Translating the Diabetes Prevention Program Lifestyle Intervention for Weight Loss Into Primary Care

Abstract

Background:The Diabetes Prevention Program (DPP) lifestyle intervention reduced the incidence of type 2 diabetes mellitus (DM) among high-risk adults by 58%, with weight loss as the dominant predictor. However, it has not been adequately translated into primary care. Methods:We evaluated 2 adapted DPP lifestyle interventions among overweight or obese adults who were recruited from 1 primary care clinic and had pre-DM and/or metabolic syndrome. Participants were randomized to (1) a coach-led group intervention (n = 79), (2) a selfdirected DVD intervention (n = 81), or (3) usual care (n=81). During a 3-month intensive intervention phase, the DPP-based behavioral weight-loss curriculum was delivered by lifestyle coach-led small groups or homebased DVD. During the maintenance phase, participants in both interventions received lifestyle change coaching and support remotely-through secure email within an electronic health record system and the American Heart Association Heart360 website for weight and physical activity goal setting and self-monitoring. The primary outcome was change in body mass index (BMI) (calculated as weight in kilograms divided by height in meters squared) from baseline to 15 months.Results: At baseline, participants had a mean (SD) age of 52.9 (10.6) years and a mean BMI of 32.0 (5.4); 47% were female; 78%, non-Hispanic white; and 17%, Asian/ Pacific Islander. At month 15, the meanϮSE change in BMI from baseline was Ϫ2.2Ϯ0.3 in the coach-led group vs Ϫ0.9 Ϯ 0.3 in the usual care group (P Ͻ .001) and Ϫ1.6Ϯ0.3 in the self-directed group vs usual care (P=.02). The percentages of participants who achieved the 7% DPPbased weight-loss goal were 37.0% (P=.003) and 35.9% (P=.004) in the coach-led and self-directed groups, respectively, vs 14.4% in the usual care group. Both interventions also achieved greater net improvements in waist circumference and fasting plasma glucose level. Conclusion:Proven effective in a primary care setting, the 2 DPP-based lifestyle interventions are readily scalable and exportable with potential for substantial clinical and public health impact.

Should weight loss and maintenance programmes be designed differently for men? A systematic review of long-term randomised controlled trials presenting data for men and women: The ROMEO project

“…Men comprised 36% of participants in 18 of the trials (4771 from a total of 13,305 participants); in four trials numbers of men recruited were unclear [23][24][25][26]. Eleven trials [23,[26][27][28][29][30][31][32][33][34][35] were conducted in the USA; six [24,25,[36][37][38][39] in Finland and one trial from each of the following locations: Canada [40], Israel [41], Scandinavia [42], Sweden [43,43]and the UK [44].…”

“…Seven trials [24,25,[31][32][33][34]39] considered low fat reducing diets (LFRDs) either alone or in conjunction with physical activity and/or behavioural therapy. Ross and colleagues [40] examined physical activity and healthy eating advice with behavioural therapy.…”

“…For the analysis comparing mean weight loss between men and women, a total of 13 studies had eligible data [24][25][26][27]29,[31][32][33][34][36][37][38]40]. There were a total of 5890 participants with 2213 (37.6%) men and 3677 (62.4%) women (Figures 1-2).…”

Evaluation of a culturally-adapted lifestyle intervention to treat elevated cardiometabolic risk of Latino adults in primary care (Vida Sana): A randomized controlled trial

“…Per our standard practice, all group sessions will be audiotaped and a random 10% sample from the sessions by recruitment cohort will be audited and graded using a session-by-session rating scale from a previous trial. 37 The coach will complete a checklist of critical intervention behaviors and materials delivered during each session. Self-monitoring records and Smartphone application communication are readily retrievable and will be reviewed as part of routine quality control efforts.…”

Diabetes risk reduction in primary care: Evaluation of the Ontario Primary Care Diabetes Prevention Program

“…It demonstrated clinically significant improvements to body mass index (BMI), waist circumference, and fasting blood glucose compared to usual care. 16 Several other studies have documented the feasibility of offering a DPP-style program in community settings. [17][18][19] The Ontario Ministry of Health and Long-Term Care (MOHLTC) launched the Ontario Diabetes Strategy in 2008.…”