The role of Sociodemographic factors on goal achievement in a community-based diabetes prevention program behavioral lifestyle intervention

Abstract

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.

Does recruiting patients to diabetes prevention programmes via primary care reinforce existing inequalities in care provision between general practices? A retrospective observational study

“…There are known sociodemographic inequalities in both the prevalence of non-diabetic hyperglycaemia and the transition to type 2 diabetes,43 44 with socioeconomically disadvantaged people more likely to progress to type 2 diabetes. Furthermore, findings from diabetes prevention programmes in other countries have shown sociodemographic disparities in the effectiveness of diabetes prevention interventions 45 46. In addition to these previously documented inequalities in the incidence of non-diabetic hyperglycaemia and the effectiveness of DPPs, our results suggest that there are also potential inequalities in the identification and referral phases of these programmes.…”

Examining paradoxical session attendance and weight loss relationships in a clinic based lifestyle modification intervention

“…Even after adjustment for various other sociodemographic and clinical factors, non‐Hispanic White participants were almost twice as likely as Hispanic participants, 2.5 times as likely as non‐Hispanic Asian participants, and almost 3 times as likely as non‐Hispanic Black participants to experience positive weight‐loss outcomes despite low session attendance. Studies have previously documented lower success at weight‐loss goal achievement through LMIs for non‐Hispanic Black participants specifically, and there is increasing study regarding how socio‐cultural factors and longstanding societal inequities, including the daily stress of discrimination, could be contributing to worse health outcomes for people from historically marginalized communities 39–42 . However, our study contributes to the new finding that non‐Hispanic White participants are more likely to achieve weight loss goals despite low engagement, which could suggest that non‐Hispanic White patients experience better healthcare overall (access, racial concordance, quality of care) and societal privileges than racially and ethnically minoritized people.…”

“…Studies have previously documented lower success at weight‐loss goal achievement through LMIs for non‐Hispanic Black participants specifically, and there is increasing study regarding how socio‐cultural factors and longstanding societal inequities, including the daily stress of discrimination, could be contributing to worse health outcomes for people from historically marginalized communities. 39 , 40 , 41 , 42 However, our study contributes to the new finding that non‐Hispanic White participants are more likely to achieve weight loss goals despite low engagement, which could suggest that non‐Hispanic White patients experience better healthcare overall (access, racial concordance, quality of care) and societal privileges than racially and ethnically minoritized people. This underscores the need for both further research with Hispanics, non‐Hispanic Blacks, non‐Hispanic Asians, and individuals of other non‐Hispanic communities to better understand barriers and unmet needs in the context of LMIs, and also the development of tailored LMIs that are culturally sensitive and able to respond to those needs.…”

The Implementation and Outcome of Diabetes Prevention Program Lifestyle Intervention in High Risk or Prediabetes: A Review of the Literature

“…Age and socio-demographic characteristics are among those associated with participation and success in diabetes mellitus prevention programmes, according to a literature review (Devaraj et al, 2021; Venkataramani et al, 2019). According to Venkataramani et al (2019), more than 25% of individuals have never taken part in a diabetic mellitus preventive programme and have no interest in doing…”