Healthy Living Partnerships to Prevent Diabetes (HELP PD): Design and methods

Abstract

Although the Diabetes Prevention Program (DPP) developed a lifestyle weight loss intervention that has been demonstrated to prevent type 2 diabetes in high-risk individuals, it has yet to be widely adopted at the community level. The Healthy Living Partnership to Prevent Diabetes study (HELP PD) was designed to translate the DPP approach for use in community settings as a cost-effective intervention led by Community Health Workers (CHW's) and administered through a Diabetes Care Center (DCC). Approximately 300 overweight and obese (BMI 25-40 kg/m 2 ) individuals with prediabetes (fasting blood glucose 95-124 mg/dl) were randomly assigned to either a lifestyle weight loss intervention (LW) or an enhanced usual care comparison condition (UC). The goal of LW is ≥7% weight loss achieved through increases in physical activity (180 min/wk) and decreases in caloric intake (approximately 1500 kcal/day). The intervention consists of CHW-led group-mediated cognitive behavioral meetings that occur weekly for 6 months and monthly thereafter for 18 months. UC consists of 2 individual meetings with a registered dietitian and a monthly newsletter. The primary outcome is change in fasting blood glucose. Secondary outcomes include cardiovascular risk factors, health-related quality of life, and social cognitive variables. Outcomes are masked and are collected every 6 months. The cost-effectiveness of the program will also be assessed. A community-based program that is administered through local DCC's and that harnesses the experience of community members (CHW's) may be a promising strategy for the widespread dissemination of interventions effective at preventing type 2 diabetes in high risk individuals.

The healthy living partnerships to prevent diabetes and the diabetes prevention program: a comparison of year 1 and 2 intervention results

“…According to a recent meta-analysis of 22 DPP translational studies, these programs have achieved modest success with an average 12-month weight loss of 2.32 kg [13]. The Healthy Living Partnerships to Prevent Diabetes (HELP PD) trial was one of the largest randomized controlled trials to translate the methods of the original DPP [14]. Previously we have shown that the HELP PD intervention was effective in reducing fasting glucose relative to an enhanced usual care condition [9,10].…”

“…All participants signed informed consent and the Institutional Review Board of Wake Forest University Health Sciences approved the trial. Details regarding the HELP PD trial design, participant recruitment, outcomes, and cost have been published elsewhere [9,10,14,15,[22][23][24]. For the purpose of this evaluation, only data from participants in the lifestyle intervention arm is included.…”

A systematic review of the translational research on the Diabetes Prevention Program

“…It also appears that community health workers may not be optimal providers for a DPP. Additional research is indicated as a preliminary report of a DPP provided by health professionals and community health workers with T2D has demonstrated promising results [37,38]. The effectiveness of community health workers in other behavioral interventions has been variable, depending on their role and the population served.…”

Cultural adaptation of a peer-led lifestyle intervention program for diabetes prevention in India: the Kerala diabetes prevention program (K-DPP)

“…Absetz, Oldenburg and their colleagues used the Fin-DPS as a benchmark for the Good Ageing in Lahti (GOAL) Region Lifestyle Implementation Trial in Finland [13,14], and the Greater Green Triangle Diabetes Prevention Program (GTT DPP) adapted and tested the GOAL model in Australia [15]. These studies have now been followed by a number of translational studies based on either the Fin-DPS or the US DPP model in other high-income countries (HICs) such as the United States [16][17][18], United Kingdom [19,20], Netherlands [21], Europe [22][23][24], Australia [25] and Japan [10,26]. In the case of the US DPP, the Centers for Disease Control and Prevention (CDC) have now developed a curriculum to ensure adapted programs meet requirements for recognition.…”

“…To date, cultural adaptation of T2DM prevention programs has mainly occurred with ethnic groups or indigenous population within HICs and has included settings such as churches [27], health centres and community centres [17,[28][29][30][31][32][33][34][35][36][37]. Efforts to adapt programs and models of delivery for T2DM prevention in lowand middle-income countries (LMICs) have been very limited.…”