Translating the Diabetes Prevention Program Into Practice

Jackson, Lindsey

doi:10.1177/0145721708330153

Cited by 91 publications

(80 citation statements)

References 26 publications

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“…ADOPTION AND SUSTAINABILITY REMAINS A CHALLENGE Consistent with the systematic review by Jackson [9], sustained adoption and sustainability appear to be occurring less frequently than hoped in the implementation studies reported in this special section. The cost of lifestyle interventions has traditionally been singled out as the primary implementation challenge, but this is likely the case because lifestyle interventions are one of very few efficacious health services that are not reimbursed by public and commercial health insurance companies.…”

Section: Progress and The Next Horizonsupporting

confidence: 63%

“…The obvious approach to reduce the cost of a lifestyle intervention is to reduce the number of visits; however, this invariably reduces the impact on both weight and other clinical endpoints [9,23]. Research that utilizes novel and cost-effective ways of preserving efficacy while reducing burden is needed.…”

Section: Progress and The Next Horizonmentioning

confidence: 99%

“…Since then, translational work across myriad settings has been forthcoming. In 2009, a systematic review was performed of the seven studies testing translation into community settings of lifestyle interventions specifically based on the DPP [9]. All reported significant weight loss; however, weight loss achieved (2.6-6%) was typically less than that in the DPP (6.9%).…”

mentioning

confidence: 99%

“…treatment intensity [9], high prevalence of comorbid conditions associated with poor adherence [12], less motivated samples, and unknown treatment fidelity [9]. Greater insight into the implementation process, including the facilitators and barriers, is needed to inform translational research on lifestyle interventions for obesity and type 2 diabetes.…”

mentioning

confidence: 99%

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The current state of lifestyle intervention implementation research: where do we go next?

Pagoto

2011

Behav. Med. Pract. Policy Res.

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In the USA, the prevalence of obesity is 33.8% [1] and type 2 diabetes is 27% [2]. The landmark Diabetes Prevention Program (DPP) showed that a lifestyle intervention facilitating a 7% weight loss had a significantly greater impact on diabetes risk than placebo or metformin with a risk reduction of 58% over 3 years [3]. Similar findings were reported in diabetes prevention studies in Finland and China [4,5]. The impact of lifestyle interventions appears to be long term [3,4]. In the 10-year follow-up of the DPP, the incidence of diabetes in the placebo and metformin groups (who had been offered the lifestyle intervention following the initial intervention period) fell to equal that of the lifestyle group; however, the cumulative incidence of diabetes remained lowest in the lifestyle group [6]. The China Da Qing Study revealed reduced incidence of diabetes from a lifestyle intervention at 20-year follow-up [5]. Widespread availability of lifestyle interventions could have a tremendous impact on public health.In 2003, the United States Preventive Services Task Force assigned intensive lifestyle weight loss interventions, a B grade based on a review of the literature, with fair to good evidence for modest, sustained weight loss [7]. In spite of the evidence, intensive lifestyle interventions have not become a part of standard health care practice and are not a third party reimbursable service, with only a few exceptions. A significant barrier to large-scale adoption is the feasibility of translating intensive lifestyle intervention into real world settings. The DPP lifestyle intervention cost US $2,780 per person over 3 years and required 135 visit hours [8]. Although the cost was not significantly higher than the metformin group, visit time was 3.5 times higher. The amount of visit time is high relative to most services available in the current health care environment. To impact public health, research is needed to inform the process of translation and implementation of intensive lifestyle interventions into affordable, feasible, and sustainable programs not just in healthcare settings but also in community settings such as community centers, worksites, schools, and churches. To catalyze translational research efforts, in 2006, the National Institute for Diabetes and Digestive and Kidney Diseases sponsored a funding initiative for translational research in diabetes prevention and management. Since then, translational work across myriad settings has been forthcoming. In 2009, a systematic review was performed of the seven studies testing translation into community settings of lifestyle interventions specifically based on the DPP [9]. All reported significant weight loss; however, weight loss achieved (2.6-6%) was typically less than that in the DPP (6.9%). Only three examined 1-year outcomes, but all three had significant weight loss at 1 year. I recently surveyed the authors of these seven programs and found that only two were confirmed to be ongoing, one in a hospital setting [10] and the other in the Young Men's...

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Section: Progress and The Next Horizonsupporting

confidence: 63%

Section: Progress and The Next Horizonmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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The current state of lifestyle intervention implementation research: where do we go next?

Pagoto

2011

Behav. Med. Pract. Policy Res.

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“…The deteriorated blood glucose health among obese adults in the United States calls for lifestyle interventions (diet and exercise) on a national scale. Community‐based public health intervention programs may help increase physical activity and diet quality to alleviate the problem 44, 45. Obese adults at high risk of diabetes and CVD may require more intense approaches to achieve weight loss using lifestyle interventions alone or in combination with weight loss medications 42, 43, 46, 47.…”

Section: Discussionmentioning

confidence: 99%

Trends in Cardiovascular Health Metrics in Obese Adults: National Health and Nutrition Examination Survey (NHANES), 1988–2014

Guo

Garvey

2016

JAHA

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BackgroundNo study has quantified trends in the prevalence of cardiovascular disease risk factors and cardiovascular health metrics among obese people in the United States in recent years.Methods and ResultsWe examined the secular changes in cardiovascular health metrics and key cardiovascular disease risk factors among obese adults (aged ≥20 years) in the United States. We included 18 626 obese adults (body mass index ≥30) from the National Health and Nutrition Examination Survey (NHANES) III and NHANES 1999–2014. Among those obese adults, there were decreases in mean systolic blood pressure, diastolic blood pressure, and total cholesterol levels and increases in mean high‐density lipoprotein cholesterol levels and mean hemoglobin A1c levels. Prevalence of blood pressure health and lipid health remained stable during the period 1988–2014, whereas prevalence of blood glucose health decreased significantly during this period. Prevalence of freedom from cardiovascular disease risk factors remained stable at ≈15% among the adult obese population during the period 1988–2014, whereas prevalence of presence of all 3 risk factors increased from 16.4% to 22.4% during this period, commensurate with a decline in those with 1 to 2 risk factors (from 69.6% to 62.4%).ConclusionsDuring the past 3 decades, blood pressure health and blood lipid health remained stable or improved, whereas blood glucose health deteriorated among adult obese population. This resulted in an overall decrease in cardiovascular health status among obese adults and greater risk of type 2 diabetes mellitus. The data argue for interventions targeted to those obese persons who are metabolically unhealthy to stem rising rates of diabetes mellitus.

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Trends in Cardiovascular Health Metrics and Associations With All-Cause and CVD Mortality Among US Adults

Yang¹,

Cogswell²,

Flanders³

et al. 2012

JAMA

695

624

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Context Recent recommendations from the American Heart Association aim to improve cardiovascular health by encouraging the general population to meet 7 cardiovascular health metrics: not smoking; being physically active; having normal blood pressure, blood glucose and total cholesterol levels, and weight; and eating a healthy diet. Objective To examine time trends in cardiovascular health metrics and to estimate joint associations and population-attributable fractions of these metrics in relation to all-cause and cardiovascular disease (CVD) mortality risk.

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Translating the Diabetes Prevention Program Into Practice

Cited by 91 publications

References 26 publications

The current state of lifestyle intervention implementation research: where do we go next?

The current state of lifestyle intervention implementation research: where do we go next?

Trends in Cardiovascular Health Metrics in Obese Adults: National Health and Nutrition Examination Survey (NHANES), 1988–2014

Trends in Cardiovascular Health Metrics and Associations With All-Cause and CVD Mortality Among US Adults

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