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Rittenhouse BE, Alolayan S, Eguale T, Segal AR, Doucette J. The cost-effectiveness of metformin in the US diabetes prevention program trial: Simple interpretations need not apply. Prev Med 2024; 178:107819. [PMID: 38092328 DOI: 10.1016/j.ypmed.2023.107819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 11/02/2023] [Accepted: 12/09/2023] [Indexed: 01/07/2024]
Abstract
Based on previously published US Diabetes Prevention Program (DPP) cost-effectiveness analyses (CEAs) metformin continues to be promoted as "cost-effective." We review the DPP within-trial CEA to assess this claim. Treatment alternatives included placebo (plus standard lifestyle advice), branded metformin and individual lifestyle modification. We added generic metformin as an alternative. Original published CEA data were taken as given and re-analyzed according to accepted principles for calculating incremental cost-effectiveness ratios (ICERs) in the economic evaluation field. With more than two treatments as in the DPP, these require attention to the rankings of interventions according to cost or effect prior to stipulating appropriate ICERs to calculate. With proper ICERs neither branded nor generic metformin was cost-effective, regardless of the value assumed for the willingness to pay for the quality-adjusted life year outcome assessed. Metformin alternatives were technically inefficient compared to placebo or the lifestyle modification alternative. Net loss calculations indicated substantial costs/health losses to using metformin instead of the optimal lifestyle alternative in response to metformin having been inaccurately labelled "cost-effective" in the original CEA. That CEA and subsequent analyses and citations of such analyses continue to claim that both metformin and lifestyle modification are cost-effective in diabetes prevention based on DPP data. Using metformin implies substantial costs and health losses compared to the cost-effective lifestyle modification. It may be that metformin has a role in cost-effective diabetes prevention, but this has yet to be shown based on DPP data.
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Affiliation(s)
- Brian E Rittenhouse
- Massachusetts College of Pharmacy and Health Sciences, 179 Longwood Ave, Boston, MA 02115, United States of America.
| | | | - Tewodros Eguale
- Massachusetts College of Pharmacy and Health Sciences, 179 Longwood Ave, Boston, MA 02115, United States of America; Brigham and Women's Hospital, Boston, MA, United States of America.
| | - Alissa R Segal
- Massachusetts College of Pharmacy and Health Sciences, 179 Longwood Ave, Boston, MA 02115, United States of America; Joslin Diabetes Center, Boston, MA, United States of America.
| | - Joanne Doucette
- Massachusetts College of Pharmacy and Health Sciences, 179 Longwood Ave, Boston, MA 02115, United States of America.
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2
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Ling I, Zambrana RE, Echeverria S, López L. Peer Support to Enhance Type 2 Diabetes Prevention Among African American and Latino Adults. Endocrinol Metab Clin North Am 2023; 52:573-583. [PMID: 37865474 DOI: 10.1016/j.ecl.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2023]
Abstract
Social support occurs within complex social networks that are diffusely embedded within the social determinants of health. Social networks operate through five primary interconnected pathways: (1) provision of social support; (2) social influence; (3) social engagement; (4) social capital; and (5) social cohesion. Research has demonstrated that increased social support can have a beneficial impact on Type 2 Diabetes (T2DM) prevention and outcomes through culturally tailored Diabetes Prevention Programs in minority communities. Further research is needed to fully measure the impact of social network peer support on T2DM outcomes to better operationalize and scale up community specific interventions.
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Affiliation(s)
- Irving Ling
- Kaiser Permanente Northern California, 2425 Geary Boulevard, San Francisco, CA 94115, USA
| | - Ruth Enid Zambrana
- Harriet Tubman Department of Women, Gender and Sexuality Studies, University of Maryland, Consortium on Race, Gender and Ethnicity, Susquehanna Hall, 4200 Lehigh Road Room 4117, College Park, MD 20742, USA
| | - Sandra Echeverria
- Department of Public Health Education, 437 Coleman Building, 1408 Walker Avenue, Greensboro, NC 27412, USA
| | - Lenny López
- University of California San Francisco, San Francisco VA Medical Center, 4150 Clement Street, San Francisco, CA 94121, USA.
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3
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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4
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Huang HC, Szwerinski NK, Nasrallah C, Huang Q, Chopra V, Venditti EM, Azar KMJ, Romanelli RJ. Lifestyle change program engagement in real-world clinical practice: a mixed-methods analysis. Transl Behav Med 2023; 13:168-182. [PMID: 36694916 PMCID: PMC10068905 DOI: 10.1093/tbm/ibac098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Participant engagement in structured lifestyle change programs (LCPs) is essential for adopting behaviors that promote weight loss; however, the challenges to, and facilitators that promote, engagement with such programs are not well understood. We conducted a mixed-methods study among real-world LCP participants to assess factors associated with program engagement and to examine the reasons for withdrawal. Using electronic health records (EHR), we identified LCP eligible participants between 2010 and 2017. Multivariable logistic regression was used to assess associations between program engagement and baseline characteristics. Semi-structured interviews with LCP participants were conducted and thematically analyzed to examine reasons for withdrawal. A total of 1,813 LCP participants were included. The median number of sessions attended was 10 of 21-25 sessions. Highest LCP engagement was associated with factors potentially related to self-efficacy/motivation, such as older age, higher baseline weight, prior healthcare utilization and an absence of a history of smoking or depression. Engagement was also negatively associated with being Non-Hispanic Black versus White. The qualitative analysis of the interviews revealed four general themes pertaining to participants' withdrawal: competing priorities, perceived program effectiveness, characteristics of the program, and facilitator-related factors. Taken together, results from this mixed-methods study suggest that motivation and self-efficacy are important for program engagement; future LCP enhancements should incorporate flexible formats that may help participants manage competing priorities and maximize personal and cultural relevance for all racial/ethnic groups, especially those who have not benefitted fully. Furthermore, participants should be encouraged to set realistic goals to manage expectations.
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Affiliation(s)
- Hsiao-Ching Huang
- Sutter Health, Center for Health Systems Research, Palo Alto, CA 94301, USA
| | - Nina K Szwerinski
- Sutter Health, Center for Health Systems Research, Palo Alto, CA 94301, USA
| | | | - Qiwen Huang
- Sutter Health, Center for Health Systems Research, Palo Alto, CA 94301, USA
| | - Vidita Chopra
- Sutter Health, Center for Health Systems Research, Palo Alto, CA 94301, USA
| | - Elizabeth M Venditti
- Department of Psychiatry, Diabetes Prevention Support Center, University of Pittsburgh, Pittsburgh, PA 15213, USA
- Department of Epidemiology, Diabetes Prevention Support Center, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Kristen M J Azar
- Sutter Health, Center for Health Systems Research, Palo Alto, CA 94301, USA
| | - Robert J Romanelli
- Sutter Health, Center for Health Systems Research, Palo Alto, CA 94301, USA
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Golovaty I, Ritchie ND, Tuomilehto J, Mohan V, Ali MK, Gregg EW, Bergman M, Moin T. Two decades of diabetes prevention efforts: A call to innovate and revitalize our approach to lifestyle change. Diabetes Res Clin Pract 2023; 198:110195. [PMID: 36470316 PMCID: PMC10079599 DOI: 10.1016/j.diabres.2022.110195] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 11/07/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022]
Abstract
The impact of global diabetes prevention efforts has been modest despite the promise of landmark diabetes prevention trials nearly twenty years ago. While national and regional initiatives show potential, challenges remain to adapt large-scale strategies in the real-world that fits individuals and their communities. Additionally, the sedentary lifestyle changes during the COVID-19 pandemic and guidelines that now call for earlier screening (e.g., US Preventative Task Force) will increase the pool of eligible adults worldwide. Thus, a more adaptable, person-centered approach that expands the current toolkit is urgently needed to innovate and revitalize our approach to diabetes prevention. This review identifies key priorities to optimize the population-level delivery of diabetes prevention based on a consensus-based evaluation of the current evidence among experts in global translational programs; key priorities identified include (1) participant eligibility, (2) intervention intensity, (3) delivery components, (4) behavioral economics, (5) technology, and (6) the role of pharmacotherapy. We offer a conceptual framework for a broader, person-centered approach to better address an individual's risk, readiness, barriers, and digital competency.
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Affiliation(s)
- Ilya Golovaty
- Division of General Internal Medicine, University of Washington School of Medicine, Seattle, WA, USA; General Medicine Service, VA Puget Sound Health Care System, Seattle, WA, USA.
| | - Natalie D Ritchie
- Office of Research, Denver Health and Hospital Authority, Denver, CO. Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO. University of Colorado College of Nursing, Aurora, CO, USA
| | - Jaakko Tuomilehto
- Public Health Promotion Unit, Finnish Institute for Health and Welfare, Helsinki, Finland; Department of Public Health, University of Helsinki, Helsinki, Finland; Saudi Diabetes Research Group, King Abdulaziz University Jeddah, Saudi Arabia; Department of International Health, National School of Public Health, Instituto de Salud Carlos III. Madrid, Spain
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation & Chairman, Dr. Mohan's Diabetes Specialties Centre, Chennai, India
| | - Mohammed K Ali
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA, USA; Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Edward W Gregg
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
| | - Michael Bergman
- Division of Endocrinology and Metabolism, Department of Medicine and of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Tannaz Moin
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA; VA Greater Los Angeles Health System and HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, CA, USA
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6
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Welshons KF, Johnson NA, Gold AL, Reicks M. Diabetes prevention program outcomes by in-person versus distance delivery mode among ethnically diverse, primarily lower-income adults. Digit Health 2023; 9:20552076231173524. [PMID: 37188080 PMCID: PMC10176546 DOI: 10.1177/20552076231173524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 04/14/2023] [Indexed: 05/17/2023] Open
Abstract
Objective Physical activity and weight loss outcomes of a diabetes prevention program were compared for ethnically diverse adults, with the majority participating in public assistance programs. Outcomes were compared for those who completed the program in person versus by distance delivery. Methods A two-group, pre-post study design compared National Diabetes Prevention Program outcomes based on in-person delivery (2018-2020 pre-COVID-19 pandemic, n = 47) and distance delivery (after March 2020, n = 31). Outcomes were measured or self-reported depending on the delivery method. Linear mixed models with a random intercept for coach and covariates were used to assess delivery mode group differences in percent weight loss and weekly physical activity minutes. Results Completion rates were similar by in-person versus distance delivery mode (57% vs. 65%). Among those who completed the program, the mean age was 58 years, the mean baseline body mass index was 33, and 39% were Hispanic. The majority were female (87%), participating in a public assistance program (63%), and living in a micropolitan area (61%). Percent weight loss was greater in the distance delivery group (7.7%) compared to the in-person group (4.7%) in the unadjusted analysis (p = 0.009) but not when adjusted for covariates. No differences were observed in adjusted weekly physical activity minutes between the in-person (219 min) versus the distance group (148 min). Conclusions No differences were observed by delivery mode in percent weight loss or weekly physical activity minutes, indicating that distance delivery does not compromise program effectiveness.
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Affiliation(s)
- Kate F Welshons
- University of Minnesota
Extension, Department of Family, Health and Wellbeing, St Paul, MN,
USA
| | - Nikki A Johnson
- University of Minnesota
Extension, Department of Family, Health and Wellbeing, St Paul, MN,
USA
- Department of Health, Nutrition, and
Exercise Science, North Dakota State University Extension, Fargo, ND, USA
| | - Abby L Gold
- Department of Food Science and
Nutrition, University of Minnesota, St Paul, MN, USA
| | - Marla Reicks
- Department of Food Science and
Nutrition, University of Minnesota, St Paul, MN, USA
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7
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Williams LB, Moser DK, Gustafson A, Waters TM, Rayens MK, Karle ER, Kriska AM. Reaching high-risk Black adults for diabetes prevention programming during a pandemic: The design of Fit & Faithful a randomized controlled community trial. Contemp Clin Trials 2022; 123:106973. [PMID: 36334705 PMCID: PMC10155857 DOI: 10.1016/j.cct.2022.106973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 10/14/2022] [Accepted: 10/20/2022] [Indexed: 11/08/2022]
Abstract
Obesity is a key risk factor for Type 2 diabetes (T2D). Alarmingly, 87% of US adults have overweight or obesity, with non-Hispanic black adults having higher obesity and T2D prevalence than non-Hispanic white. The Diabetes Prevention Program (DPP) demonstrated the clinical benefits of lifestyle intervention (LI). While the DPP LI is effective, some participants don't achieve clinically significant weight loss in the current group-based translation paradigm. Black adults have the lowest adjusted weight loss (3.2%) among all racial/ethnic groups. Early intervention nonresponse defined as ≤1% weight loss at intervention week 4 is linked to lower probability of achieving weight loss goals. This paper describes the design and methods of a cluster randomized controlled trial among black weight loss nonresponders nested in 20 community sites (primarily churches). Descriptions of the adaptations made to transition the program to virtual format during the COVID-19 pandemic are also included. Trained community health workers deliver a group-based, 6-month long DPP over 18 sessions via Zoom. Additionally, nonresponders in the enhanced group receive weekly telephone support to provide individual-level intervention to help overcome weight loss barriers. Outcomes include weight, physical activity level, blood pressure, and dietary behaviors; these are compared between nonresponders in the enhanced intervention group and nonresponders in the active control group. Cost, mediators, and moderators are explored. If found to efficacious, these enhanced strategies could be standardized as a supplement for use with DPP nonresponders.
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Affiliation(s)
- Lovoria B Williams
- University of Kentucky, College of Nursing, 751 Rose Street, Lexington, KY 40536, United States.
| | - Debra K Moser
- University of Kentucky, College of Nursing, 751 Rose Street, Lexington, KY 40536, United States
| | - Alison Gustafson
- University of Kentucky, College of Agriculture, Department of Dietetics and Human Nutrition, 206g Funkhouser, Lexington, KY 40536, United States
| | - Teresa M Waters
- University of Kentucky, College of Public Health Department of Health Management and Policy, 111 Washington Avenue, Lexington, KY 40536, United States
| | - Mary Kay Rayens
- University of Kentucky, College of Nursing, 751 Rose Street, Lexington, KY 40536, United States; University of Kentucky, College of Public Health Department of Health Management and Policy, 111 Washington Avenue, Lexington, KY 40536, United States
| | - Erika R Karle
- University of Kentucky, College of Nursing, 751 Rose Street, Lexington, KY 40536, United States
| | - Andrea M Kriska
- University of Pittsburgh, Graduate School of Public Health, Department of Epidemiology, 130 Desoto Street, Pittsburgh, PA 15261, United States
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8
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Abstract
There are many nonmodifiable and modifiable risk factors for type 2 diabetes. Nonmodifiable risk factors include age, genetics, epigenetics, and social determinants of health (including education level, socioeconomic status, and noise and arsenic exposure). Modifiable risk factors include obesity, the microbiome, diet, cigarette smoking, sleep duration, sleep quality, and sedentary behavior. Major lifestyle interventions to prevent and treat diabetes relate to these risk factors. Weight loss is the lifestyle intervention with the largest benefit for both preventing and treating diabetes. Exercise, even without weight loss, significantly reduces the incidence of type 2 diabetes.
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Baucom KJW, Bauman T, Gutierrez Chavez M, Nemirovsky Y, Aguirre MC, Ramos C, Asnaani A, Gutner CA, Ritchie ND, Shah M. Barriers to participation and lifestyle change among lower versus higher income participants in the National Diabetes Prevention Program: lifestyle coach perspectives. Transl Behav Med 2022; 12:860-869. [PMID: 35554612 PMCID: PMC9385121 DOI: 10.1093/tbm/ibac032] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Individuals from socioeconomically disadvantaged groups have lesser participation and success in the National Diabetes Prevention Program (NDPP). Barriers to NDPP participation and lifestyle change were examined from the perspective of Lifestyle Coaches serving lower versus higher income participants. Lifestyle Coaches (n = 211) who serve lower income (n = 82) or higher income (n = 129) participants reported on observed barriers to NDPP participation and lifestyle change and ranked the three most significant barriers to (a) NDPP participation and (b) lifestyle change. Group differences in number/type of barriers were examined using t-tests and chi-square analyses, and ranking differences were examined using multilevel cumulative logit models. Lifestyle Coaches of lower income (versus higher income) participants reported two additional barriers on average. Ranked barriers to participation were similar between groups, and notably included physical/emotional barriers. However, for lifestyle change, those serving lower income groups were more likely to rank lack of access to healthy grocery stores, but less likely to rank low motivation and lack of family support. Lifestyle Coaches of lower income participants were less likely to rank long wait period prior to enrollment as the most significant barrier to participation, and to rank lack of time off from work as the most significant barrier to lifestyle change. Despite more barriers observed among lower versus higher income participants, overlap in the most significant barriers highlights the potential utility of widely addressing common barriers among NDPP participants. In particular, physical and emotional barriers have been overlooked, yet deserve greater attention in future research and practice.
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Affiliation(s)
| | - Tali Bauman
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | | | - Yanina Nemirovsky
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | - Monique C Aguirre
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | - Carmen Ramos
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Anu Asnaani
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | - Cassidy A Gutner
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Natalie D Ritchie
- Ambulatory Care Services, Denver Health and Hospital Authority, Denver, CO, USA,Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA
| | - Megha Shah
- Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, GA, USA
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10
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Gholami M, Jackson NJ, Chung UYR, Duru OK, Shedd K, Soetenga S, Loeb T, Elashoff D, Hamilton AB, Mangione CM, Slusser W, Moin T. Evaluation of the University of California Diabetes Prevention Program (UC DPP) Initiative. BMC Public Health 2021; 21:1775. [PMID: 34592981 PMCID: PMC8482560 DOI: 10.1186/s12889-021-11731-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 09/03/2021] [Indexed: 11/25/2022] Open
Abstract
Background Type 2 diabetes can negatively impact long term health outcomes, healthcare costs and quality of life. However, intensive lifestyle interventions, including the Diabetes Prevention Program (DPP), can significantly lower risk of incident type 2 diabetes among overweight adults with prediabetes. Unfortunately, the majority of adults in the US who are at risk of developing diabetes do not engage in DPP-based lifestyle change programs. Increased adoption of evidence-based obesity and diabetes prevention interventions, such as the DPP, may help large employers reduce health risks and improve health outcomes among employees. In 2018, the University of California Office of thePresident (UCOP) implemented the UC DPP Initiative, a novel, multi-component program to address diabetes and obesity prevention across the UC system. Methods The goal of our study is to conduct a multifaceted evaluation of the UC DPP Initiative using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Our evaluation will integrate unique and diverse UC data sources, including electronic health record (EHR) data, administrative claims, campus-based DPP cohort data, qualitative interviews and site visits. Our primary outcome of interest is the mean percent weight change among three groups of overweight/obese UC beneficiaries at risk for diabetes at 12-month follow-up. Secondary outcomes include mean percent weight change at 24-month follow-up, barriers and facilitators associated with implementatio, as well as the degree of program adoption and maintenance. Discussion Our study will help inform diabetes and obesity prevention efforts across the UC system. Findings from this evaluation will also be highly applicable to universities and large employers, as well as community organizers, healthcare organizations and insurers implementing the DPP and/or other health promotion interventions.
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Affiliation(s)
| | - Nicholas J Jackson
- David Geffen School of Medicine at the University of California, Los Angeles, 1100 Glendon Ave, Suite 850, Los Angeles, CA, 90024, USA
| | - Un Young Rebecca Chung
- David Geffen School of Medicine at the University of California, Los Angeles, 1100 Glendon Ave, Suite 850, Los Angeles, CA, 90024, USA
| | - O Kenrik Duru
- David Geffen School of Medicine at the University of California, Los Angeles, 1100 Glendon Ave, Suite 850, Los Angeles, CA, 90024, USA
| | - Kelly Shedd
- Campus Recreation, University of California, Los Angeles, Los Angeles, CA, USA
| | - Samantha Soetenga
- Campus Recreation, University of California, Los Angeles, Los Angeles, CA, USA
| | - Tamara Loeb
- David Geffen School of Medicine at the University of California, Los Angeles, 1100 Glendon Ave, Suite 850, Los Angeles, CA, 90024, USA
| | - David Elashoff
- David Geffen School of Medicine at the University of California, Los Angeles, 1100 Glendon Ave, Suite 850, Los Angeles, CA, 90024, USA
| | - Alison B Hamilton
- David Geffen School of Medicine at the University of California, Los Angeles, 1100 Glendon Ave, Suite 850, Los Angeles, CA, 90024, USA.,VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Carol M Mangione
- David Geffen School of Medicine at the University of California, Los Angeles, 1100 Glendon Ave, Suite 850, Los Angeles, CA, 90024, USA
| | - Wendelin Slusser
- David Geffen School of Medicine at the University of California, Los Angeles, 1100 Glendon Ave, Suite 850, Los Angeles, CA, 90024, USA
| | - Tannaz Moin
- David Geffen School of Medicine at the University of California, Los Angeles, 1100 Glendon Ave, Suite 850, Los Angeles, CA, 90024, USA. .,VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
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11
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Wilson KE, Michaud TL, Almeida FA, Schwab RJ, Porter GC, Aquilina KH, Brito FA, Golden CA, Dressler EV, Kittel CA, Harvin LN, Boggs AE, Katula JA, Estabrooks PA. Using a population health management approach to enroll participants in a diabetes prevention trial: reach outcomes from the PREDICTS randomized clinical trial. Transl Behav Med 2021; 11:1066-1077. [PMID: 33677529 PMCID: PMC8158170 DOI: 10.1093/tbm/ibab010] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Population health management (PHM) strategies to address diabetes prevention have the potential to engage large numbers of at-risk individuals in a short duration. We examined a PHM approach to recruit participants to a diabetes prevention clinical trial in a metropolitan health system. We examined reach and representativeness and assessed differences from active and passive respondents to recruitment outreach, and participants enrolled through two clinical screening protocols. The PHM approach included an electronic health record (EHR) query, physician review of identified patients, letter invitation, and telephone follow-up. Data describe the reach and representativeness of potential participants at multiple stages during the recruitment process. Subgroup analyses examined proportional reach, participant differences based on passive versus active recruitment response, and clinical screening method used to determine diabetes risk status. The PHM approach identified 10,177 potential participants to receive a physician letter invitation, 60% were contacted by telephone, 2,796 (46%) completed telephone screening, 1,961 were eligible from telephone screen, and 599 were enrolled in 15 months. Accrual was unaffected by shifting clinical screening protocols despite the increase in participant burden. Relative to census data, study participants were more likely to be obese, female, older, and Caucasian. Relative to the patient population, enrolled participants were less likely to be Black and were older. Active respondents were more likely to have a higher income than passive responders. PHM strategies have the potential to reach a large number of participants in a relatively short period, though concerted efforts are needed to increase participant diversity.
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Affiliation(s)
- Kathryn E Wilson
- Department of Kinesiology and Health, College of Education and Human Development, Georgia State University, Sports Arena, Atlanta, GA, USA.,Center for the Study of Stress, Trauma, and Resilience, College of Education and Human Development, Georgia State University, Atlanta, GA, USA
| | - Tzeyu L Michaud
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA.,Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Fabio A Almeida
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA.,Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Robert J Schwab
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA.,Internal Medicine Division of General Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Gwenndolyn C Porter
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Kathryn H Aquilina
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Fabiana A Brito
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA.,Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Caitlin A Golden
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Emily V Dressler
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Carol A Kittel
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Lea N Harvin
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Ashley E Boggs
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA
| | - Jeffrey A Katula
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA
| | - Paul A Estabrooks
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA.,Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
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Nhim K, Khan T, Gruss S, Wozniak G, Kirley K, Schumacher P, Albright A. Facilitators to referrals to CDC's National Diabetes Prevention Program in primary care practices and pharmacies: DocStyles 2016-2017. Prev Med 2021; 149:106614. [PMID: 33989676 PMCID: PMC8562779 DOI: 10.1016/j.ypmed.2021.106614] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 04/12/2021] [Accepted: 05/09/2021] [Indexed: 01/22/2023]
Abstract
Despite evidence of the effectiveness of behavioral change interventions for type 2 diabetes prevention, health care provider referrals to organizations offering the National Diabetes Prevention Program (National DPP) lifestyle change program (LCP) remain suboptimal. This study examined facilitators of LCP referrals among primary care providers and pharmacists (providers). We analyzed data on 1956 providers from 2016 to 2017 DocStyles web-based surveys. Pearson chi-square or Fisher's exact tests were used for bivariate associations between facilitators, provider characteristics, and their self-reported referral and bi-directional referral (where they received patient status updates back from the LCPs) to an LCP. Multiple logistic regressions were used to estimate the effects of facilitators to referral practices, controlling for providers' characteristics. Geocoding was done at the street level for in-person, public LCP class locations and at the zip code level for survey respondents to create a density measure for LCP availability within 10 miles. Overall, 21% of providers referred their patients with prediabetes to LCPs, and 6.4% engaged in bi-directional referral. Provider practices that established clinical-community linkages (CCLs) with LCPs (AOR = 4.88), used electronic health records (EHRs) to manage patients (AOR = 2.94), or practiced within 10 miles of an in-person, public LCP class location (AOR = 1.49) were more likely to refer. Establishing CCLs with LCPs (AOR = 8.59) and using EHRs (AOR = 1.86) were also facilitators of bi-directional referral. This study highlights the importance of establishing CCLs between provider settings and organizations offering the National DPP LCP, increasing use of EHRs to manage patients, and increasing availability of in-person LCP class locations near provider practices.
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Affiliation(s)
- Kunthea Nhim
- Centers for Disease Control and Prevention, Division of Diabetes Translation, 4770 Buford Hwy, Mail Stop S107-3, Atlanta, GA 30341, USA.
| | - Tamkeen Khan
- American Medical Association, 330 N. Wabash Avenue, Suite 39300, Chicago, IL 60611, USA.
| | - Stephanie Gruss
- Centers for Disease Control and Prevention, Division of Diabetes Translation, 4770 Buford Hwy, Mail Stop S107-3, Atlanta, GA 30341, USA.
| | - Gregory Wozniak
- American Medical Association, 330 N. Wabash Avenue, Suite 39300, Chicago, IL 60611, USA.
| | - Kate Kirley
- American Medical Association, 330 N. Wabash Avenue, Suite 39300, Chicago, IL 60611, USA.
| | - Patricia Schumacher
- Centers for Disease Control and Prevention, Division of Diabetes Translation, 4770 Buford Hwy, Mail Stop S107-3, Atlanta, GA 30341, USA.
| | - Ann Albright
- Centers for Disease Control and Prevention, Division of Diabetes Translation, 4770 Buford Hwy, Mail Stop S107-3, Atlanta, GA 30341, USA.
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Azar KMJ, Nasrallah C, Szwerinski NK, Petersen JJ, Halley MC, Greenwood D, Romanelli RJ. Implementation of a group-based diabetes prevention program within a healthcare delivery system. BMC Health Serv Res 2019; 19:694. [PMID: 31615525 PMCID: PMC6792249 DOI: 10.1186/s12913-019-4569-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 09/30/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Group-based Diabetes Prevention Programs (DPP), aligned with recommendations from the Centers for Disease Control and Prevention, promote clinically significant weight loss and reduce cardio-metabolic risks. Studies have examined implementation of the DPP in community settings, but less is known about its integration in healthcare systems. In 2010, a group-based DPP known as the Group Lifestyle Balance (GLB) was implemented within a large healthcare delivery system in Northern California, across three geographically distinct regional administration divisions of the organization within 12 state counties, with varying underlying socio-demographics. The regional divisions implemented the program independently, allowing for natural variation in its real-world integration. We leveraged this natural experiment to qualitatively assess the implementation of a DPP in this healthcare system and, especially, its fidelity to the original GLB curriculum and potential heterogeneity in implementation across clinics and regional divisions. METHODS Using purposive sampling, we conducted semi-structured interviews with DPP lifestyle coaches. Data were analyzed using mixed-method techniques, guided by an implementation outcomes framework consisting of eight constructs: acceptability, adoption, appropriateness, cost, feasibility, fidelity, penetration, and sustainability. RESULTS We conducted 33 interviews at 20 clinics across the three regional administrative divisions. Consistencies in implementation of the program were found across regions in terms of satisfaction with the evidence base (acceptability), referral methods (adoption), eligibility criteria (fidelity), and strategies to increase retention and effectiveness (sustainability). Heterogeneity in implementation across regions were found in all categories, including: the number and frequency of sessions (fidelity); program branding (adoption); lifestyle coach training (adoption), and patient-facing cost (cost). Lifestyle coaches expressed differing attitudes about curriculum content (acceptability) and suitability of educational level (appropriateness). While difficulties with recruitment were common across regions (feasibility), strategies used to address these challenges differed (sustainability). CONCLUSIONS Variation exists in the implementation of the DPP within a large multi-site healthcare system, revealing a dynamic and important tension between retaining fidelity to the original program and tailoring the program to meet the local needs. Moreover, certain challenges across sites may represent opportunities for considering alternative implementation to anticipate these barriers. Further research is needed to explore how differences in implementation domains impact program effectiveness.
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Affiliation(s)
- Kristen M J Azar
- Palo Alto Medical Foundation Research Institute, 795 El Camino Real, Ames Building, Palo Alto, CA, 94301, USA.
| | - Catherine Nasrallah
- Palo Alto Medical Foundation Research Institute, 795 El Camino Real, Ames Building, Palo Alto, CA, 94301, USA
| | - Nina K Szwerinski
- Palo Alto Medical Foundation Research Institute, 795 El Camino Real, Ames Building, Palo Alto, CA, 94301, USA
| | - John J Petersen
- Palo Alto Medical Foundation Research Institute, 795 El Camino Real, Ames Building, Palo Alto, CA, 94301, USA
| | - Meghan C Halley
- Palo Alto Medical Foundation Research Institute, 795 El Camino Real, Ames Building, Palo Alto, CA, 94301, USA
| | - Deborah Greenwood
- Palo Alto Medical Foundation Research Institute, 795 El Camino Real, Ames Building, Palo Alto, CA, 94301, USA
| | - Robert J Romanelli
- Palo Alto Medical Foundation Research Institute, 795 El Camino Real, Ames Building, Palo Alto, CA, 94301, USA
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14
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Nhim K, Gruss SM, Porterfield DS, Jacobs S, Elkins W, Luman ET, Van Aacken S, Schumacher P, Albright A. Using a RE-AIM framework to identify promising practices in National Diabetes Prevention Program implementation. Implement Sci 2019; 14:81. [PMID: 31412894 PMCID: PMC6694543 DOI: 10.1186/s13012-019-0928-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 07/25/2019] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The National Diabetes Prevention Program (National DPP) is rapidly expanding in an effort to help those at high risk of type 2 diabetes prevent or delay the disease. In 2012, the Centers for Disease Control and Prevention funded six national organizations to scale and sustain multistate delivery of the National DPP lifestyle change intervention (LCI). This study aims to describe reach, adoption, and maintenance during the 4-year funding period and to assess associations between site-level factors and program effectiveness regarding participant attendance and participation duration. METHODS The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework was used to guide the evaluation from October 2012 to September 2016. Multilevel linear regressions were used to examine associations between participant-level demographics and site-level strategies and number of sessions attended, attendance in months 7-12, and duration of participation. RESULTS The six funded national organizations increased the number of participating sites from 68 in 2012 to 164 by 2016 across 38 states and enrolled 14,876 eligible participants. By September 2016, coverage for the National DPP LCI was secured for 42 private insurers and 7 public payers. Nearly 200 employers were recruited to offer the LCI on site to their employees. Site-level strategies significantly associated with higher overall attendance, attendance in months 7-12, and longer participation duration included using self-referral or word of mouth as a recruitment strategy, providing non-monetary incentives for participation, and using cultural adaptations to address participants' needs. Sites receiving referrals from healthcare providers or health systems also had higher attendance in months 7-12 and longer participation duration. At the participant level, better outcomes were achieved among those aged 65+ (vs. 18-44 or 45-64), those who were overweight (vs. obesity), those who were non-Hispanic white (vs. non-Hispanic black or multiracial/other races), and those eligible based on a blood test or history of gestational diabetes mellitus (vs. screening positive on a risk test). CONCLUSIONS In a time of rapid dissemination of the National DPP LCI the findings of this evaluation can be used to enhance program implementation and translate lessons learned to similar organizations and settings.
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Affiliation(s)
- Kunthea Nhim
- Division of Diabetes Translation, Centers for Disease Control and Prevention, 4770 Buford Hwy. Mailstop S107-3, Atlanta, GA, 30341, USA.
| | - Stephanie M Gruss
- Division of Diabetes Translation, Centers for Disease Control and Prevention, 4770 Buford Hwy. Mailstop S107-3, Atlanta, GA, 30341, USA
| | - Deborah S Porterfield
- RTI International, RTP, NC, and the University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Sara Jacobs
- RTI International, P.O. Box 12194, 3040 E. Cornwallis Road, Rearch Triagle Park, NC 27709-2194, USA
| | - Wendi Elkins
- RTI International, P.O. Box 12194, 3040 E. Cornwallis Road, Rearch Triagle Park, NC 27709-2194, USA
| | - Elizabeth T Luman
- Division of Diabetes Translation, Centers for Disease Control and Prevention, 4770 Buford Hwy. Mailstop S107-3, Atlanta, GA, 30341, USA
| | - Susan Van Aacken
- Division of Diabetes Translation, Centers for Disease Control and Prevention, 4770 Buford Hwy. Mailstop S107-3, Atlanta, GA, 30341, USA
| | - Patricia Schumacher
- Division of Diabetes Translation, Centers for Disease Control and Prevention, 4770 Buford Hwy. Mailstop S107-3, Atlanta, GA, 30341, USA
| | - Ann Albright
- Division of Diabetes Translation, Centers for Disease Control and Prevention, 4770 Buford Hwy. Mailstop S107-3, Atlanta, GA, 30341, USA
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Abstract
PURPOSE OF REVIEW This article highlights foundational evidence, translation studies, and current research behind type 2 diabetes prevention efforts worldwide, with focus on high-risk populations, and whole-population approaches as catalysts to global prevention. RECENT FINDINGS Continued focus on the goals of foundational lifestyle change program trials and their global translations, and the targeting of those at highest risk through both in-person and virtual modes of program delivery, is critical. Whole-population approaches (e.g., socioeconomic policies, healthy food promotion, environmental/systems changes) and awareness raising are essential complements to efforts aimed at high-risk populations. Successful type 2 diabetes prevention strategies are being realized in the USA through the National Diabetes Prevention Program and elsewhere in the world. A multi-tiered approach involving appropriate risk targeting and whole-population efforts is essential to curb the global diabetes epidemic.
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Affiliation(s)
- Stephanie M. Gruss
- 0000 0001 2163 0069grid.416738.fDivision of Diabetes Translation, Centers for Disease Control and Prevention, 4770 Buford Hwy., Mailstop F75, Atlanta, GA 30341 USA
| | - Kunthea Nhim
- 0000 0001 2163 0069grid.416738.fDivision of Diabetes Translation, Centers for Disease Control and Prevention, 4770 Buford Hwy., Mailstop F75, Atlanta, GA 30341 USA
| | - Edward Gregg
- 0000 0001 2113 8111grid.7445.2Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Miriam Bell
- 0000 0001 2163 0069grid.416738.fDivision of Diabetes Translation, Centers for Disease Control and Prevention, 4770 Buford Hwy., Mailstop F75, Atlanta, GA 30341 USA
| | - Elizabeth Luman
- 0000 0001 2163 0069grid.416738.fDivision of Diabetes Translation, Centers for Disease Control and Prevention, 4770 Buford Hwy., Mailstop F75, Atlanta, GA 30341 USA
| | - Ann Albright
- 0000 0001 2163 0069grid.416738.fDivision of Diabetes Translation, Centers for Disease Control and Prevention, 4770 Buford Hwy., Mailstop F75, Atlanta, GA 30341 USA
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O'Reilly S, Versace V, Mohebbi M, Lim S, Janus E, Dunbar J. The effect of a diabetes prevention program on dietary quality in women with previous gestational diabetes. BMC Womens Health 2019; 19:88. [PMID: 31269928 PMCID: PMC6610772 DOI: 10.1186/s12905-019-0788-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 06/24/2019] [Indexed: 12/12/2022]
Abstract
Background Women with gestational diabetes have low diet quality. We evaluated the effectiveness of a group-based lifestyle modification program for improvement of dietary quality in women with previous gestational diabetes predominantly within their first postnatal year. Methods Women were randomised to intervention (n = 284) or usual care (n = 289). Dietary data was collected at baseline and twelve months using a food frequency questionnaire and recoded into the Australian Recommended Food Score (ARFS). Mixed model analyses investigated the intervention effect on ARFS (per-protocol-set (PPS) excluded women without the minimum intervention exposure). Results Baseline mean total ARFS was low (31.8 ± 8.9, maximum score = 74) and no significant changes were seen in total ARFS (Cohen’s D = − 0.06). 2% reduction in alcohol for intervention (0.05, 0.26) compared with − 1% for usual care (Odds ratio: 0.68; 95%CI 0.46, 0.99). Dairy ARFS sub-category significantly improved (low fat/saturated fat foods) in the intervention group over time compared with usual care for the PPS analysis (dairy + 0.28 in intervention (95%CI 0.08, 0.48) compared with + 0.02 in usual care (95%CI -0.14, 0.18) (group-by-treatment interaction p = 0.05, Cohen’s D = 0.14)). Conclusions Engaging with the intervention improved aspects of diet quality that aligned with minimum intervention exposure, but the total diet quality remains low. Further research is needed to improve diabetes prevention program engagement. Trial registration Australian New Zealand Clinical Trials Registry ANZCTRN12610000338066, April 2010.
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Affiliation(s)
- Sharleen O'Reilly
- UCD Institute of Food and Health, University College Dublin, Dublin, Ireland.
| | - Vincent Versace
- Deakin Rural Health, School of Medicine, Deakin University, Geelong, Australia
| | | | - Siew Lim
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Australia
| | - Edward Janus
- General Internal Medicine Unit, Western Health and Department of Medicine, Melbourne Medical School - Western Precinct, University of Melbourne, Melbourne, Australia
| | - James Dunbar
- Deakin Rural Health, School of Medicine, Deakin University, Geelong, Australia
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Gilbertson NM, Mandelson JA, Hilovsky K, Akers JD, Hargens TA, Wenos DL, Edwards ES. Combining supervised run interval training or moderate-intensity continuous training with the diabetes prevention program on clinical outcomes. Eur J Appl Physiol 2019; 119:1503-1512. [PMID: 30980133 DOI: 10.1007/s00421-019-04137-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 04/03/2019] [Indexed: 02/03/2023]
Abstract
PURPOSE The present study was designed to evaluate the 16 weeks diabetes prevention program (DPP) combined with instructed run sprint interval training (INT) or moderate-intensity continuous training (MICT) on glycemic control, body composition, fitness, exercise adherence, and perceived exercise enjoyment in sedentary, adults with prediabetes. METHODS Participants completed three weekly supervised sessions of INT (4-10 bouts of 30 s maximal sprints followed by a 4 min active recovery) or MICT (30-60 min at 45-55% HRR) exercise coupled with the DPP for 16 weeks. At baseline, 8 and 16 weeks, participants completed fitness and clinical assessments as well as questionnaires to assess group and time differences. RESULTS Twenty-nine study participants (INT n = 17, MICT n = 12) were randomized, however, significantly (p = 0.024) more participants withdrew from the INT (n = 11) than MICT (n = 4) treatment. There was no significant difference between groups in perceived exercise enjoyment, but, the MICT group significantly improved their perceived exercise enjoyment (10.8 ± 14.2; p = 0.021) from baseline to 16 weeks. Both INT and MICT groups decreased their body weight (2.0 ± 0.8 vs. - 5.5 ± 1.4 kg; p < 0.001), BMI (- 0.6 ± 0.3 vs. - 2.1 ± 0.5 kg/m2; p < 0.001), body fat mass (1.4 ± 0.6 vs. - 4.2 ± 1.0 kg; p < 0.001), fasting glucose (- 0.09 ± 0.01 vs. - 0.18 ± 0.02 mmol/L; p = 0.020), and HbA1c (- 0.21 ± 0.09 vs. - 0.12 ± 0.12%; p = 0.001), respectively, however, the MICT had greater reductions (GxT: p ≤ 0.05) in body weight, BMI, and body fat than the INT group. CONCLUSION Sixteen weeks of MICT is adhered to better and elicits greater improvements in body composition than INT. Nevertheless, both interventions similarly reduced fasting glucose and HbA1c in adults with prediabetes, suggesting either treatment could be effective for T2D prevention.
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Affiliation(s)
- Nicole M Gilbertson
- Department of Kinesiology, James Madison University, 261 Bluestone Drive MSC 2302, Harrisonburg, VA, 22807, USA
| | - Joan A Mandelson
- Department of Health Professions, James Madison University, Harrisonburg, VA, USA
| | - Kathryn Hilovsky
- Department of Kinesiology, James Madison University, 261 Bluestone Drive MSC 2302, Harrisonburg, VA, 22807, USA
| | - Jeremy D Akers
- Department of Health Professions, James Madison University, Harrisonburg, VA, USA
| | - Trent A Hargens
- Department of Kinesiology, James Madison University, 261 Bluestone Drive MSC 2302, Harrisonburg, VA, 22807, USA
| | - David L Wenos
- Department of Health Professions, James Madison University, Harrisonburg, VA, USA
| | - Elizabeth S Edwards
- Department of Kinesiology, James Madison University, 261 Bluestone Drive MSC 2302, Harrisonburg, VA, 22807, USA. .,Morrison Bruce Center, James Madison University, Harrisonburg, VA, USA.
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Sorkin DH, Rook KS, Campos B, Marquez B, Solares J, Mukamel DB, Marcus B, Kilgore D, Dow E, Ngo-Metzger Q, Nguyen DV, Biegler K. Rationale and study protocol for Unidas por la Vida (United for Life): A dyadic weight-loss intervention for high-risk Latina mothers and their adult daughters. Contemp Clin Trials 2018; 69:10-20. [PMID: 29597006 PMCID: PMC5964027 DOI: 10.1016/j.cct.2018.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 03/18/2018] [Accepted: 03/20/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Half of Mexican-American women are under-active and nearly 78% are overweight/obese. The high lifetime risk of developing type 2 diabetes necessitates a culturally appropriate lifestyle intervention. PURPOSE Unidas por la Vida is a novel dyadic intervention that capitalizes on the centrality of family in Latino culture to mobilize an existing family dyad as a resource for health behavior change. The intervention aims to improve health behaviors and promote weight loss in two at-risk members of the same family: mothers with type 2 diabetes and their overweight/obese adult daughters who are at risk for developing diabetes. METHODS Participants (N = 460 mother-adult daughter dyads) will be randomized into one of three conditions: 1) dyadic participation (mothers-daughters) in a lifestyle intervention; 2) individual participation (mothers alone; unrelated daughters alone) in a lifestyle intervention; and 3) mother-daughter dyads in a minimal intervention control group. RESULTS The primary outcome is weight loss. Secondary outcomes include physical activity, dietary intake, physiological measures (e.g. HbA1c), and body composition. Both the dyadic and individual interventions are expected to produce greater weight loss at 6, 12, and 18 months than those in minimal intervention control group, with women assigned to the dyadic intervention expected to lose more weight and to maintain the weight loss longer than women assigned to the individual intervention. CONCLUSION Because health risks are often shared by multiple members of at-risk families, culturally appropriate, dyadic interventions have the potential to increase the success of behavior change efforts and to extend their reach to multiple family members. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT02741037.
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Affiliation(s)
- Dara H Sorkin
- Department of Medicine, University of California, Irvine, Irvine, CA, USA.
| | - Karen S Rook
- Department of Psychology and Social Behavior, University of California Irvine, Irvine, CA, USA
| | - Belinda Campos
- Department of Chicano/Latino Studies, University of California Irvine, Irvine, CA, USA
| | - Becky Marquez
- School of Public Health, Brown University, Providence, RI, USA
| | | | - Dana B Mukamel
- Department of Medicine, University of California, Irvine, Irvine, CA, USA
| | - Bess Marcus
- School of Public Health, Brown University, Providence, RI, USA
| | - David Kilgore
- Department of Family Medicine, University of California Irvine, Irvine, CA, USA
| | - Emily Dow
- Department of Family Medicine, University of California Irvine, Irvine, CA, USA
| | - Quyen Ngo-Metzger
- Department of Medicine, University of California, Irvine, Irvine, CA, USA; US Preventive Services Task Force, Agency for Healthcare Research and Quality, Rockville, MD, USA
| | - Danh V Nguyen
- Department of Medicine, University of California, Irvine, Irvine, CA, USA; Biostatistics, Epidemiology and Research Design, University of California Irvine, Irvine, CA, USA
| | - Kelly Biegler
- Department of Medicine, University of California, Irvine, Irvine, CA, USA
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19
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Alzahrani S, Nelson J, Moss SF, Paulus JK, Knowler WC, Pittas AG. H. pylori seroprevalence and risk of diabetes: An ancillary case-control study nested in the diabetes prevention program. J Diabetes Complications 2017; 31:1515-1520. [PMID: 28739267 PMCID: PMC5603174 DOI: 10.1016/j.jdiacomp.2017.05.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 05/24/2017] [Accepted: 05/30/2017] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To determine the association between H. pylori infection and risk of incident diabetes in adults at high risk for diabetes who participated in the Diabetes Prevention Program (DPP) study. METHODS In a nested case-control study conducted among 421 adults with newly diagnosed diabetes and 421 matched controls, we examined the association between serological status of H. pylori at baseline and risk of incident diabetes over a mean follow-up period of 2.6years. Using data from the baseline visit of the DPP, we also examined the cross-sectional association between presence of H. pylori antibodies and insulin sensitivity, insulin secretion and the disposition index-like measure after a 75-g oral glucose tolerance test (OGTT). RESULTS At baseline, H. pylori antibodies were present in 40% of participants who developed diabetes and 39% of controls. After adjusting for matching factors, there was no association between exposure to H. pylori and incident diabetes (odds ratio [OR] of 1.04 (95% CI, 0.77 to 1.40). In cross-sectional analyses, H. pylori status was not significantly associated with insulin sensitivity and disposition index-like measure from OGTT. CONCLUSIONS In adults at high risk for diabetes, H. pylori seropositivity was not associated with risk of developing diabetes.
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Affiliation(s)
- Saud Alzahrani
- Division of Endocrinology, Diabetes and Metabolism, Tufts Medical Center, Boston, MA; Department of Medicine, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.
| | - Jason Nelson
- Predictive Analytics and Comparative Effectiveness (PACE) Center, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
| | - Steven F Moss
- Division of Gastroenterology, Brown University, Providence, RI
| | - Jessica K Paulus
- Predictive Analytics and Comparative Effectiveness (PACE) Center, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
| | - William C Knowler
- National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ
| | - Anastassios G Pittas
- Division of Endocrinology, Diabetes and Metabolism, Tufts Medical Center, Boston, MA; Department of Medicine, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
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Abstract
PURPOSE OF REVIEW Multi-sector partnerships are broadly considered to be of value for diabetes prevention and management. The purpose of this article is to summarize academic and government collaborations focused on diabetes prevention and management. RECENT FINDINGS Using a narrative review approach, we identified 17 articles describing 10 academic and government partnerships for diabetes management and surveillance. Challenges and gaps in the literature include complexity of diabetes management vis a vis current healthcare infrastructure; a paucity of racial/ethnic diversity in translational efforts; and the time/effort needed to maintain strong relationships across partner institutions. Academic and government partnerships are of value for diabetes prevention and management activities. Acknowledgment that the key priorities of government programming are often costs and feasibility is critical for collaborations to be successful. Future translational efforts of diabetes prevention and management programs should focus on the following: (1) expansion of partnerships between academia and local health departments; (2) increased utilization of implementation science for enhanced and efficient implementation and dissemination; and (3) harnessing of technological advances for data analysis, patient communication, and report generation.
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Affiliation(s)
- Stella S Yi
- Department of Population Health, NYU School of Medicine, 550 First Ave VZN Suite 844, 8th floor, New York, NY, 10016, USA.
| | - Shadi Chamany
- New York City Department of Health and Mental Hygiene, Division of Primary Care and Prevention, New York, NY, USA
| | - Lorna Thorpe
- Department of Population Health, NYU School of Medicine, 550 First Ave VZN Suite 844, 8th floor, New York, NY, 10016, USA
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Rollo ME, Aguiar EJ, Pursey KM, Morgan PJ, Plotnikoff RC, Young MD, Collins CE, Callister R. Impact on dietary intake of a self-directed, gender-tailored diabetes prevention program in men. World J Diabetes 2017; 8:414-421. [PMID: 28861179 PMCID: PMC5561041 DOI: 10.4239/wjd.v8.i8.414] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 02/16/2017] [Accepted: 03/24/2017] [Indexed: 02/05/2023] Open
Abstract
AIM To investigate changes in dietary intake following a 6-mo randomised controlled trial of the self-directed, gender-tailored type 2 diabetes mellitus (T2DM) Prevention Using LifeStyle Education (PULSE) program in men.
METHODS Men aged 18-65 years, with a body mass index (BMI) 25-40 kg/m2, and at high risk for developing T2DM were recruited from the Hunter Region of New South Wales, Australia. Eligible participants were randomised into one of two groups: (1) waitlist control; or (2) PULSE intervention. Dietary intake was assessed at baseline and immediately post-program using the Australian Eating Survey food frequency questionnaire and diet quality measured using the Australian Recommended Food Score (ARFS).
RESULTS One hundred and one participants (n = 48, control; n = 53, intervention, mean age 52.3 ± 9.7 years, BMI of 32.6 ± 3.3 kg/m2) commenced the study. Following the active phase, differences between groups were observed for proportion of total energy consumed from healthful (core) foods (+7.6%EI, P < 0.001), energy-dense, nutrient-poor foods (-7.6%EI, P < 0.001), sodium (-369 mg, P = 0.047), and diet quality (ARFS) (+4.3, P = 0.004), including sub-scales for fruit (+1.1, P = 0.03), meat (+0.9, P = 0.004) and non-meat protein (+0.5, P = 0.03).
CONCLUSION The PULSE prevention program’s nutrition messages led to significant improvements in dietary intake in men at risk of T2DM.
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Zhang C, Zhang R. More effective glycaemic control by metformin in African Americans than in Whites in the prediabetic population. Diabetes Metab 2015; 41:173-5. [PMID: 25659998 DOI: 10.1016/j.diabet.2015.01.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Revised: 01/07/2015] [Accepted: 01/13/2015] [Indexed: 11/29/2022]
Abstract
AIM Metformin, a first-line diabetes drug, delays the onset of type 2 diabetes in the prediabetic population; however, in prediabetic patients, differences in glycaemic response to metformin among racial groups are unknown. We aimed to compare glucose-lowering effects of metformin between Whites and African Americans (AAs). METHODS We performed a secondary analysis using data from the diabetes prevention program, a multi-center randomized clinical trial, in which all participants were prediabetic. The metformin group (582 Whites and 210 AAs) received 850 mg of metformin twice daily, and was followed for 3 years. RESULTS We found that after 6 months on metformin, Whites had a drop of 3.89 ± 0.39 (mg/dL, mean ± SEM) in the fasting plasma glucose level, significantly less than that in African Americans (6.04 ± 0.72, P=0.006); at years 1 and 2, the differences were also significant. Consistently, the linear mixed model showed that, within 1 year of metformin treatment, the rate in reduction of glucose levels was more pronounced in AAs than in Whites (P=0.025 following adjustment for age and sex). CONCLUSIONS Therefore, AAs have a better glycaemic response to metformin treatment than Whites in the prediabetic population.
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Affiliation(s)
- C Zhang
- Division of Geriatric and Palliative Medicine, School of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - R Zhang
- Center for Molecular Medicine and Genetics, and the Cardiovascular Research Institute, School of Medicine, Wayne State University, Detroit, MI, USA.
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Abstract
International clinical trials have demonstrated compelling evidence on the prevention or delay of type 2 diabetes (T2D) by lifestyle change programs. Numerous studies have translated the Diabetes Prevention Program (DPP) protocol to "real-world" settings. The purpose of this paper is to review the translational research of the DPP protocol in adults at-risk for T2D. This study is a systematic review based on the guidelines from the Cochrane Handbook for Systematic Reviews. There were 16 studies that translated the DPP protocol in four distinct settings: (a) hospital outpatient, (b) primary care, (c) community, and (d) work and church. Settings varied considerably in terms of reach, efficacy, adoption, implementation, and maintenance. There were strengths and limitations to each setting. Better understanding of program adaptation and mediators and moderators to program efficacy are indicated. Future research also needs to continue to explore mechanisms to improve access and long-term outcomes.
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Affiliation(s)
- Robin Whittemore
- Yale School of Nursing, 100 Church Street South, New Haven, CT 06536 USA
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