One-Year Results of a Community-Based Translation of the Diabetes Prevention Program

Abstract

OBJECTIVEAlthough the Diabetes Prevention Program (DPP) and the Finnish Diabetes Prevention Study (FDPS) demonstrated that weight loss from lifestyle change reduces type 2 diabetes incidence in patients with prediabetes, the translation into community settings has been difficult. The objective of this study is to report the first-year results of a community-based translation of the DPP lifestyle weight loss (LWL) intervention on fasting glucose, insulin resistance, and adiposity.RESEARCH DESIGN AND METHODSWe randomly assigned 301 overweight and obese volunteers (BMI 25–40 kg/m2) with fasting blood glucose values between 95 and 125 mg/dL to a group-based translation of the DPP LWL intervention administered through a diabetes education program (DEP) and delivered by community health workers (CHWs) or to an enhanced usual-care condition. CHWs were volunteers with well-controlled type 2 diabetes. A total of 42.5% of participants were male, mean age was 57.9 years, 26% were of a race/ethnicity other than white, and 80% reported having an education beyond high school. The primary outcome is mean fasting glucose over 12 months of follow-up, adjusting for baseline glucose.RESULTSCompared with usual-care participants, LWL intervention participants experienced significantly greater decreases in blood glucose (−4.3 vs. −0.4 mg/dL; P < 0.001), insulin (−6.5 vs. −2.7 μU/mL; P < 0.001), homeostasis model assessment of insulin resistance (−1.9 vs. −0.8; P < 0.001), weight (−7.1 vs. −1.4 kg; P < 0.001), BMI (−2.1 vs. −0.3 kg/m2; P < 0.001), and waist circumference (−5.9 vs. −0.8 cm; P < 0.001).CONCLUSIONSThis translation of the DPP intervention conducted in community settings, administered through a DEP, and delivered by CHWs holds great promise for the prevention of diabetes by significantly decreasing glucose, insulin, and adiposity.

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

“…Trial Registration: NCT00631345; Clinicaltrials. gov, registered March 5, 2008 IRB: Wake Forest University Health Sciences; IRB00000613; initial approval 10/10/2006 the broader population [3][4][5][6][7][8][9][10][11][12]. 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]. We also reported that the intervention could be done at a lower cost than the DPP intervention [15].…”

“…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.…”

Community Health Workers in Low-, Middle-, and High-Income Countries: An Overview of Their History, Recent Evolution, and Current Effectiveness

“…Of 16 studies reviewed, investigators noted that significant reductions in hemoglobin A1C values were reported in eight studies. A recent review of literature published in 2011 and 2012 assessing the evidence emerging from community-based participatory research approaches involving CHWs provided evidence of improved glycemic control or reduced risk of disease progression (2,3,7,19,43,60,61,111,116,127). Cancer screening.…”

Implementation fidelity of a voluntary sector-led diabetes education programme

“…These include goal-setting, action-planning, self-monitoring, progress feedback, problem-solving, and reviewing goals. Group-based interventions have been shown to be effective for diabetes prevention, self-management and support, providing an environment that facilitates peer discussions about problems and personal experiences, resulting in significant benefits, including weight loss, improved fasting glucose levels, improved energy, and improved emotional state (Katula et al, 2011;Trento et al, 2010;Holma et al, 2008).…”