Translating the diabetes prevention program into the community

With only two matched YMCA sites, it was not possible to adjust for potential clustering by site. Conclusions: The YMCA may be a promising channel for wide-scale dissemination of a low-cost approach to lifestyle diabetes prevention. Translating the Diabetes Prevention Program into the Community.

N2 - Background: The Diabetes Prevention Program DPP found that an intensive lifestyle intervention can reduce the development of diabetes by more than half in adults with prediabetes, but there is little information about the feasibility of offering such an intervention in community settings.

AB - Background: The Diabetes Prevention Program DPP found that an intensive lifestyle intervention can reduce the development of diabetes by more than half in adults with prediabetes, but there is little information about the feasibility of offering such an intervention in community settings.

Medicine, General Medicine Division. Overview Fingerprint. Methods: A keyword search of PubMed and review of citation lists of relevant articles yielded articles. A secondary outcome of improvement in metabolic syndrome components was also included.

Inclusion criteria included application of a DPP-based curriculum to a community setting and publication in English. Results: Seven articles were included in the review. The majority of subjects were female Approximately three-fourths of the population had at least a high school education When comparing the GLB intervention population to the overall screening population to determine generalizability, no statistically significant differences were apparent age: GLB [ Table 1 also depicts the proportion of GLB subjects with each component of metabolic syndrome at baseline.

Abdominal obesity was the most prevalent In subjects who provided data at this time, A total of When improvement in metabolic syndrome components was examined, similar patterns were observed. When change in the proportion of subjects who met individual metabolic syndrome criteria was examined over time, significant trends were observed Table 2. Imputation analyses revealed the same pattern of significant results. There are two principle findings from this nonrandomized prospective intervention study.

Additionally, significant improvements occurred in waist circumference, blood pressure, triglycerides, and HDL cholesterol levels. To our knowledge, this is one of few reports to demonstrate the feasibility and effectiveness of translating the national DPP into an urban medically underserved community. Moreover, it is one of very few that demonstrated sustained weight loss and metabolic syndrome risk reduction in a community setting.

Numerous studies reported initial weight loss and reduction in metabolic syndrome risk parameters immediately after a lifestyle intervention; however, they did not report the maintenance of health outcomes 11 — Translating the national DPP into the targeted community required an adaptation of the original DPP methodologies to better suit diverse populations, resources, and selected nonclinical screening sites. Fasting blood work was required, along with anthropometric measurements. Measuring BMI and laboratory data enabled us to assess whether our intervention was indeed effective in reducing risk for type 2 diabetes and CVD among participants.

The LHCs were members of the study community and fostered a comfortable and familiar atmosphere for participants. LHCs scheduled follow-up visits, encouraged participation, and provided any missed information. These completion and attendance rates compare positively to other community-based programs 11 , 20 , Sustainable weight loss is often the goal for interventions aimed at preventing or delaying type 2 diabetes and CVD 5 , 7 , 18 , Lack of accuracy in self-reporting of food consumption and physical activity is commonly documented in weight loss studies This study goes without exception.

There was an overall resistance toward self-reporting both food consumption and activity levels. Calories and fat grams were often inaccurately documented, and portion sizes were usually not recorded. A similar pattern occurred when reporting minutes of activity. Although pedometers were introduced to help track daily activity, there was reluctance in using them. Common barriers included inaccuracy or inconvenience. Given these issues, these data were not considered.

Nonetheless, participants verbally indicated minimal success achieving the physical activity goal of min per week. Perhaps a method to obtain activity measures could include tracking the frequency of gym visits. Although it should be noted, despite the free YMCA membership, only 55 of the 88 participants obtained their membership.

Reasons for not using the YMCA included perceived lack of time, distance, and apprehension toward a facility atmosphere. Although food intake and physical activity data were not captured, subjects experienced improvements in weight and most parameters of metabolic syndrome after the intervention. Physical inactivity may explain this finding, since activity aids in the regulation of blood glucose in people without diabetes regardless of body mass Improvement in blood glucose may be seen with further weight loss and increases in physical activity.

For example, all subjects were volunteers able to attend morning screenings. This inherently introduced volunteer bias, since only those available in the morning could participate, and may have contributed to the small sample size of the cohort. Efforts to recruit more men may include the use of male LHCs and targeting traditional male professions.

Modified strategies to avoid fasting blood work may enhance recruitment of both male and females in need of more flexible screening schedules. Our study was underpowered to detect significant differences in the primary and secondary outcomes due to the small sample size. Initial sample size calculations estimated that subjects would provide sufficient power to demonstrate valid changes in the proportion of subjects who decrease at least one parameter of metabolic syndrome.

Therefore, it is possible these findings are subject to type II error where we failed to detect a difference when one truly existed. Thus, if there were improvements, we were unable to detect them. However, those findings that showed statistically significant differences represent true differences.

As attrition may be perceived as a major limitation in our data, we performed last-response-carried-forward imputations for the 19 individuals who did provide 6-month follow-up data. The results remained unchanged with the same significant pattern as was seen in the nonimputed analyses. While imputation analyses allow adjustment for attrition, it must be noted that they provide an overestimation of the intervention effect.

These preliminary results suggest that adults in an urban medically underserved community can decrease their risk for type 2 diabetes and CVD through participation in a GLB intervention, and short-term sustainability is feasible. As a result, a local insurer became interested in this initiative.

Discussions are underway for making primary prevention a billable and reimbursable service in the Pittsburgh area. Future analysis will include long-term follow-up of these subjects.

Study design of a nonrandomized prospective GLB intervention study. Change in the proportion of subjects meeting the criteria for components of the metabolic syndrome over time after the GLB intervention baseline, 3-month, and 6-month reassessment.

All analyses are adjusted for age, sex, race, mean number of GLB classes attended, and time. This research was sponsored by funding from the U. Air Force, administered by the U. Review of material does not imply Department of the Air Force endorsement of factual accuracy or opinion. We acknowledge Rhonda Lee and Helen Tomasic for their efforts on this project.