolled (93.3% and 70.2%, respectively) in organizations classified as for-profit businesses or insurers. Participants in combination programs were enrolled almost exclusively in organizations classified as medical providers (89%). The National DPP has reached nearly half a million participants since its inception in 2012, but continued expansion is critical to stem the tide of type 2 diabetes among the many Americans at high risk.

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An Examination of Gender Differences in the National Diabetes Prevention Program’s Lifestyle Change Program

Cited by 18 publications

References 15 publications

Barriers and Facilitators to Enrollment and Retention in the National Diabetes Prevention Program: Perspectives of Women and Clinicians Within a Health System

Barriers and Facilitators to Enrollment and Retention in the National Diabetes Prevention Program: Perspectives of Women and Clinicians Within a Health System

Use of metformin following a population-level intervention to encourage people with pre-diabetes to enroll in the National Diabetes Prevention Program

Delivering the National Diabetes Prevention Program: Assessment of Enrollment in In-Person and Virtual Organizations

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