Background Little is known about how adverse, midlife metabolic profiles impact future physical functioning. We hypothesized that a higher number of midlife metabolic syndrome (MetS) components are associated with poorer physical performance in early old age for multi-ethnic women. Methods MetS status from 1996-2011 (8 visits) and objective physical performance in 2015/2016 (short physical performance battery (SPPB; 0-12), 40-foot walk (m/s), 4-meter gait speed (m/s), chair stands (sec), stair climb (sec)) were assessed in the Study of Women’s Health Across the Nation (SWAN; n=1722; age 65.4±2.7 years; 26.9% African American, 10.1% Chinese, 9.8% Japanese, 5.5% Hispanic). Poisson latent class growth modeling identified MetS component trajectory groups: none (23.9%), 1=low-MetS (28.7%), 2=mid-MetS (30.9%), and >3=high-MetS (16.5%). Adjusted linear regression related MetS groups to physical performance outcomes. Results High-MetS versus none had higher BMI, pain, financial strain, and lower physical activity and self-reported health (p<0.0001). Compared to White, African American and Hispanic women were more likely to be in the high-MetS groups and had worse physical functioning along with Chinese women (SPPB, chair stand, stair climb, and gait speed - not Hispanic). After adjustments, high-MetS versus none demonstrated significantly worse 40-ft walk (β:-0.08; 95% CI:-0.13, -0.03), gait speed (β:-0.09; 95% CI:-0.15, -0.02), SPPB (β:-0.79; 95% CI: -1.15, -0.44), and chair stands (β:0.69; 95% CI: 0.09, 1.28), but no difference in stair climb. Conclusions Midlife MetS groups were related to poor physical performance in early old age multi-ethnic women. Midlife management of metabolic function may improve physical performance later in life.

Background The Diabetes Prevention Program (DPP) behavioral lifestyle intervention was effective among a diverse sample of adults with prediabetes. Demonstrated effectiveness in translated versions of the DPP lifestyle intervention (such as Group Lifestyle Balance, DPP-GLB) led to widescale usage with national program oversight and reimbursement. However, little is known about the success of these DPP-translation programs across subgroups of sociodemographic factors. This current effort investigated potential disparities in DPP-translation program primary goal achievement (physical activity and weight) by key sociodemographic factors. Methods Data were combined from two 12-month community-based DPP-GLB trials among overweight/obese individuals with prediabetes and/or metabolic syndrome. We evaluated change in weight (kilograms and percent) and activity (MET-hrs/week) and goal achievement (yes/no; ≥5% weight loss and 150 min per week activity) after 6 and 12 months of intervention within and across subgroups of race/ethnicity (non-Hispanic white, non-Hispanic black), employment status, education, income, and gender. Results Among 240 participants (85%) with complete data, most sociodemographic subgroups demonstrated significant weight loss. However, non-Hispanic white lost more weight at both 6 and 12 months compared to non-Hispanic black participants [median weight loss (IQR), 6 months: 5.7% (2.7–9.0) vs. 1.5% (1.2–7.5) p = .01 and 12 months: 4.8% (1.1–9.6) vs. 1.1% (− 2.0–3.7) p = .01, respectively]. In addition, a larger percentage of non-Hispanic white demonstrated a 5% weight loss at 6 and 12 months. Employment was significantly related to 12-month weight loss, with retired participants being the most successful. Men, participants with graduate degrees, and those with higher income were most likely to meet the activity goal at baseline and 12 months. Differences in physical activity goal achievement across gender, education, and income groups were significant at baseline, attenuated after 6 months, then re-emerged at 12 months. Conclusions The DPP-GLB was effective in promoting weight loss and helped to alleviate disparities in physical activity levels after 6 months. Despite overall program success, differences in weight loss achievement by race/ethnicity were found and disparities in activity re-emerged after 12 months of intervention. These results support the need for intervention modification providing more tailored approaches to marginalized groups to maximize the achievement and maintenance of DPP-GLB behavioral goals. Trial registration NCT01050205, NCT02467881.

Introduction The American Heart Association created “Life’s Simple Seven” metrics to estimate progress toward improving US cardiovascular health in a standardized manner. Given the widespread use of federally funded Diabetes Prevention Program (DPP)-based lifestyle interventions such as the Group Lifestyle Balance (DPP-GLB), evaluation of change in health metrics within such a program is of national interest. This study examined change in cardiovascular health metric scores during the course of a yearlong DPP-GLB intervention. Methods Data were combined from 2 similar randomized trials offering a community based DPP-GLB lifestyle intervention to overweight/obese individuals with prediabetes and/or metabolic syndrome. Pre/post lifestyle intervention participation changes in 5 of the 7 cardiovascular health metrics were examined at 6 and 12 months (BMI, blood pressure, total cholesterol, fasting plasma glucose, physical activity). Smoking was rare and diet was not measured. Results Among 305 participants with complete data (81.8% of 373 eligible adults), significant improvements were demonstrated in all 5 risk factors measured continuously at 6 and 12 months. There were significant positive shifts in the “ideal” and “total” metric scores at both time points. Also noted were beneficial shifts in the proportion of participants across categories for BMI, activity, and blood pressure. Conclusion AHA-metrics could have clinical utility in estimating an individual’s cardiovascular health status and in capturing improvement in cardiometabolic/behavioral risk factors resulting from participation in a community-based translation of the DPP lifestyle intervention.

No abstract

Purpose The purpose of this study was to examine how maintenance session attendance and 6-month weight loss (WL) goal achievement impacted 12-month 5% WL success in older adults participating in a community-based Diabetes Prevention Program (DPP) lifestyle intervention. Methods Data were combined from 2 community trials that delivered the 12-month DPP-based Group Lifestyle Balance (GLB) to overweight/obese adults (mean age = 62 years, 76% women) with prediabetes and/or metabolic syndrome. Included participants (n = 238) attended ≥4 core sessions (months 0-6) and had complete data on maintenance attendance (≥4 of 6 sessions during months 7-12) and 6- and 12-month WL (5% WL goal, yes/no). Multivariate logistic regression was used to estimate the odds of 12-month 5% WL associated with maintenance attendance and 6-month WL. Associations between age (Medicare-eligible ≥65 vs <65 years) and WL and attendance were examined. Results Both attending ≥4 maintenance sessions and meeting the 6-month 5% WL goal increased the odds of meeting the 12-month 5% WL goal. For those not meeting the 6-month WL goal, maintenance session attendance did not improve odds of 12-month WL success. Medicare-eligible adults ≥65 years were more likely to meet the 12-month WL goal (odds ratio = 3.03, 95% CI, 1.58-5.81) versus <65 years. Conclusions The results of this study provide important information regarding participant attendance and WL for providers offering DPP-based lifestyle intervention programs across the country who are seeking Medicare reimbursement. Understanding Medicare reimbursement-defined success will allow these providers to focus on and develop strategies to enhance program effectiveness and sustainability.

BACKGROUND Digital health programs that incorporate frequent blood pressure (BP) self-monitoring and comprehensive support for behavior change offer a scalable solution for hypertension (HTN) management. OBJECTIVE We examined the impact of a digital HTN self-management and lifestyle change support program on BP over 12 months. METHODS Data was analyzed from a retrospective observational cohort of commercially insured members (n=1,117) that started the Omada for HTN program between 1/1/19-9/30/21. Paired t-tests and linear regression were used to measure change in SBP over 12 months, by SBP control at baseline (≥130 vs. <130). RESULTS Members were on average 50.9 years old, 50.8% were female, 60.5% white and 70.5% had uncontrolled SBP at baseline (≥130). At 12 months, members with uncontrolled SBP experienced significant reductions in both unadjusted (mean (95%CI): -8.1mmHg (-9.0, -7.1)) and adjusted SBP (-8.0mmHg (-9.0, -7.1)). Members with uncontrolled SBP also had significant reductions in diastolic BP (-4.7mmHg; -5.3, -4.1), weight (-6.5lbs (-7.7, -5.3); 2.7% weight loss) and body mass index (-1.1kg/m2) (-1.3, -0.9)). Those with controlled SBP maintained within BP goal range. Additionally, 48% of members with uncontrolled BP experienced enough change in BP to improve their BP category. CONCLUSIONS This study provides real-world evidence that a comprehensive digital health program involving HTN education, at-home BP monitoring, and behavior change coaching support was effective for self-managing HTN over 12 months.

Introduction: The AHA created “Life’s Simple Seven” metrics to measure progress toward the goal of improving the cardiovascular (CV) health of all Americans, classifying each metric as “ideal”, “intermediate,” or “poor”. Few studies have examined the impact of behavioral lifestyle interventions on CV health metrics. We evaluated changes in CV health metrics during the course of a CDC recognized Diabetes Prevention Program-based lifestyle intervention known as Group Lifestyle Balance (DPP-GLB). Hypothesis: DPP-GLB will be associated with improvements in CV health metrics after 6 months of intervention and maintenance of these improvements at 12 months post-baseline. Methods: We used combined data from two similar intervention trials (occurring 6 years apart) offering a 12 month DPP-GLB program in the community setting to overweight/obese individuals with prediabetes and/or metabolic syndrome. Changes in individual CV health metrics (BMI, blood pressure, total cholesterol, fasting blood glucose, physical activity; measures of smoking and diet were not available) and total metric score (sum of metric profile where ideal=2, intermediate=1 and poor=0 for each metric, possible “total “range of 0-10) were considered after 6 and 12 months of intervention. Results: Among 222 participants (76%) with complete data for all 5 metrics at intervention baseline, 6 and 12 month follow up, there was a significant beneficial shift from baseline to 6 and 12 months in the proportion of participants within CV health metric categories for BMI, physical activity and blood pressure (Figure 1). Total metric score also improved significantly (p<0.01, signed-rank test) at 6 [median (IQR) change: +1.0 (0-1.0)] and 12 months [median (IQR) change: 0.0 (0-1.0)]. Significant improvement was also seen in the median number of ideal metrics at 6 and 12 months (p<0.01 for both). Conclusions: The DPP-GLB intervention was successful in improving CV health metrics at both 6 and 12 months, demonstrating the potential of this program to decrease CVD risk.

BACKGROUND Modest weight loss is recommended for individuals with type 2 diabetes (T2D) to help improve glycemic control and reduce cardiovascular disease risk. Continuous glucose monitoring (CGM) is recommended as a standard of care for individuals with T2D who use insulin, but more research is needed to inform recommendations for CGM use in all T2D populations. Digital diabetes self-management programs can help individuals with T2D lose weight and improve glycemic control. Less is known about the impact of CGM on program engagement within digital programs for diabetes self-management and the relationship between CGM use and weight loss for those with T2D. OBJECTIVE The primary objective of this study was to examine the difference in percent weight loss from baseline to 6 months between CGM users and non-users among commercially insured members with T2D in a digital program for diabetes self-management (Omada for Diabetes). METHODS A non-randomized retrospective observational cohort study was performed using data from 2,612 Omada for Diabetes program members (mean age=52.3 years, 56.4% female, 63.5% white) who started the program between January 1, 2021 and September 30, 2021. Data analyses examined the difference in percent weight loss over 6 months between CGM users and non-users overall as well as stratified by body mass index, program engagement, and CGM-adherence, and associations between program engagement and CGM group. RESULTS A higher percentage of CGM users (57.6%) than non-users (48.4%) were classified as ‘highly engaged’ with the Omada for Diabetes program (p<.001). Both groups showed significant within-group mean percent weight loss from baseline to 6 months (-2.0% CGM users, -1.8% non-users, p<.001), but no differences were detected between groups. When stratified by program engagement, highly engaged CGM users and non-users had significantly greater percent weight loss compared to those with normal/low engagement (CGM users: -2.50% vs. -1.33%, p=.004; non-users: -2.43% vs. -1.30%, p<.001). In fully adjusted models, CGM users and non-users had significant reductions in percent weight loss (β=-2.0%, 95% CI (-2.42, -1.57), β=-1.87%, 95% CI (-2.11, -1.63), respectively). CONCLUSIONS Members participating in the Omada for Diabetes program had a significant change in mean percent body weight from program start to 6 months regardless of CGM status. A higher percentage of CGM users were more engaged with the program than non-users, and higher engagement across both groups was associated with greater percent weight loss. Further understanding the impact that CGM has in digital diabetes self-management programs for T2D could enhance program effectiveness, encourage sustained engagement, and inform standard of care recommendations. CLINICALTRIAL N/A