Diabetes Prevention within a Large Health Care System

Abstract

Background: The Group Lifestyle Balance™ (GLB) program is an adaption of the landmark Diabetes Prevention Program that has been recognized by the CDC as a model curriculum for diabetes prevention. The implementation of GLB at 8 predominantly autonomous and highly diverse clinics within a single, large multi-specialty healthcare organization provides a unique opportunity to evaluate the program in a real-world setting. Methods: We conducted structured interviews with GLB facilitators at Sutter Health, a Healthcare Delivery System in Northern California, using snowball sampling. Interview questions were based on the RE-AIM framework to explore the reach, effectiveness, adoption, implementation and maintenance of the program between sites. We focused this analysis on a single regional affiliate of Sutter, with 8 clinic sites offering GLB to examine potential within-region variation. Results: Ten GLB facilitators were interviewed, representing 8 clinical sites within the Sutter Health regional affiliate. All the facilitators were diabetes educators; 9 were registered dietitians and 1 was a registered nurse. Five sites began offering GLB in 2010, followed by two sites in 2013 and one in 2015. Eligibility criteria were the same across sites, and included all patients regardless of risk factors, except pregnant women. While all sites consistently offer 12 weekly “core” sessions over a 3-month period, the maintenance sessions are optional and are only offered at half of the sites. Almost all facilitators (n= 9) reported that they use a modified version of the curriculum developed by the University of Pittsburgh and all mentioned that they provide participants with additional information. Conclusion: These preliminary data suggest that the GLB program has been implemented within a regional affiliate of a healthcare system, consistently, yet with some variation in the use of the post-core maintenance curriculum. Future work will examine the effectiveness of GLB based on the type of curriculum and duration of the program. Disclosure K.M.J. Azar: Research Support; Self; Janssen Scientific Affairs, LLC., Regeneron Pharmaceuticals, Inc..C. Nasrallah: None. N. Szwerinski: None. V. Chopra: None. M. Halley: None. R. Romanelli: Research Support; Self; Janssen Scientific Affairs, LLC., Regeneron Pharmaceuticals, Inc., Pfizer Inc..