Translating the Diabetes Prevention Program Into an Urban Medically Underserved Community

Abstract

OBJECTIVE -The objective of this study was to determine if a community-based modified Diabetes Prevention Program Group Lifestyle Balance (GLB) intervention, for individuals with metabolic syndrome, was effective in decreasing risk for type 2 diabetes and cardiovascular disease (CVD) in an urban medically underserved community, and subsequently to determine if improvements in clinical outcomes could be sustained in the short term. RESEARCH DESIGN AND METHODS-This nonrandomized prospective intervention study used a one-group design to test the effectiveness of a community-based GLB intervention. Residents from 11 targeted neighborhoods were screened for metabolic syndrome (n ϭ 573) and took part in a 12-week GLB intervention (n ϭ 88) that addressed safe weight loss and physical activity.RESULTS -A marked decline in weight (46.4% lost Ն5% and 26.1% lost Ն7%) was observed in individuals after completion of the intervention. Of these subjects, 87.5% (n ϭ 28) and 66.7% (n ϭ 12) sustained the 5% and 7% reduction, respectively, at the 6-month reassessment. Over one-third of the population (43.5%, n ϭ 30) experienced improvements in one or more component of metabolic syndrome, and 73.3% (n ϭ 22) sustained this improvement at the 6-month reassessment. Additional improvements occurred in waist circumference (P Ͻ 0.009) and blood pressure levels (P ϭ 0.04) after adjustment for age, sex, race, mean number of GLB classes attended, and time.CONCLUSIONS -Adults in an urban medically underserved community can decrease their risk for type 2 diabetes and CVD through participation in a GLB intervention, and shortterm sustainability is feasible. Future research will include long-term follow-up of these subjects.

A systematic review of the translational research on the Diabetes Prevention Program

“…Only one program was provided by trained community peer educators [30] which reached a highly diverse and large sample (n=293), provided the fewest sessions (n=6), yet demonstrated little weight loss (1.5 kg at 3 months). One program employed a community health worker to assist health professionals [31].…”

“…There were four distinct settings of diabetes prevention translational research: (a) hospital outpatient or diabetes education model of care [23][24][25] with one study a comparative effectiveness study comparing an on-site program to a telehealth program [26], (b) primary care [21,22,27] with one study combining primary care with an online program [28], (c) community settings (i.e., Young Men's Christian Association (YMCA)) [20,[29][30][31], and (d) church or workplace settings [32][33][34][35] ( Tables 2, 3, 4, and 5).…”

“…Pagoto et al [25] demonstrated that participants with depression, binge eating disorder, or T2D were less likely to improve weight outcomes and suggested that participants with these conditions may require a more intensive or different approach to lifestyle change. Other potential moderators to program outcomes include age, baseline BMI, and physical functioning [21,25,31]. Expanding the reach of diabetes translational research to more heterogenous samples enhances generalizability but has the potential to confound the interpretation of results.…”

Modifying the Diabetes Prevention Program to Adolescents in a School Setting: A Feasibility Study

“…The study focused on educational modules aimed at healthy eating, physical activity, and individual coaching support. Since that time, the DPP has been translated to several adult community-based settings with positive results [12][13][14]. The DPP modification was preferable to the HEALHTY study procedures, as it could be readily incorporated into the existing school curriculum.…”

Diabetes risk reduction in primary care: Evaluation of the Ontario Primary Care Diabetes Prevention Program

“…8 Multiple trials show the risk of progression from prediabetes to diabetes can be reduced through lifestyle interventions focused on weight reduction, dietary change and physical activity. [10][11][12][13][14] Both the landmark US Diabetes Prevention Program (DPP) and the Finnish Diabetes Prevention studies achieved an initial diabetes risk reduction of up to 58% compared to control. 12,15 Follow-up studies show this risk reduction can be sustained.…”