Rationale, design, and baseline characteristics of a community-based comparative effectiveness trial to prevent type 2 diabetes in economically disadvantaged adults: The RAPID Study

Abstract

Reaching out And Preventing Increases in Diabetes (RAPID) is a community-based randomized trial evaluating the comparative costs and effectiveness of a group-based adaption of the DPP lifestyle intervention developed and implemented in partnership with the YMCA. RAPID enrolled adult primary care patients, with BMI 24 kg/m2 or higher and abnormal glucose metabolism (HbA1c 5.7-6.9% or fasting plasma glucose 100-125 mg/dL). 509 participants were enrolled and randomized to one of two groups: standard clinical advice plus free-of-charge access to a group-based adaption of the DPP offered by the Y, versus standard clinical advice alone. Key outcomes for future analysis will include differences in body weight and other cardiovascular risk factors over a 24-month intervention period. At baseline, RAPID participants had a mean (SD) age of 51 ± 12.1 years, weight of 225.1 ± 56.2 Ibs, and BMI of 36.9 ± 8.6 kg/m2. 70.7% were women, 57.2% were African American, 35.4% were non-Hispanic White, and 3.2% were Hispanic. Mean HbA1c was 6.05 ± 0.34%. Additionally, 55.4% of participants had a baseline systolic blood pressure of ≥130 mmHg, 33.1% had a total blood cholesterol exceeding 200 mg/dl, and 74% reported a household income of <$25,000. The RAPID Study successfully randomized a large cohort of participants with a wide distribution of age, body weight, and race who are at high risk for developing type 2 diabetes.

A Spanish-Language Risk Perception Survey for Developing Diabetes: Translation Process and Assessment of Psychometric Properties

“…Individual perception of diabetes risk may determine engagement in preventive lifestyle modifications. Diabetes prevention effectiveness trials, including a large ongoing trial of a Diabetes Prevention Program modeled intervention offered through a partnership between a health system and the YMCA (Ackermann et al, 2014), are measuring diabetes risk perception with the English-language version of the RPS-DD. Future similar effectiveness trials in Spanish-speaking at-risk populations may benefit from the newly created Spanish-language translation of the RPS-DD and the reliability and validation evidence.…”

Effects of a Community-based Lifestyle Intervention on Change in Physical Activity Among Economically Disadvantaged Adults With Prediabetes

“…10,11 Briefly, RAPID (N=509) was a two-arm, individually randomized intervention trial comparing brief diabetes prevention counseling alone (control condition, n=252) versus brief counseling plus YDPP (n=257). A computer-generated list was used to identify patients at risk for diabetes from 9 metropolitan primary care clinics.…”

“…A thorough description of the intervention has been published. 10 YDPP was based on the DPP lifestyle intervention 14 with two important differences: 1) YDPP was delivered in a group format rather than on an individual basis and 2) YMCA wellness instructors rather than health care professionals delivered program content. YDPP goals included: 1) 7% weight loss and 2) engaging in 150 minutes/week of moderate PA (equivalent to walking).…”

“…On the basis of our pilot research, we anticipated that only 35–38% of YDPP participants would participate at a meaningful level. 10 Completion of 9 or more YDPP sessions was defined as a meaningful dose of participation.…”

“…Our primary study, Reaching Out to Prevent Increases in Diabetes (RAPID) was a 2-year, NIH-funded study designed to evaluate a collaborative model to prevent T2DM by linking health system efforts to identify low-income adults with pre-diabetes with a community-based lifestyle intervention referred to as the YMCA adaptation of the U.S. Diabetes Prevention Program or YDPP. 10 Lay health instructors employed by the YMCA delivered this group-based adaptation of the DPP lifestyle intervention. YDPP goals included losing 5% of baseline body weight and achieving at least 150 min/wk of moderate intensity PA. Twelve month outcomes revealed that RAPID participants achieved meaningful weight loss (2.3 kg (95% CI 1.1 to 3.4 kg).…”