Evaluation of the University of California Diabetes Prevention Program (UC DPP) Initiative

Workplace Culture of Health and Equitable Workforce Well-Being: A Scoping Literature Review

ObjectiveTo evaluate the evidence base regarding employer-sponsored health and wellbeing (HWB) programs in relation to addressing workforce health inequities.Data SourceMultiple databases were systematically searched to identify research studies published between 2013 and 2022 regarding employer-sponsored HWB programs.Study Inclusion and Exclusion CriteriaResearchers included studies based on the following criteria: (1) described an employer-sponsored initiative to improve employee HWB; (2) included employees as the population of interest; (3) provided detail regarding participant demographics, and (4) included outcomes measures.Data ExtractionFour researchers screened the identified studies with abstraction conducted by a primary and secondary reviewer. Of the 3420 articles identified, 98 studies were eligible and abstracted.Data SynthesisData synthesis focused on research approach and design, as well as work setting, HWB program characteristics, and approach to inclusion of historically underrepresented or low-wage subpopulations.ResultsThe majority of studies highlighted programs focused on improving employee physical health (54) and/or mental health (24) or the workplace environment (27). Fourteen studies incorporated a randomized experimental design. Though nine studies intentionally recruited historically underrepresented populations and ten studies involved low-wage workers, none included race or ethnicity as independent variables. Various facilitators and barriers to employee participation were explored.ConclusionsDespite increasing employer focus on workforce HWB, few studies explored the program implications on historically underrepresented or low-wage populations or subpopulations.

Development and Impact of a Community-Delivered, Multisectoral Lifestyle Management Service for People Living With Type 2 Diabetes (Logan Healthy Living): Protocol for a Pragmatic, Single-Arm Intervention Study

BACKGROUND

Type 2 diabetes is the fastest-growing chronic condition in Australia, with higher prevalence in disadvantaged groups. Logan Healthy Living by UQ Health Care is a proof-of-concept, interprofessional allied health clinic focused on supporting people with and at risk of type 2 diabetes in Logan, a region in South East Queensland, Australia, with high levels of health inequity. Logan Healthy Living is supported by the Queensland Government through Health and Wellbeing Queensland and a broader multisectoral alliance including primary health care; tertiary hospital and health services; and government, community, and university sectors.

OBJECTIVE

This paper describes the establishment of Logan Healthy Living and outlines the evaluation protocol for the service's type 2 diabetes lifestyle management program.

METHODS

The context and setting of Logan Healthy Living are presented, and the process for establishing the multisectoral partnerships, development and governance of the service, and the facility are described. The lifestyle management program is an 8-week, group-based program that includes 1 hour of education and 1 hour of supervised, individually tailored exercise each week. The theoretical underpinnings and the program are described in detail. The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework will guide evaluation of the program and inform key questions regarding the number and characteristics of the clients (reach); diabetes-related distress, health behaviors (physical activity and diet), quality of life, self-management self-efficacy, loneliness, community involvement, anthropometric measures, hemoglobin A1c levels, physical function, and health care use (effectiveness); referral pathways (adoption); fidelity, appropriateness, acceptability, and costs (implementation); and long-term effectiveness (maintenance). Data will be drawn from a purposefully embedded minimum dataset and data registry, with the process for designing and embedding data collection into practice (via surveys, in-person measures, and client management software) described in detail.

RESULTS

Ethics approval has been obtained for the data registry. Logan Healthy Living is a 4-year proof of concept that concludes on December 31, 2024, with findings expected to be reported starting in 2025.

CONCLUSIONS

While multisectoral responses are needed for complex community health challenges, the processes for achieving these are rarely documented, and the description of the development of Logan Healthy Living has the potential to inform future partnerships. The findings of the evaluation will provide important new knowledge on the impact of a community-delivered type 2 diabetes program on individuals, the community, and the health system in an area of high health inequity.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/69477.

Implementation lessons learned from the University of California's Diabetes Prevention Program Initiative

BACKGROUND

The University of California's Diabetes Prevention Program (UC DPP) Initiative was implemented systemwide to address diabetes and obesity risk on all 10 campuses. As little is known about implementing lifestyle change programs in university settings, we examined implementation partners' (i.e., UC DPP leaders and campus leads) perceptions of factors influencing program success on UC campuses.

METHODS

We conducted qualitative interviews with UC DPP leaders and campus leads to examine challenges and opportunities with university-based DPP delivery models. Interviews were recorded, professionally transcribed, and reviewed in detail by the research team. Transcripts were analyzed using rapid qualitative analysis (RQA). The study was approved by the UCLA Institutional Review Board. All implementation partners provided verbal informed consent.

RESULTS

Twenty-six implementation partners (8 UC DPP leaders and 18 campus leads) completed interviews in 2021. Seven themes were identified as critical for implementation, including (1) marketing and recruitment (i.e., market and recruit broadly through established channels as well as target at-risk populations); (2) enrollment (i.e., offer the program during convenient times and let participants know what to expect); (3) use an adaptable, evidence-based program; (4) secure funding for the program, participants, lifestyle coaches, and space; (5) hire experienced and dedicated staff and lifestyle coaches; (6) ensure leadership support; and (7) utilize campus linkages and resources. Perceptions of challenges faced with respect to these themes are also described.

CONCLUSIONS

This is one of the first studies to examine the challenges and opportunities of delivering an intensive lifestyle change program across 10 university sites. Understanding factors that enhance success of university-based diabetes prevention programs can facilitate UC DPP efforts and help inform delivery strategies of health and wellness programs across other university settings more broadly.

Synthesis of multi-responsive poly(NIPA-co-DMAEMA)-PBA hydrogel nanoparticles in aqueous solution for application as glucose-sensitive insulin-releasing nanoparticles

Objectives

This study aimed to present an innovative method for synthesizing pH-thermo-glucose responsive poly(NIPA-co-DMAEMA)-PBA hydrogel nanoparticles via single-step aqueous free radical polymerization.

Methods

The synthesis process involved free radical polymerization in an aqueous solution, and the resulting nanoparticles were characterized for their physical and chemical properties by 1H NMR, Dynamic Light Scattering (DLS) and Scanning Electron Microscopy (SEM). Insulin-loaded poly(NIPA-co-DMAEMA)-PBA hydrogel nanoparticles were prepared and evaluated for their insulin capture and release properties at different pH and temperature, in addition to different glucose concentrations, with the release profile of insulin quantitatively evaluated using the Bradford method.

Results

1H NMR results confirmed successful PBA incorporation, and DLS outcomes consistently indicated a transition to a more hydrophobic state above the Lower Critical Solution Temperature (LCST) of NIPA and DMAEMA. While pH responsiveness exhibited variation, insulin release generally increased with rising pH from acidic to neutral conditions, aligning with the anticipated augmentation of anionic PBA moieties and increased hydrogel hydrophilicity. Increased insulin release in the presence of glucose, particularly for formulations with the lowest mol % PBA, along with a slight increase for the highest mol % PBA formulation when increasing glucose from 1 to 4 mg/mL, supported the potential of this approach for nanoparticle synthesis tailored for glucose-responsive insulin release.

Conclusions

This work successfully demonstrates a novel method for synthesizing responsive hydrogel nanoparticles and underscores their potential for controlled insulin release in response to glucose concentrations. The observed pH-dependent insulin release patterns and the influence of PBA content on responsiveness highlight the versatility and promise of this nanoparticle synthesis approach for applications in glucose-responsive drug delivery systems.

Graphical abstract

Poly(NIPA) nanoparticles containing PBA moieties are normally synthesized in two or more steps in the presence of organic solvents. Here we propose a new method for the synthesis of multiresponsive hydrogel poly(NIPA-co-DMAEMA)-PBA nanoparticles in aqueous medium in a single reaction to provide a fast and effective strategy for the production of glucose-responsive multi-systems in aqueous media from free radical polymerization.

Multilevel perceptions of the virtual delivery of the University of California Diabetes Prevention Program on RE-AIM domains due to COVID-19 mandates

Background

The University of California's Diabetes Prevention Program (UC DPP) Initiative was implemented across all 10 UC campuses in 2018. The COVID-19 pandemic and accompanying mandates required swift changes to program delivery, including pivoting from in-person to virtual delivery (i.e., Zoom). Our goal was to assess multilevel constituent perceptions of the use of a virtual platform to deliver UC DPP due to COVID-19 mandates.

Methods

We conducted qualitative interviews with 68 UC DPP participants, coordinators, and leaders to examine the use of virtual platform delivery on the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) of UC DPP. Transcripts were analyzed using rapid qualitative analysis and emergent themes were categorized using domains corresponding to RE-AIM framework.

Results

Among UC DPP participants (n = 42), virtual delivery primarily impacted perceptions of UC DPP effectiveness and implementation. Some participants perceived program effectiveness to be negatively impacted, given their preference for in-person sessions, which they felt provided more engagement, peer support, and accountability. Implementation challenges included problems with virtual format (e.g., "Zoom fatigue"); however, several benefits were also noted (e.g., increased flexibility, maintenance of DPP connections during campus closures). UC DPP coordinators (n = 18) perceived virtual delivery as positively impacting UC DPP reach, since virtual platforms provided access for some who could not participate in-person, and negatively impacting effectiveness due to reduced engagement and lower peer support. UC leaders (n = 8) perceived that use of the virtual format had a positive impact on reach (e.g., increased availability, accessibility) and negatively impacted effectiveness (e.g., less intensive interactions on a virtual platform). Across constituent levels, the use of a virtual platform had little to no impact on perceptions of adoption and maintenance of UC DPP.

Conclusion

Perceptions of the reach, effectiveness, and implementation of UC DPP using a virtual platform varied across constituents, although all groups noted a potential negative impact on overall program effectiveness. Unanticipated program adaptations, including virtual delivery, present potential benefits as well as perceived drawbacks, primarily across the effectiveness domain. Understanding differential constituent perceptions of the impact of virtual delivery can help maximize RE-AIM and inform future UC DPP delivery strategies.

Twelve-Month Reach and Effectiveness of a University-Based Diabetes Prevention Initiative

INTRODUCTION

The University of California (UC) implemented the Diabetes Prevention Program (DPP) to address diabetes and obesity risk. This project examined the reach and effectiveness of this university-based DPP delivery approach.

METHODS

This project compared 12-month weight change among three groups of UC beneficiaries with overweight/obesity: (1) those who received invitation letters and enrolled in UC DPP, (2) those mailed invitation letters but did not enroll, and (3) those who were not mailed letters and did not enroll (controls). Using 2012-2022 EHR, administrative and DPP cohort data, an interrupted time series was conducted in 2022-2023 to compare group differences in rate of weight change.

RESULTS

Among 6,231 beneficiaries (132 UC DPP aware enrollees, 1,750 DPP aware non-enrollees, 4,349 controls), UC DPP enrollees were older (mean age 49), mostly women (76%), and more diverse (33% Asian, 8% Black, 20% Hispanic, 4% Multi/Other). Over 12 months of follow-up, UC DPP enrollee postenrollment rate of weight loss was -0.68 lbs./month. UC DPP enrollees had significantly greater weight change from pre- to post-enrollment than DPP aware non-enrollees (adjusted Δ-1.02 vs. Δ-0.07 lbs./month, difference= -0.95, p<0.001). Weight change among all participants who received letters with/without DPP enrollment was similar to controls.

CONCLUSIONS

UC DPP reached a diverse group and was effective for weight loss at 12-month follow-up. However, UC DPP invitation letters to raise prediabetes and DPP awareness were not associated with significant weight change in the absence of DPP enrollment. University-based approaches to DPP delivery are effective and may enhance reach of DPP among at-risk adults.

Discrepancy in diagnoses of diabetes and prediabetes using fasting plasma glucose and glycosylated hemoglobin and the underdiagnosis by ICD-10 coding: data from a tertiary hospital in Thailand

Background

Early detection of prediabetes and diabetes better prevents long-term health complications. FPG and HbA1c levels are some common laboratory tests utilized as tools to diagnose diabetes and prediabetes, but the agreement rate between these two diagnostic tests varies, which could lead to underdiagnosis and thus undertreatment. This study aimed to analyze the agreement rate between FPG and HbA1c, as well as the physicians' accuracy of using these results to make a prediabetes or diabetes diagnosis through ICD-10 coding at a tertiary care hospital in Bangkok, Thailand.

Methods

A cross-sectional descriptive study was conducted using secondary data collected in a tertiary hospital's check-up clinic from August 16, 2019 to June 30, 2022 to study the prevalence and diagnosis of diabetes and prediabetes, determined through FPG and HbA1c laboratory results. We analyzed the two laboratory tests' diagnosis agreement rate and the physicians' accuracy of diagnosing diabetes and prediabetes in ICD-10 coding using the FPG and HbA1c results.

Results

Among 8,024 asymptomatic participants, the period prevalence diagnosed through laboratory results was 5.8% for diabetes and 19.8% for prediabetes. Diabetes and prediabetes prevalence based on laboratory data differs from that of ICD-10 coding data. Specifically, 79.6% of diabetes patients and 32.3% of prediabetes patients were coded using the ICD-10 coding system. 4,094 individuals had both FPG and HbA1c data. The agreement rate for diagnosing diabetes and prediabetes between the two laboratory results is 89.5%, with Kappa statistics of 0.58. Using only one of the two laboratory results would have missed a substantial number of patients.

Conclusion

Our findings highlight screening test discrepancies and underdiagnosis issues that impede diagnostic accuracy enhancement and refined patient management strategies. Early diagnoses of prediabetes and diabetes, especially before symptoms arise, could increase health consciousness in individuals, thereby enabling the implementation of lifestyle modifications and prevention of serious health complications. We emphasize the importance of diagnosing these conditions using both FPG and HbA1c, along with subsequent accurate ICD-10 coding. Even though some hospitals lack certified HbA1c testing, we suggest enhancing the availability of HbA1c testing, which could benefit many people in Thailand.Clinical trial registration:https://www.thaiclinicaltrials.org, identifier [TCTR20230824003].