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Choi JY, Choi D, Mehta NK, Ali MK, Patel SA. Diabetes Disparities in the United States: Trends by Educational Attainment from 2001 to 2020. Am J Prev Med 2024; 67:319-327. [PMID: 38615980 PMCID: PMC11338700 DOI: 10.1016/j.amepre.2024.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 04/06/2024] [Accepted: 04/07/2024] [Indexed: 04/16/2024]
Abstract
INTRODUCTION Tracking changes in socioeconomic disparities in diabetes in the U.S. is important to evaluate progress in health equity and guide prevention efforts. Disparities in diabetes prevalence by educational attainment from 2001 to 2020 were investigated. METHODS Using a serial cross-sectional design, data from 33,220 adults aged 30-79 assessed in nine rounds of the National Health and Nutrition Examination Surveys between 2001 and 2020 were analyzed in 2023-2024. Diabetes was defined as self-reported prior diagnosis, elevated glycated hemoglobin (HbA1c≥6.5%), or use of diabetes medications. Marginalized age- and covariate-adjusted prevalence differences (PD) and prevalence ratios (PR) of diabetes by educational attainment (less than high school graduation, high school graduation, some college education or associate degree, or college graduation [reference]) by calendar period (2001-2004, 2005-2008, 2009-2012, 2013-2016, 2017-2020) were derived from logistic regression models. RESULTS From 2001 to 2020, age-adjusted diabetes prevalence was consistently higher among adults without a college degree. Adults without a high school diploma exhibited the largest disparities in both 2001-2004 (PD 8.0%; 95%CI 5.6-10.5 and PR 2.1; 95%CI 1.5-2.6) and 2017-20 (PD 11.0%; 95%CI 6.7-15.2 and PR 2.1; 95%CI 1.5-2.7). Between 2001-2004 and 2017-2020, the absolute disparity in diabetes changed only among adults with a high school diploma (increase from PD 1.7%; 95%CI -0.5- 3.9 to PD 8.8% 95%CI 4.1-13.4, respectively), while the PR did not change in any group. Education-related disparities in diabetes were attenuated after accounting for socio-demographic factors and BMI. CONCLUSIONS From 2001 to 2020, national education-related disparities in diabetes prevalence have shown no signs of narrowing.
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Affiliation(s)
- Ji Young Choi
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Daesung Choi
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Neil K Mehta
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, Texas
| | - Mohammed K Ali
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia; Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, Georgia
| | - Shivani A Patel
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia.
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Damschroder LJ, Hamilton A, Coste MF, Bean-Mayberry B, Richardson C, Chanfreau C, Oberman RS, Lesser R, Lewis J, Raffa SD, Goldstein MG, Haskell S, Finley E, Moin T. Real-world impacts from a decade of Quality Enhancement Research Initiative-partnered projects to translate the Diabetes Prevention Program in the Veterans Health Administration. Health Serv Res 2024. [PMID: 38967218 DOI: 10.1111/1475-6773.14349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2024] Open
Abstract
OBJECTIVES To describe the impacts of four Veterans Health Administration (VA) Quality Enhancement Research Initiative (QUERI) projects implementing an evidence-based lifestyle intervention known as the Diabetes Prevention Program (DPP). DATA SOURCES AND STUDY SETTING 2012-2024 VA administrative and survey data. STUDY DESIGN This is a summary of findings and impacts from four effectiveness-implementation projects focused on in-person and/or online DPP across VA sites. DATA COLLECTION/EXTRACTION METHODS Patient demographics, participation data, and key findings and impacts were summarized across reports from the VA Diabetes-Mellitus Quality Enhancement Research Initiative (QUERI-DM) Diabetes Prevention Program (VA DPP) Trial, QUERI-DM Online DPP Trial, the Enhancing Mental and Physical Health of Women through Engagement and Retention (EMPOWER) QUERI DPP Project, and EMPOWER 2.0 QUERI Program. PRINCIPAL FINDINGS Between 2012 and 2024, four VA QUERI studies enrolled 963 Veterans in DPP across 16 VA sites. All participants had overweight/obesity with one additional risk factor for type 2 diabetes (i.e., prediabetes, elevated risk score, or history of gestational diabetes) and 56% (N = 536) were women. In addition to enhancing the reach of and engagement in diabetes prevention services among Veterans, these projects resulted in three key impacts as follows: (1) informing the national redesign of VA MOVE! including recommendations to increase the number of MOVE! sessions and revise guidelines across 150+ VA sites, (2) enhancing the national evidence base to support online DPP delivery options with citations in national care guidelines outside VA, and (3) demonstrating the importance of gender-tailoring of preventive care services by and for women Veterans to enhance engagement in preventive services. CONCLUSIONS Over the past decade, the evolution of VA QUERI DPP projects increased the reach of and engagement in diabetes prevention services among Veterans, including women Veterans who have been harder to engage in lifestyle change programs in VA, and resulted in three key impacts informing type 2 diabetes and obesity prevention efforts within and outside of VA.
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Affiliation(s)
- Laura J Damschroder
- Ann Arbor VA Medical Center for Clinical Management Research, Ann Arbor, Michigan, USA
| | - Alison Hamilton
- VA Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California, USA
- David Geffen School of Medicine at the University of California Los Angeles (UCLA), Los Angeles, California, USA
| | - Melissa Farmer Coste
- VA Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California, USA
| | - Bevanne Bean-Mayberry
- VA Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California, USA
- David Geffen School of Medicine at the University of California Los Angeles (UCLA), Los Angeles, California, USA
| | - Caroline Richardson
- Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA
| | - Catherine Chanfreau
- VA Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California, USA
- VHA Informatics and Computing Infrastructure (VINCI), VA Salt Lake City Healthcare System, Salt Lake City, Utah, USA
| | - Rebecca S Oberman
- VA Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California, USA
| | - Rachel Lesser
- VA Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California, USA
| | - Jackie Lewis
- VA Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California, USA
| | - Sue D Raffa
- VHA National Center for Health Promotion and Disease Prevention, Durham, North Carolina, USA
| | - Micheal G Goldstein
- Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA
- VHA National Center for Health Promotion and Disease Prevention, Durham, North Carolina, USA
| | - Sally Haskell
- VHA Office of Women's Health, Washington, DC, USA
- Yale School of Medicine, New Haven, Connecticut, USA
| | - Erin Finley
- VA Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California, USA
- Long School of Medicine, University of Texas Health Science Center San Antonio, San Antonio, Texas, USA
| | - Tannaz Moin
- VA Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California, USA
- David Geffen School of Medicine at the University of California Los Angeles (UCLA), Los Angeles, California, USA
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MacPherson MM, Johnston C, Cranston KD, Der S, Sim JAP, Jung ME. Identification of Intervention Characteristics Within Diabetes Prevention Programs Using the Template for Intervention Description and Replication: A Scoping Review. Can J Diabetes 2024; 48:273-280. [PMID: 38417737 DOI: 10.1016/j.jcjd.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 01/19/2024] [Accepted: 02/21/2024] [Indexed: 03/01/2024]
Abstract
OBJECTIVES Diabetes prevention programs (DPPs) targeting dietary and physical activity behaviour change have been shown to decrease the incidence of type 2 diabetes; however, a more thorough reporting of intervention characteristics is needed to expedite the translation of such programs into different communities. In this scoping review, we aim to synthesize how DPPs are being reported and implemented. METHODS A scoping review using Arkey and O'Malley methods was conducted in accordance with the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analysis. MEDLINE, CINAHL, PsycINFO, EMBASE, and SPORTDiscus were searched for studies relating to diabetes prevention and diet/exercise interventions. Only studies delivering a diet/exercise intervention for adults identified as "at risk" for developing type 2 diabetes were included. The Template for Intervention Description and Replication (TIDieR) was used to guide data extraction, and each DPP was scored on a scale from 0 to 2 for how thoroughly it reported each of the items (0 = did not report, 2 = reported in full; total score out of 26). RESULTS Of the 25,110 publications screened, 351 (based on 220 programs) met the inclusion criteria and were included for data extraction. No studies comprehensively reported on all TIDieR domains (mean TIDieR score: 15.7 of 26; range 7 to 25). Reporting was particularly poor among domains related to "modifications," "tailoring," and "how well (planned/actual)." "How well (planned)" assesses the intended delivery of an intervention, detailing the initial strategies and components as per the original design, whereas "how well (actual)" evaluates the extent to which the intervention was executed as planned during the study, including any deviations or modifications made in practice. CONCLUSIONS Although there is evidence to suggest that DPPs are efficacious, a more thorough reporting of program content and delivery is needed to improve the ability for effective programs to be implemented or translated into different communities.
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Affiliation(s)
- Megan M MacPherson
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
| | - Cara Johnston
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
| | - Kaela D Cranston
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
| | - Sarah Der
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
| | - Jenna A P Sim
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
| | - Mary E Jung
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada.
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Hu L, Wyatt LC, Mohsin F, Lim S, Zanowiak J, Mammen S, Hussain S, Ali SH, Onakomaiya D, Belli HM, Aifah A, Islam NS. Characterizing Technology Use and Preferences for Health Communication in South Asian Immigrants With Prediabetes or Diabetes: Cross-Sectional Descriptive Study. JMIR Form Res 2024; 8:e52687. [PMID: 38669062 PMCID: PMC11087851 DOI: 10.2196/52687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 03/12/2024] [Accepted: 03/14/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Type 2 diabetes disproportionately affects South Asian subgroups. Lifestyle prevention programs help prevent and manage diabetes; however, there is a need to tailor these programs for mobile health (mHealth). OBJECTIVE This study examined technology access, current use, and preferences for health communication among South Asian immigrants diagnosed with or at risk for diabetes, overall and by sex. We examined factors associated with interest in receiving diabetes information by (1) text message, (2) online (videos, voice notes, online forums), and (3) none or skipped, adjusting for sociodemographic characteristics and technology access. METHODS We used baseline data collected in 2019-2021 from two clinical trials among South Asian immigrants in New York City (NYC), with one trial focused on diabetes prevention and the other focused on diabetes management. Descriptive statistics were used to examine overall and sex-stratified impacts of sociodemographics on technology use. Overall logistic regression was used to examine the preference for diabetes information by text message, online (videos, voice notes, or forums), and no interest/skipped response. RESULTS The overall sample (N=816) had a mean age of 51.8 years (SD 11.0), and was mostly female (462/816, 56.6%), married (756/816, 92.6%), with below high school education (476/816, 58.3%) and limited English proficiency (731/816, 89.6%). Most participants had a smartphone (611/816, 74.9%) and reported interest in receiving diabetes information via text message (609/816, 74.6%). Compared to male participants, female participants were significantly less likely to own smartphones (317/462, 68.6% vs 294/354, 83.1%) or use social media apps (Viber: 102/462, 22.1% vs 111/354, 31.4%; WhatsApp: 279/462, 60.4% vs 255/354, 72.0%; Facebook: Messenger 72/462, 15.6% vs 150/354, 42.4%). A preference for receiving diabetes information via text messaging was associated with male sex (adjusted odds ratio [AOR] 1.63, 95% CI 1.01-2.55; P=.04), current unemployment (AOR 1.62, 95% CI 1.03-2.53; P=.04), above high school education (AOR 2.17, 95% CI 1.41-3.32; P<.001), and owning a smart device (AOR 3.35, 95% CI 2.17-5.18; P<.001). A preference for videos, voice notes, or online forums was associated with male sex (AOR 2.38, 95% CI 1.59-3.57; P<.001) and ownership of a smart device (AOR 5.19, 95% CI 2.83-9.51; P<.001). No interest/skipping the question was associated with female sex (AOR 2.66, 95% CI 1.55-4.56; P<.001), high school education or below (AOR 2.02, 95% CI 1.22-3.36; P=.01), not being married (AOR 2.26, 95% CI 1.13-4.52; P=.02), current employment (AOR 1.96, 95% CI 1.18-3.29; P=.01), and not owning a smart device (AOR 2.06, 95% CI 2.06-5.44; P<.001). CONCLUSIONS Technology access and social media usage were moderately high in primarily low-income South Asian immigrants in NYC with prediabetes or diabetes. Sex, education, marital status, and employment were associated with interest in mHealth interventions. Additional support to South Asian women may be required when designing and developing mHealth interventions. TRIAL REGISTRATION ClinicalTrials.gov NCT03333044; https://classic.clinicaltrials.gov/ct2/show/NCT03333044, ClinicalTrials.gov NCT03188094; https://classic.clinicaltrials.gov/ct2/show/NCT03188094. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s13063-019-3711-y.
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Affiliation(s)
- Lu Hu
- Department of Population Health, Center for Healthful Behavior Change, Institute for Excellence in Health Equity, New York University Grossman School of Medicine, New York, NY, United States
| | - Laura C Wyatt
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
| | - Farhan Mohsin
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
| | - Sahnah Lim
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
| | - Jennifer Zanowiak
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
| | - Shinu Mammen
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
| | - Sarah Hussain
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
| | - Shahmir H Ali
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, United States
| | - Deborah Onakomaiya
- Vilcek Institute of Graduate Biomedical Sciences, New York University Grossman School of Medicine, New York, NY, United States
| | - Hayley M Belli
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
| | - Angela Aifah
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
| | - Nadia S Islam
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
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Gerber S, Silver RE, Das SK, Greene SS, Dix SR, Ramirez I, Morcos CL, Dao MC, Ceglia L, Roberts SB. Development and Feasibility of an eHealth Diabetes Prevention Program Adapted for Older Adults-Results from a Randomized Control Pilot Study. Nutrients 2024; 16:930. [PMID: 38612963 PMCID: PMC11154527 DOI: 10.3390/nu16070930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 03/11/2024] [Accepted: 03/13/2024] [Indexed: 04/14/2024] Open
Abstract
Lifestyle programs that reduce health risks and support weight loss (WL) in older adults face adherence and attendance challenges due to reduced energy requirements, impaired mobility, lack of transportation, and low social support. Tailored lifestyle and weight management programs are needed to better support healthy aging for older adults. Here, we developed and piloted an age-adapted, remotely delivered modification of the Diabetes Prevention Program (DPP). The modification includes age-appropriate goals, visuals, and examples; flexible dietary composition; remote classroom and fitness-monitoring technology; and standardized online classroom materials employing pedagogical and behavior change theory. The modifications were designed to safeguard fidelity and to boost adherence, engagement, and knowledge integration, with the convenience of a fully remote WL program for diverse older adults. Six-month pilot data are presented from older adults (55-85 years, body mass index (BMI) 27-39.9 kg/m2, N = 20) randomly allocated to an online DPP intervention with weight, diet, and activity monitored remotely, or into a waitlisted control. The intervention achieved 100% attendance and adherence to self-monitoring. The intervention group mean (±SD) body weight change was -9.5% (±4.1); 90% lost ≥ 5%. By contrast, the control group gained 2.4% (±1.8). Once thought incompatible with older adults, remote interventions are feasible for older adults and can support fidelity, adherence, engagement, and clinically significant WL. Standardized materials are provided for future implementation.
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Affiliation(s)
- Suzannah Gerber
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, MA 02111, USA (S.S.G.); (S.R.D.); (C.L.M.)
| | - Rachel E. Silver
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, 711 Washington Street, Boston, MA 02111, USA
| | - Sai Krupa Das
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, MA 02111, USA (S.S.G.); (S.R.D.); (C.L.M.)
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, 711 Washington Street, Boston, MA 02111, USA
| | - Savana S. Greene
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, MA 02111, USA (S.S.G.); (S.R.D.); (C.L.M.)
| | - Sadie R. Dix
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, MA 02111, USA (S.S.G.); (S.R.D.); (C.L.M.)
| | - Isabella Ramirez
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, MA 02111, USA (S.S.G.); (S.R.D.); (C.L.M.)
| | - Christina L. Morcos
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, MA 02111, USA (S.S.G.); (S.R.D.); (C.L.M.)
| | - Maria Carlota Dao
- Department of Agriculture, Nutrition, and Food Systems, University of New Hampshire, Durham, NH 03824, USA;
| | - Lisa Ceglia
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, 711 Washington Street, Boston, MA 02111, USA
- Division of Endocrinology, Diabetes and Metabolism, Tufts Medical Center, Boston, MA 02111, USA
| | - Susan B. Roberts
- Geisel School of Medicine, Dartmouth College, 1 Rope Ferry Rd., Hanover, NH 03755, USA;
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Steenkamp DW, Fantasia KL, Wolpert HA. Optimizing Glycemic Outcomes for Minoritized and Medically Underserved Adults Living with Type 1 Diabetes. Endocrinol Metab Clin North Am 2024; 53:67-80. [PMID: 38272599 DOI: 10.1016/j.ecl.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
Individuals living with type 1 diabetes (T1D) from medically underserved communities have poorer health outcomes. Efforts to improve outcomes include a focus on team-based care, activation of behavior change, and enhancing self-management skills and practices. Advanced diabetes technologies are part of the standard of care for adults with T1D. However, health care providers often carry implicit biases and may be uncomfortable with recommending technologies to patients who have traditionally been excluded from efficacy trials or have limited real-world exposure to devices. We review the literature on this topic and provide an approach to address these issues in clinical practice.
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Affiliation(s)
- Devin W Steenkamp
- Section of Endocrinology, Diabetes and Nutrition, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, 72 East Concord Street, C3, Boston, MA 02118, USA.
| | - Kathryn L Fantasia
- Section of Endocrinology, Diabetes and Nutrition, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, 72 East Concord Street, C3, Boston, MA 02118, USA; Department of Medicine, Evans Center for Implementation and Improvement Sciences (CIIS), Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Howard A Wolpert
- Section of Endocrinology, Diabetes and Nutrition, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, 72 East Concord Street, C3, Boston, MA 02118, USA
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Ritchie ND, Turk MT. Enhancing access and impact of the Medicare Diabetes Prevention Program using telehealth: a narrative review. Mhealth 2023; 10:10. [PMID: 38323146 PMCID: PMC10839516 DOI: 10.21037/mhealth-23-37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 11/16/2023] [Indexed: 02/08/2024] Open
Abstract
Background and Objective Over 26 million older adults in the United States (US) have prediabetes, which is often a precursor to type 2 diabetes. The Medicare Diabetes Prevention Program (MDPP) is an evidence-based, lifestyle program for older-adult Medicare beneficiaries to prevent progression to diabetes. However, the MDPP has been drastically underutilized. Telehealth delivery may be a promising strategy to increase the reach and impact of the MDPP, including for underserved populations. The objective of this narrative review is to explore the role of telehealth on the accessibility and effectiveness of diabetes prevention programs (DPPs) for older adults. Methods We searched the online databases of MEDLINE, APA PsycInfo, CINAHL, and Academic Search Elite for studies that used telehealth to deliver DPPs to older adults through distance learning, i.e., live program delivery where participants join via phone- or video-conferencing. Relevant information from policy documents and related publications was also included. Key Content and Findings Three themes emerged from the literature on telehealth delivery of DPPs for older adults (I) clinical effectiveness for weight loss, (II) feasibility and acceptability of this format; and (III) policy considerations to support greater public health impact. There is a growing body of recent evidence to suggest that older adults achieve a clinically meaningful amount of weight loss from participation in telehealth DPPs. The literature suggests that telehealth program delivery is feasible, and older adults find it acceptable, with some specific accommodations. Effectiveness and acceptability of telehealth interventions were also noted for older adults from rural, ethnically-diverse, and low-income groups. Policy considerations include adjustments in rulemaking by the Centers for Medicare and Medicaid Services (CMS) to allow MDPP delivery via telehealth using distance learning, along with sufficient reimbursement rates. Conclusions The evidence indicates that delivery of the MDPP via telehealth is beneficial for increasing program reach and impact, including among underserved groups, as well as providing social support for older participants. Scalable delivery of the MDPP via telehealth is essential to make a national, population-level impact for older adults with prediabetes who receive Medicare benefits.
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Affiliation(s)
- Natalie D. Ritchie
- Office of Research, Denver Health and Hospital Authority, Denver, CO, USA
- Department of Psychiatry, University of Colorado School of Medicine, Denver, CO, USA
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Madrigal L, Haardörfer R, Kegler MC, Piper S, Blais LM, Weber MB, Escoffery C. A structural equation model of CFIR inner and outer setting constructs, organization characteristics, and national DPP enrollment. Implement Sci Commun 2023; 4:142. [PMID: 37978574 PMCID: PMC10657127 DOI: 10.1186/s43058-023-00522-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 10/28/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND The National Diabetes Prevention Program (DPP) has made great strides in increasing accessibility to its year-long, evidence-based lifestyle change program, with around 3000 organizations having delivered the program. This large dissemination effort offers a unique opportunity to identify organization-level factors associated with program implementation and reach (enrollment) across diverse settings. The purpose of this study was to quantitatively examine the relationships among Consolidated Framework for Implementation Research (CFIR) Inner Setting and Outer Setting constructs and the implementation outcome of reach. METHODS This study analyzed data from a 2021 cross-sectional online survey with 586 National DPP Staff (lifestyle coaches, master trainers, program coordinators) with information about their organization, implementation outcomes, and responses to quantitative CFIR Inner Setting and Outer Setting construct items. Structural equation modeling was used to test a hypothesized path model with Inner and Outer Setting variables to explore direct and indirect pathways to enrollment. RESULTS The CFIR items had good internal consistency and indicated areas of implementation strength and weakness. Eight variables included as part of the CFIR structural characteristics and one organization characteristic variable had significant direct relationships with enrollment. The length of delivery, number of lifestyle coaches, number of full-time staff, large organization size, and organizations delivering in rural, suburban, and/or urban settings all had positive significant direct relationships with enrollment, while academic organizations and organizations with only non-White participants enrolled in their National DPP lifestyle change programs had a negative association with enrollment. CONCLUSIONS Participant reach is an important implementation outcome for the National DPP and vital to making population-level decreases in diabetes incidence in the USA. Our findings suggest that to facilitate enrollment, program implementers should focus on organizational structural characteristics such as staffing. Strengths of this study include the use of adapted and newly developed quantitative CFIR measures and structural equation modeling. Health prevention programs can use the methods and findings from this study to further understand and inform the impact of organization factors on implementation outcomes.
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Affiliation(s)
- Lillian Madrigal
- Rollins School of Public Health Emory University, 1518 Clifton Rd, Atlanta, GA, 30322, USA.
| | - Regine Haardörfer
- Rollins School of Public Health Emory University, 1518 Clifton Rd, Atlanta, GA, 30322, USA
| | - Michelle C Kegler
- Rollins School of Public Health Emory University, 1518 Clifton Rd, Atlanta, GA, 30322, USA
| | - Sarah Piper
- Rollins School of Public Health Emory University, 1518 Clifton Rd, Atlanta, GA, 30322, USA
| | - Linelle M Blais
- Rollins School of Public Health Emory University, 1518 Clifton Rd, Atlanta, GA, 30322, USA
| | - Mary Beth Weber
- Rollins School of Public Health Emory University, 1518 Clifton Rd, Atlanta, GA, 30322, USA
| | - Cam Escoffery
- Rollins School of Public Health Emory University, 1518 Clifton Rd, Atlanta, GA, 30322, USA
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Gorin SS, Hirko K. Primary Prevention of Cancer: A Multilevel Approach to Behavioral Risk Factor Reduction in Racially and Ethnically Minoritized Groups. Cancer J 2023; 29:354-361. [PMID: 37963370 DOI: 10.1097/ppo.0000000000000686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
ABSTRACT Cancer continues to be the second most common cause of death in the United States. Racially and ethnically minoritized populations continue to experience disparities in cancer prevention compared with majority populations. Multilevel interventions-from policy, communities, health care institutions, clinical teams, families, and individuals-may be uniquely suited to reducing health disparities through behavioral risk factor modification in these populations. The aim of this article is to provide a brief overview of the evidence for primary prevention among racially and ethnically minoritized subpopulations in the United States. We focus on the epidemiology of tobacco use, obesity, diet and physical activity, alcohol use, sun exposure, and smoking, as well as increasing uptake of the Human Papillomavirus Vaccine (HPV), as mutable behavioral risk factors. We describe interventions at the policy level, including raising excise taxes on tobacco products; within communities and with community partners, for safe greenways and parks, and local healthful food; health care institutions, with reminder systems for HPV vaccinations; among clinicians, by screening for alcohol use and providing tailored weight reduction approaches; families, with HPV education; and among individuals, routinely using sun protection. A multilevel approach to primary prevention of cancer can modify many of the risk factors in racially and ethnically minoritized populations for whom cancer is already a burden.
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Affiliation(s)
- Sherri Sheinfeld Gorin
- From the Department of Family Medicine, The School of Medicine, and the School of Public Health, The University of Michigan, Ann Arbor, MI
| | - Kelly Hirko
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI
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10
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Materia FT, Smyth JM, Puoane T, Tsolekile L, Goggin K, Kodish SR, Fox AT, Resnicow K, Werntz S, Catley D. Implementing text-messaging to support and enhance delivery of health behavior change interventions in low- to middle-income countries: case study of the Lifestyle Africa intervention. BMC Public Health 2023; 23:1526. [PMID: 37563595 PMCID: PMC10416414 DOI: 10.1186/s12889-023-16388-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 07/25/2023] [Indexed: 08/12/2023] Open
Abstract
The prevalence of non-communicable diseases, such as diabetes and cardiovascular disease, is rising in low- and middle-income countries (LMICs). Health behavior change (HBC) interventions such as the widely used Diabetes Prevention Program (DPP) are effective at reducing chronic disease risk, but have not been adapted for LMICs. Leveraging mobile health (mHealth) technology such as text messaging (SMS) to enhance reach and participant engagement with these interventions has great promise, yet we lack evidence-informed approaches to guide the integration of SMS specifically to support HBC interventions in LMIC contexts. To address this gap, we integrated guidance from the mHealth literature with expertise and first-hand experience to establish specific development steps for building and implementing SMS systems to support HBC programming in LMICs. Specifically, we provide real-world examples of each development step by describing our experience in designing and delivering an SMS system to support a culturally-adapted DPP designed for delivery in South Africa. We outline eight key SMS development steps, including: 1) determining if SMS is appropriate; 2) developing system architecture and programming; 3) developing theory-based messages; 4) developing SMS technology; 5) addressing international SMS delivery; 6) testing; 7) system training and technical support; and 8) cost considerations. We discuss lessons learned and extractable principles that may be of use to other mHealth and HBC researchers working in similar LMIC contexts.Trial registration Clinicaltrials.gov, NCT03342274 . Registered 10 November 2017.
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Affiliation(s)
- Frank T Materia
- Division of Health Services and Outcomes Research, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO, 64108, USA.
| | - Joshua M Smyth
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA, USA
- Penn State College of Medicine, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Thandi Puoane
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Lungiswa Tsolekile
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Kathy Goggin
- Division of Health Services and Outcomes Research, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO, 64108, USA
- School of Medicine, University of Missouri - Kansas City, Kansas City, MO, USA
- School of Pharmacy, University of Missouri - Kansas City, Kansas City, MO, USA
| | - Stephen R Kodish
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA, USA
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA
| | - Andrew T Fox
- Division of Health Services and Outcomes Research, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO, 64108, USA
| | - Ken Resnicow
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | | | - Delwyn Catley
- School of Medicine, University of Missouri - Kansas City, Kansas City, MO, USA
- Center for Children's Healthy Lifestyles and Nutrition, Children's Mercy Kansas City, Kansas City, MO, USA
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11
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Linehan CJ, Nelson T, Bailey CV, Gel E, Coonrod DV, Roth CK. Sentinel Surveillance of SARS-CoV-2 Rates and Equity Impacts using Labor and Delivery Patients in Phoenix, Arizona. Prev Med Rep 2022; 30:102049. [PMCID: PMC9637539 DOI: 10.1016/j.pmedr.2022.102049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 09/14/2022] [Accepted: 11/05/2022] [Indexed: 11/09/2022] Open
Abstract
Proactive management of SARS-CoV-2 requires timely and complete population data to track the evolution of the virus and identify at risk populations. However, many cases are asymptomatic and are not easily discovered through traditional testing efforts. Sentinel surveillance can be used to estimate the prevalence of infections for geographical areas but requires identification of sentinels who are representative of the larger population. Our goal is to evaluate applicability of a population of labor and delivery patients for sentinel surveillance system for monitoring the prevalence of SARS-CoV-2 infection. We tested 5307 labor and delivery patients from two hospitals in Phoenix, Arizona, finding 195 SARS-CoV-2 positive. Most positive cases were associated with people who were asymptomatic (79.44%), similar to statewide rates. Our results add to the growing body of evidence that SARS-CoV-2 disproportionately impacts people of color, with Black people having the highest positive rates (5.92%). People with private medical insurance had the lowest positive rates (2.53%), while Medicaid patients had a positive rate of 5.54% and people without insurance had the highest positive rates (6.12%). With diverse people reporting for care and being tested regardless of symptoms, labor and delivery patients may serve as ideal sentinels for asymptomatic detection of SARS-CoV-2 and monitoring impacts across a wide range of social and economic classes. A more robust system for infectious disease management requires the expanded participation of additional hospitals so that the sentinels are more representative of the population at large, reflecting geographic and neighborhood level patterns of infection and risk.
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Affiliation(s)
- Caitlyn J. Linehan
- Corresponding author at: Department of Geography, 4806 Ellison Hall, University of California, Santa Barbara, Santa Barbara, California, 93106, United States
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12
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Auster-Gussman LA, Lockwood KG, Graham SA, Stein N, Branch OH. Reach of a Fully Digital Diabetes Prevention Program in Health Professional Shortage Areas. Popul Health Manag 2022; 25:441-448. [PMID: 35200043 PMCID: PMC9419962 DOI: 10.1089/pop.2021.0283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The National Diabetes Prevention Program (NDPP) offers lifestyle change education to adults at risk for diabetes across the United States, but its reach is curbed due, in part, to limitations of traditional in-person programs. Diabetes Prevention Programs (DPPs) that are fully digital may increase reach by overcoming these barriers. The aim of this research was to examine the reach of Lark's DPP, a fully digital artificial-intelligence-powered DPP. This study assessed geographic features and demographic characteristics of a sample of Lark DPP commercial health plan members with complete data (N = 16,327) and compared several demographic features with a large composite sample of members from DPPs across the nation (NDPP; N = 143,489) and a National Health Interview Survey (NHIS) sample of prediabetic adults in the United States (NHIS; N = 2118). Examination of the Lark DPP sample revealed that 24.4% of members lived in rural areas, 30.8% lived in whole county health professional shortage areas, and only 7.6% of members lived in a zip code with an in-person DPP. When comparing the Lark sample with the NDPP and NHIS samples, Lark DPP enrollees tended to be younger and have a higher body mass index (BMI) (p's < 0.001). Lark provides convenient access to a DPP for individuals living in hard-to-reach areas who may face barriers to participating in in-person or telephonic DPPs or who prefer a digital program. Compared with the NDPP sample, Lark is also reaching younger and higher BMI users, who are traditionally difficult to enroll and have a high need for intervention.
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Affiliation(s)
| | - Kimberly G Lockwood
- Clinical Studies and Research, Lark Health, Mountain View, California, USA.,Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
| | - Sarah A Graham
- Clinical Studies and Research, Lark Health, Mountain View, California, USA
| | - Natalie Stein
- Clinical Studies and Research, Lark Health, Mountain View, California, USA
| | - OraLee H Branch
- Clinical Studies and Research, Lark Health, Mountain View, California, USA
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13
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Bonet Olivencia S, Rao AH, Smith A, Sasangohar F. Eliciting Requirements for a Diabetes Self-Management Application for Underserved Populations: A Multi-Stakeholder Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:127. [PMID: 35010385 PMCID: PMC8751044 DOI: 10.3390/ijerph19010127] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/16/2021] [Accepted: 12/17/2021] [Indexed: 06/14/2023]
Abstract
Medically underserved communities have limited access to effective disease management resources in the U.S. Mobile health applications (mHealth apps) offer patients a cost-effective way to monitor and self-manage their condition and to communicate with providers; however, current diabetes self-management apps have rarely included end-users from underserved communities in the design process. This research documents key stakeholder-driven design requirements for a diabetes self-management app for medically underserved patients. Semi-structured survey interviews were carried out on 97 patients with diabetes and 11 healthcare providers from medically underserved counties in South Texas, to elicit perspectives and preferences regarding a diabetes self-management app, and their beliefs regarding such an app's usage and utility. Patients emphasized the need for accessible educational content and for quick access to guidance on regulating blood sugar, diet, and exercise and physical activity using multimedia rather than textual forms. Healthcare providers indicated that glucose monitoring, educational content, and the graphical visualization of diabetes data were among the top-rated app features. These findings suggest that specific design requirements for the underserved can improve the adoption, usability, and sustainability of such interventions. Designers should consider health literacy and numeracy, linguistic barriers, data visualization, data entry complexity, and information exchange capabilities.
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Affiliation(s)
- Samuel Bonet Olivencia
- Department of Industrial & Systems Engineering, Texas A&M University, College Station, TX 77843, USA; (S.B.O.); (A.H.R.); (A.S.)
| | - Arjun H. Rao
- Department of Industrial & Systems Engineering, Texas A&M University, College Station, TX 77843, USA; (S.B.O.); (A.H.R.); (A.S.)
| | - Alec Smith
- Department of Industrial & Systems Engineering, Texas A&M University, College Station, TX 77843, USA; (S.B.O.); (A.H.R.); (A.S.)
| | - Farzan Sasangohar
- Department of Industrial & Systems Engineering, Texas A&M University, College Station, TX 77843, USA; (S.B.O.); (A.H.R.); (A.S.)
- Center for Outcomes Research, Houston Methodist, Houston, TX 77030, USA
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14
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Babagoli MA, Nieto-Martínez R, González-Rivas JP, Sivaramakrishnan K, Mechanick JI. Roles for community health workers in diabetes prevention and management in low- and middle-income countries. CAD SAUDE PUBLICA 2021; 37:e00287120. [PMID: 34730688 DOI: 10.1590/0102-311x00287120] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 01/12/2021] [Indexed: 11/22/2022] Open
Abstract
Diabetes prevalence is increasing worldwide, especially in low- and middle-income countries (LMIC), posing the need for improved detection and management strategies. Chronic disease models and lifestyle medicine provide structures for action. Community health workers (CHWs) can significantly contribute to chronic disease care if they are trained and integrated into low-resource health systems. Although most current CHWs worldwide are performing maternal/child health and infectious disease-related tasks, other programs involving CHWs for noncommunicable disease prevention and management are increasing. In this article, we discuss the advantages, challenges, and questions regarding possible roles assigned to CHWs in the prevention and management of diabetes. These roles include performing simple screening tests, implementing lifestyle/behavioral interventions, and connecting patients with alternatives to biomedicine. Specifically, CHWs can aid diabetes epidemiological surveillance by conducting risk score-based screening or capillary glucose testing, and they can facilitate diabetes self-management by delivering interventions described in the transcultural diabetes nutrition algorithm. Furthermore, while this role has not formally been assigned, CHWs can leverage their intimate knowledge of local practices to provide decision-making support to patients in environments with pluralistic health systems. Ethnocultural differences in CHW functions and transcultural adaptations of their roles in diabetes care should also be considered. In summary, CHWs can improve diabetes care by screening high-risk individuals and implementing lifestyle interventions, especially in LMIC.
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Affiliation(s)
- Masih A Babagoli
- Institute for Global Health Sciences, University of California, San Francisco, U.S.A.,Center for the History and Ethics of Public Health, Columbia University, New York, U.S.A
| | - Ramfis Nieto-Martínez
- LifeDoc Health, Memphis, U.S.A.,Harvard TH Chan School of Public Health, Harvard University, Boston, U.S.A
| | - Juan P González-Rivas
- Foundation for the Clinic, Public Health, and Epidemiological Research of Venezuela, Caracas, Venezuela.,International Clinical Research Center, St Anne's University Hospital, Czech Republic
| | | | - Jeffrey I Mechanick
- Kravis Center for Clinical Cardiovascular Health at Mount Sinai Heart, New York, U.S.A.,Division of Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, U.S.A
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15
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Devaraj SM, Napoleone JM, Miller RG, Rockette-Wagner B, Arena VC, Mitchell-Miland C, Saad MB, Kriska AM. The role of Sociodemographic factors on goal achievement in a community-based diabetes prevention program behavioral lifestyle intervention. BMC Public Health 2021; 21:1783. [PMID: 34600527 PMCID: PMC8487523 DOI: 10.1186/s12889-021-11844-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 08/29/2021] [Indexed: 01/02/2023] Open
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 .
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Affiliation(s)
- Susan M Devaraj
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, 5135 Public Health, 130 De Soto Street, Pittsburgh, PA, 15261, USA
| | - Jenna M Napoleone
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, 5135 Public Health, 130 De Soto Street, Pittsburgh, PA, 15261, USA
| | - Rachel G Miller
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, 5135 Public Health, 130 De Soto Street, Pittsburgh, PA, 15261, USA
| | - Bonny Rockette-Wagner
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, 5135 Public Health, 130 De Soto Street, Pittsburgh, PA, 15261, USA.
| | - Vincent C Arena
- Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Chantele Mitchell-Miland
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, 5135 Public Health, 130 De Soto Street, Pittsburgh, PA, 15261, USA
| | - Mohammed Bu Saad
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, 5135 Public Health, 130 De Soto Street, Pittsburgh, PA, 15261, USA
| | - Andrea M Kriska
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, 5135 Public Health, 130 De Soto Street, Pittsburgh, PA, 15261, USA
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16
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Formagini T, Brooks JV, Jacobson LT, Roberts AW. Reimbursement Policies for Diabetes Prevention Program (DPP): Implications for Racial and Ethnic Health Disparities. Kans J Med 2021; 14:234-237. [PMID: 34540140 PMCID: PMC8415384 DOI: 10.17161/kjm.vol1415125] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Grants] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 04/30/2021] [Indexed: 11/17/2022] Open
Affiliation(s)
- Taynara Formagini
- Department of Population Health, University of Kansas School of Medicine, Kansas City, KS
| | - Joanna V Brooks
- Department of Population Health, University of Kansas School of Medicine, Kansas City, KS
- University of Kansas Cancer Center, Kansas City, KS
| | - Lisette T Jacobson
- Department of Population Health, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Andrew W Roberts
- Department of Population Health, University of Kansas School of Medicine, Kansas City, KS
- University of Kansas Cancer Center, Kansas City, KS
- Department of Anesthesiology, University of Kansas School of Medicine, Kansas City, KS
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17
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Abstract
The global diabetes burden is staggering, and prevention efforts are needed to reduce the impact on individuals and populations. There is strong evidence from efficacy trials showing that lifestyle interventions promoting increased physical activity, improvements in diet, and/or weight loss significantly reduce diabetes incidence and improve cardiometabolic risk factors. Implementation research assessing the feasibility, effectiveness, and cost-effectiveness of delivering these proven programs at the community level has shown success, but more research is needed to overcome barriers to implementation in different settings globally. New avenues of research should be considered to combat this public health issue.
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Affiliation(s)
- Mary Beth Weber
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, Atlanta, GA 30322, USA.
| | - Saria Hassan
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, Atlanta, GA 30322, USA; Department of Medicine, Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA 30322, USA
| | - Rakale Quarells
- Cardiovascular Research Institute, Morehouse School of Medicine, 720 Westview Drive, SW NCPC-318, Atlanta, GA 30310, USA
| | - Megha Shah
- Department of Family and Preventive Medicine, Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA 30322, USA
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