Use and Impact of Type 2 Diabetes Prevention Interventions

Campione, Joanne R.; Ritchie, Natalie D.; Fishbein, Howard; Mardon, Russell E.; Johnson, Maurice; Pace, Wilson D.; Birch, Rebecca; Seeholzer, Eileen; Zhang, Xuanping; Proia, Krista; Siegel, Karen R.; Bullard, Kai McKeever

doi:10.1016/j.amepre.2022.04.002

Cited by 13 publications

(17 citation statements)

References 29 publications

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“…Low participation rates have been reported of DPPs in other countries. Of more than 2,000 pre-diabetic patients invited by a physician-approved letter into a community-based DPP in Canada just 12% contacted the programme [ 45 ]; while within two large health systems in the US only 28% of referrals to a DPP attended one session or more [ 46 ]. Similar results have emerged from the US nationally representative National Health Interview Surveys [ 47 ].…”

Section: Discussionmentioning

confidence: 99%

The influence of demographic, health and psychosocial factors on patient uptake of the English NHS diabetes prevention programme

Reeves

Woodham

French

et al. 2023

BMC Health Serv Res

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Background The prevention of type 2 diabetes (T2DM) is a major concern for health services around the world. The English NHS Diabetes Prevention Programme (NHS-DPP) offers a group face-to-face behaviour change intervention, based around exercise and diet, to adults with non-diabetic hyperglycaemia (NDH), referred from primary care. Previous analysis of the first 100,000 referrals revealed just over half of those referred to the NHS-DPP took up a place. This study aimed to identify the demographic, health and psychosocial factors associated with NHS-DPP uptake to help inform the development of interventions to improve uptake and address inequities between population groups. Methods Drawing on the Behavioral Model of Health Services Utilization we developed a survey questionnaire to collect data on a wide range of demographic, health and psychosocial factors that might influence uptake of the NHS-DPP. We distributed this questionnaire to a cross-sectional random sample of 597 patients referred to the NHS-DPP across 17 general practices, chosen for variation. Multivariable regression analysis was used to identify factors associated with NHS-DPP uptake. Results 325 out of 597 questionnaires were completed (54%). Only a third of responders took up the offer of a place. The best performing model for uptake (AUC = 0.78) consisted of four factors: older age; beliefs concerning personal vulnerability to T2DM; self-efficacy for reducing T2DM risk; and the efficacy of the NHS-DPP. After accounting for these, demographic and health-related factors played only a minor role. Conclusion Unlike fixed demographic characteristics, psychosocial perceptions may be amenable to change. NHS-DPP uptake rates may be improved by targeting the beliefs of patients about their risk of developing T2DM, their ability to carry out and sustain behaviours to reduce this risk, and the efficacy of the NHS-DPP in providing the necessary understanding and skills required. The recently introduced digital version of the NHS DPP could help address the even lower uptake amongst younger adults. Such changes could facilitate proportional access from across different demographic strata.

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Section: Discussionmentioning

confidence: 99%

The influence of demographic, health and psychosocial factors on patient uptake of the English NHS diabetes prevention programme

Reeves

Woodham

French

et al. 2023

BMC Health Serv Res

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“…There is even evidence that maintaining weight (i.e., preventing weight gain) reduces the risk of a T2D diagnosis. 10,23 Beyond the direct health benefits and cost savings of weight loss and maintenance, there are also benefits to engaging in the educational curriculum of a DPP. Campione et al, 10 observed that members of a lifestyle modification program who completed ≥4 educational lessons, which educate on healthy lifestyle behaviors such as diet and physical activity, had a 46% reduction in risk of T2D even in the absence of weight loss.…”

Section: Introductionmentioning

confidence: 99%

“…10,23 Beyond the direct health benefits and cost savings of weight loss and maintenance, there are also benefits to engaging in the educational curriculum of a DPP. Campione et al, 10 observed that members of a lifestyle modification program who completed ≥4 educational lessons, which educate on healthy lifestyle behaviors such as diet and physical activity, had a 46% reduction in risk of T2D even in the absence of weight loss. This reduction in T2D may be attributed to educational and motivational content focusing on healthy lifestyle concepts other than weight loss and the subsequent increase in preventive care and decrease in unnecessary hospitalizations that may occur as a result.…”

Section: Introductionmentioning

confidence: 99%

“…Lifestyle modification programs that can facilitate weight loss are recommended for all individuals who are overweight or obese 5,9 . Research has shown that individuals at high risk for diabetes who are not enrolled in a lifestyle modification program like the National Diabetes Prevention Program (DPP) gain ∼0.42 kg per year 10 . Increasing enrollment in the DPP is an ongoing challenge, but digital health offerings improve the availability of accessible programs by meeting participants when and where they need assistance 11–13 .…”

Section: Introductionmentioning

confidence: 99%

“…Hamman et al., 8 estimated a 16% reduction in the risk of converting to T2D for every 1 kg of weight loss. There is even evidence that maintaining weight (i.e., preventing weight gain) reduces the risk of a T2D diagnosis 10,23 …”

Section: Introductionmentioning

confidence: 99%

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Weight loss and modeled cost savings in a digital diabetes prevention program

Branch¹,

Rikhy²,

Auster‐Gussman³

et al. 2023

Obesity Science & Practice

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Background: Participation in the National Diabetes Prevention Program (DPP) can improve individual health through reduced risk of type 2 diabetes and save the healthcare system substantial medical costs associated with a diagnosis of type 2 diabetes and its associated complications. There is less evidence of outcomes and cost savings associated with a fully digital delivery of the DPP. Methods: This study assessed 13,593 members who provided an initial digital weight and subsequently achieved various weight loss and engagement outcomes during their participation in a digital DPP. Analyzed data included both complete observations and missing observations imputed using maximum likelihood estimation. Findings include members' behavioral correlates of weight loss and a literature-based cost-savings estimate associated with achieving three mutually exclusive weight loss or engagement benchmarks: ≥5% weight loss, >2% but <5% weight loss, and completion of ≥4 educational lessons. Results: 11,976 members (88%) provided a weight after 2 months of participation, enabling calculation of their weight nadir. Considering complete data, 97% of members maintained or lost weight. Using the imputed data for these calculations, 32.0% of members achieved ≥5%, 32.4% achieved >2% but <5%, 32.0% maintained �2%, and 3.6% gained weight. Members who lost the most weight achieved their weight nadir furthest into the program (mean day = 189, SE = 1.4) and had the longest active engagement (mean days = 268, SE = 1.4), particularly compared to members who gained weight (mean nadir day = 119, SE = 3.7; active engagement mean days = 199, SE = 4.9) (both p ≤ 0.0001). Modeled 1-year cost-savings estimates ranged from $11,229,160 to $12,960,875. Conclusions: Members of a fully digital DPP achieved clinical and engagement outcomes during their participation in the program that confer important health benefits and cost savings.

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