Rural/urban disparities in access to the National Diabetes Prevention Program

Ariel-Donges, Aviva H.; Gordon, Eliza L.; Dixon, Brittney N.; Eastman, Abraham; Bauman, Viviana; Ross, Kathryn M.; Perri, Michael G.

doi:10.1093/tbm/ibz098

Cited by 40 publications

(45 citation statements)

References 17 publications

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“…[9][10][11] Few studies have been implemented in medically underserved rural settings with local staff delivering treatment to economically disadvantaged participants, and current dissemination efforts have failed to narrow the rural-urban gap in access to weightmanagement services. 12 Comprehensive lifestyle interventions can produce initial body weight reductions of 5% to 10%, [7][8][9][10][11] a magnitude of weight loss that can yield clinically significant reductions in hypertension and hyperlipidemia and prevent the onset of type 2 diabetes. 13 However, after treatment ends, participants typically begin to regain weight-often regaining one-third to one-half of initial weight losses within 1 year.…”

Section: Introductionmentioning

confidence: 99%

Effect of Telehealth Extended Care for Maintenance of Weight Loss in Rural US Communities

et al. 2020

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IMPORTANCE Lifestyle interventions for obesity produce reductions in body weight that can decrease risk for diabetes and cardiovascular disease but are limited by suboptimal maintenance of lost weight and inadequate dissemination in low-resource communities. OBJECTIVE To evaluate the effectiveness of extended care programs for obesity management delivered remotely in rural communities through the US Cooperative Extension System. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial was conducted from October 21, 2013, to December 21, 2018, in Cooperative Extension Service offices of 14 counties in Florida. A total of 851 individuals were screened for participation; 220 individuals did not meet eligibility criteria, and 103 individuals declined to participate. Of 528 individuals who initiated a 4-month lifestyle intervention, 445 qualified for randomization. Data were analyzed from August 22 to October 21, 2019. INTERVENTIONS Participants were randomly assigned to extended care delivered via individual or group telephone counseling or an education control program delivered via email. All participants received 18 modules with posttreatment recommendations for maintaining lost weight. In the telephone-based interventions, health coaches provided participants with 18 individual or group sessions focused on problem solving for obstacles to the maintenance of weight loss. MAIN OUTCOMES AND MEASURES The primary outcome was change in body weight from the conclusion of initial intervention (month 4) to final follow-up (month 22). An additional outcome was the proportion of participants achieving at least 10% body weight reduction at follow-up. RESULTS Among 445 participants (mean [SD] age, 55.4 [10.2] years; 368 [82.7%] women; 329 [73.9%] white), 149 participants (33.5%) were randomized to individual telephone counseling, 143 participants (32.1%) were randomized to group telephone counseling, and 153 participants (34.4%) were randomized to the email education control. Mean (SD) baseline weight was 99.9 (14.6) kg, and mean (SD) weight loss after the initial intervention was 8.3 (4.9) kg. Mean weight regains at follow-up were 2.3 (95% credible interval [CrI], 1.2-3.4) kg in the individual telephone counseling group, 2.8 (95% CrI, 1.4-4.2) kg for the group telephone counseling group, and 4.1 (95% CrI, 3.1-5.0) kg for the education control group, with a significantly smaller weight regain observed in the individual telephone counseling group vs control group (posterior probability >.99). A larger proportion of participants in the individual telephone counseling group achieved at least 10% weight reductions (31.5% [95% CrI, 24.1%-40.0%]) than in the control group (19.1% [95% CrI, 14.1%-24.9%]) (posterior probability >.99).

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Section: Introductionmentioning

confidence: 99%

Effect of Telehealth Extended Care for Maintenance of Weight Loss in Rural US Communities

et al. 2020

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“…10 Such virtual delivery can also ensure wide geographic reach to fill the many gaps where in-person sites are unavailable. 11,12 Overcoming Challenges with Reach…”

Section: Successes With Reachmentioning

confidence: 99%

<p>Current Perspectives on the Impact of the National Diabetes Prevention Program: Building on Successes and Overcoming Challenges</p>

Ritchie¹,

Baucom²,

Sauder³

2020

DMSO

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To address the public health and economic burden of type 2 diabetes, the Centers for Disease Control and Prevention (CDC) began dissemination of the National Diabetes Prevention Program (NDPP) in the United States in 2010. Based on the intensive lifestyle intervention from a large efficacy trial, the NDPP aims to reduce incidence through lifestyle change and weight loss. This narrative review summarizes evidence on reach, effectiveness, and sustainability of the NDPP, while highlighting opportunities to overcome challenges in these areas. Major successes include reaching hundreds of thousands of at-risk individuals across the nation, with notable effectiveness upon full participation and widespread insurance coverage. Yet, more work is needed to ensure greater public health impact, particularly among priority populations at heightened risk who also experience disparities in program outcomes. Preliminary evidence suggests a number of strategies may improve reach and effectiveness of the NDPP, often with more rigorous study needed prior to widespread uptake. Updating the NDPP to better match the current evidence-base may also be important, such as directly targeting glycemia with a patient-centered approach and promoting metformin as an adjunct or second-line treatment. Finally, revisiting pay-for-performance reimbursement models may be critical to sustainability by ensuring adequate availability of suppliers and ultimately reducing diabetes prevalence.

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“…Access to food that is healthy and nutritious is a factor that influences the prevalence of obesity [25][26][27]. Obesity is a controllable risk factor for type 2 diabetes, which disproportionately affects rural Americans [28]. The 2006-2010 prevalence estimates of adult obesity rates for the conterminous U.S. census tracts and ZIP codes in 2399 counties have been estimated from the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System (BRFSS) [29].…”

Section: Need For Knowledge Visualizations To Communicate Knowledge Omentioning

confidence: 99%

“…As expanded and new data on obesity rates becomes available, the visualizations developed could be updated to reflect additional spatial or longitudinal trends. Obesity is a modifiable risk factor for type 2 diabetes [28], and there is consensus that nutrition therapy is an efficacious and cost-effective component of type 2 diabetic care [67]. Thus, we plan future data analytics to connect census tract level datasets on food access to census tract level diabetes-related hospital use and diabetes related complications [68,69].…”

Section: Opportunities For Census Tract Level Research On Nutritionalmentioning

confidence: 99%

Knowledge Visualizations to Inform Decision Making for Improving Food Accessibility and Reducing Obesity Rates in the United States

Isokpehi

Johnson

Campos

et al. 2020

IJERPH

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The aim of this article is to promote the use of knowledge visualization frameworks in the creation and transfer of complex public health knowledge. The accessibility to healthy food items is an example of complex public health knowledge. The United States Department of Agriculture Food Access Research Atlas (FARA) dataset contains 147 variables for 72,864 census tracts and includes 16 food accessibility variables with binary values (0 or 1). Using four-digit and 16-digit binary patterns, we have developed data analytical procedures to group the 72,684 U.S. census tracts into eight and forty groups respectively. This value-added FARA dataset facilitated the design and production of interactive knowledge visualizations that have a collective purpose of knowledge transfer and specific functions including new insights on food accessibility and obesity rates in the United States. The knowledge visualizations of the binary patterns could serve as an integrated explanation and prediction system to help answer why and what-if questions on food accessibility, nutritional inequality and nutrition therapy for diabetic care at varying geographic units. In conclusion, the approach of knowledge visualizations could inform coordinated multi-level decision making for improving food accessibility and reducing chronic diseases in locations defined by patterns of food access measures.

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Rural/urban disparities in access to the National Diabetes Prevention Program

Cited by 40 publications

References 17 publications

Effect of Telehealth Extended Care for Maintenance of Weight Loss in Rural US Communities

Effect of Telehealth Extended Care for Maintenance of Weight Loss in Rural US Communities

<p>Current Perspectives on the Impact of the National Diabetes Prevention Program: Building on Successes and Overcoming Challenges</p>

Knowledge Visualizations to Inform Decision Making for Improving Food Accessibility and Reducing Obesity Rates in the United States

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