Diabetes Prevention Program Translation in the Veterans Health Administration

Moin, Tannaz; Damschroder, Laura J.; AuYoung, Mona; Maciejewski, Matthew L.; Datta, Santanu K.; Weinreb, Jane; Steinle, Nanette I.; Billington, Charles J.; Hughes, M. E.; Makki, Fatima; Holleman, Robert G.; Kim, H. Myra; Jeffreys, Amy S.; Kinsinger, Linda; Burns, Joseph E.; Richardson, Caroline R.

doi:10.1016/j.amepre.2016.11.009

Cited by 37 publications

(29 citation statements)

References 36 publications

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“…Furthermore, in comparison with recent in-person DPP trials, which have scalability and cost-effectiveness challenges [ 27 ], results indicate that weight loss outcomes may even be higher in virtual DPP [ 28 , 29 ]. One possible reason for these outcomes is that virtual DPP allows for a participant to interact with a group and facilitator more than once per week.…”

Section: Discussionmentioning

confidence: 99%

Usefulness of a Novel Mobile Diabetes Prevention Program Delivery Platform With Human Coaching: 65-Week Observational Follow-Up

Michaelides¹,

Major²,

Pienkosz³

et al. 2018

JMIR Mhealth Uhealth

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BackgroundIt is widely recognized that the prevalence of obesity and comorbidities including prediabetes and type 2 diabetes continue to increase worldwide. Results from a 24-week Diabetes Prevention Program (DPP) fully mobile pilot intervention were previously published showing promising evidence of the usefulness of DPP-based eHealth interventions on weight loss.ObjectiveThis pilot study extends previous findings to evaluate weight loss results of core (up to week 16) and maintenance (postcore weeks) DPP interventions at 65 weeks from baseline.MethodsOriginally, 140 participants were invited and 43 overweight or obese adult participants with a diagnosis of prediabetes signed up to receive a 24-week virtual DPP with human coaching through a mobile platform. At 65 weeks, this pilot study evaluates weight loss and engagement in maintenance participants by means of repeated measures analysis of variances and backward multiple linear regression to examine predictors of weight loss. Last observation carried forward was used for endpoint measurements.ResultsAt 65 weeks, mean weight loss was 6.15% in starters who read 1 or more lessons per week on 4 or more core weeks, 7.36% in completers who read 9 or more lessons per week on core weeks, and 8.98% in maintenance completers who did any action in postcore weeks (all P<.001). Participants were highly engaged, with 80% (47/59) of the sample completing 9 lessons or more and 69% (32/47) of those completing the maintenance phase. In-app actions related to self-monitoring significantly predicted weight loss.ConclusionsIn comparison to eHealth programs, this pilot study shows that a fully mobile DPP can produce transformative weight loss. A fully mobile DPP intervention resulted in significant weight loss and high engagement during the maintenance phase, providing evidence for long-term potential as an alternative to in-person DPP by removing many of the barriers associated with in-person and other forms of virtual DPP.

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Section: Discussionmentioning

confidence: 99%

Usefulness of a Novel Mobile Diabetes Prevention Program Delivery Platform With Human Coaching: 65-Week Observational Follow-Up

Michaelides¹,

Major²,

Pienkosz³

et al. 2018

JMIR Mhealth Uhealth

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show abstract

“…Nevertheless, participation in the VA-DPP was higher than that in MOVE! (the VHA weight-loss program), and nearly all of the Centers for Disease Control and Prevention Diabetes Prevention Recognition Program standards for recognition were met (9). Overall participation in the Online-DPP (84.4% completed nine or more modules in the first 6 months) was slightly lower than the 92% reported in a Medicare population (10).…”

Section: Discussionmentioning

confidence: 88%

Older Adults and Diabetes Prevention Programs in the Veterans Health Administration

et al. 2018

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OBJECTIVETo investigate whether older veterans enrolled in two diabetes prevention programs (DPPs) in the Veterans Health Administration will have similar weight loss as younger veterans. RESEARCH DESIGN AND METHODSPost hoc analysis of data from two prospective, pragmatic, nonrandomized studies of behavioral weight management interventions that were delivered in-person (Department of Veterans Affairs [VA]-DPP) or online (Online-DPP), comparing participation and weight loss between participants aged ‡65 years (N = 120) vs. <65 years (N = 258). RESULTSOver 70% of participants in both age groups completed eight or more sessions within 6 months; a higher proportion completed eight or more sessions in the Online-DPP intervention than in the VA-DPP intervention (P < 0.05). The overall weight changes at 6 and 12 months were similar across the two age groups: ∼5 kg or 5% weight loss compared with baseline (P > 0.05). CONCLUSIONSDPPs delivered in person or online can be similarly effective in older and younger veterans. Online programs may be an important means to improve the reach of DPPs for older adults.Older veterans are disproportionally affected by diabetes, with prevalence as high as 34% in 2011 (1), compared with 25% of the general population $65 years of age (2). Thirty-six percent of older veterans have obesity, a major risk factor for diabetes (1). Clearly, effective intervention to prevent diabetes in older adults, especially older veterans, is urgently needed. The Diabetes Prevention Program (DPP) trial demonstrated that modest weight loss through lifestyle interventions can reduce diabetes incidence in high-risk individuals (2). However, few programs translating the DPP into real clinical settings included older veterans or online programs. Veterans receiving care in the Department of Veterans Affairs (VA) Veterans Health Administration (VHA) are likely to have lower overall health status and socioeconomic status than nonveterans (3). In addition, many older adults with prediabetes already have comorbidities and functional impairment that may limit their ability to complete lifestyle-based DPP programs (4). Thus, we conducted a post hoc analysis of two DPP trials in the VHA, in person (VA-DPP) and online (Online-DPP), and investigated whether veterans $65 years of age had similar participation and weight loss as younger veterans.

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“…Our study has several limitations; the most notable being the small effect size seen with the intervention overall, which may be related to the low level of session attendance in MAGDA [25]. The literature acknowledges that disengagement from an intervention results in less skills and coping strategies for weight reduction [49, 50] and other diabetes prevention programs have associated decreased participation with decreased weight reduction [51]. The definition of the PPS is another limitation for consideration as it did include reasons for exclusion that were not related to attendance and the criteria relating to a minimum exposure to the intervention was low (one in five of the group sessions).…”

Section: Discussionmentioning

confidence: 99%

The effect of a diabetes prevention program on dietary quality in women with previous gestational diabetes

et al. 2019

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Background Women with gestational diabetes have low diet quality. We evaluated the effectiveness of a group-based lifestyle modification program for improvement of dietary quality in women with previous gestational diabetes predominantly within their first postnatal year. Methods Women were randomised to intervention ( n = 284) or usual care ( n = 289). Dietary data was collected at baseline and twelve months using a food frequency questionnaire and recoded into the Australian Recommended Food Score (ARFS). Mixed model analyses investigated the intervention effect on ARFS (per-protocol-set (PPS) excluded women without the minimum intervention exposure). Results Baseline mean total ARFS was low (31.8 ± 8.9, maximum score = 74) and no significant changes were seen in total ARFS (Cohen’s D = − 0.06). 2% reduction in alcohol for intervention (0.05, 0.26) compared with − 1% for usual care (Odds ratio: 0.68; 95%CI 0.46, 0.99). Dairy ARFS sub-category significantly improved (low fat/saturated fat foods) in the intervention group over time compared with usual care for the PPS analysis (dairy + 0.28 in intervention (95%CI 0.08, 0.48) compared with + 0.02 in usual care (95%CI -0.14, 0.18) (group-by-treatment interaction p = 0.05, Cohen’s D = 0.14)). Conclusions Engaging with the intervention improved aspects of diet quality that aligned with minimum intervention exposure, but the total diet quality remains low. Further research is needed to improve diabetes prevention program engagement. Trial registration Australian New Zealand Clinical Trials Registry ANZCTRN12610000338066 , April 2010.

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Diabetes Prevention Program Translation in the Veterans Health Administration

Abstract: Features of VA-DPP may help enhance the capability of MOVE! to reach a larger proportion of the served population and promote individual-level weight maintenance.

Cited by 37 publications

References 36 publications

Usefulness of a Novel Mobile Diabetes Prevention Program Delivery Platform With Human Coaching: 65-Week Observational Follow-Up

Usefulness of a Novel Mobile Diabetes Prevention Program Delivery Platform With Human Coaching: 65-Week Observational Follow-Up

Older Adults and Diabetes Prevention Programs in the Veterans Health Administration

The effect of a diabetes prevention program on dietary quality in women with previous gestational diabetes

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