How effective were lifestyle interventions in real-world settings that were modeled on the Diabetes Prevention Program?

Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
Health Affairs (Impact Factor: 4.64). 01/2012; 31(1):67-75. DOI: 10.1377/hlthaff.2011.1009
Source: PubMed

ABSTRACT We conducted a systematic review and meta-analysis of twenty-eight US-based studies applying the findings of the Diabetes Prevention Program, a clinical trial that tested the effects of a lifestyle intervention for people at high risk for diabetes, in real-world settings. The average weight change at twelve months after the intervention was a loss of about 4 percent from participants' baseline weight. Change in weight was similar regardless of whether the intervention was delivered by clinically trained professionals or lay educators. Additional analyses limited to seventeen studies with a nine-month or greater follow-up assessment showed similar weight change. With every additional lifestyle session attended, weight loss increased by 0.26 percentage point. We conclude that costs associated with diabetes prevention can be lowered without sacrificing effectiveness, using nonmedical personnel and motivating higher attendance at program sessions.

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    ABSTRACT: Since 2007, the Australian Know your numbers (KYN) program has been used in community settings to raise awareness about blood pressure and stroke. In 2011, the program was modified to include assessment for type 2 diabetes risk. However, it is unclear which approach for assessing diabetes risk in pharmacies is best. We compared two methods: random(non-fasting) blood glucose testing (RBGT); and the Australian type 2 diabetes risk assessment tool (AUSDRISK); according to 1) identification of 'high risk' participants including head-to-head sensitivity and specificity; 2) number of referrals to doctors; 3) feasibility of implementation. 117 Queensland pharmacies voluntarily participated and were randomly allocated to RBGT and AUSDRISK or AUSDRISK only. Although discouraged, pharmacies were able to change allocated group prior to commencement. AUSDRISK is a validated self-administered questionnaire used to calculate a score that determines the 5-year risk of developing type 2 diabetes. AUSDRISK (score 12+) or RBGT (>=5.6 mmol/I) indicates a high potential risk of diabetes. Median linear regression was used to compare the two measures. Staff from 68 pharmacies also participated in a semi-structured interview during a site visit to provide feedback. Data were submitted for 5,483 KYN participants (60% female, 66% aged >55 years, 10% history of diabetes). Approximately half of the participants without existing diabetes were identified as 'high risk' based on either RBGT or AUSDRISK score. Among participants who undertook both measures, 32% recorded a high RBGT and high AUSDRISK. There was a significant association between RBGT and AUSDRISK scores. For every one point increase in AUSDRISK score there was a half point increase in RBGT levels (coefficient 0.55, 95% CI: 0.28, 0.83). Pharmacy staff reported that AUSDRISK was a simple, low cost and efficient method of assessing diabetes risk compared with RBGT, e.g. where management of sharps is not an issue. In a large, community-based sample of Australians about half of the participants without diabetes were at 'high risk 'of developing diabetes based on either AUSDRISK or RBGT results. AUSDRISK was considered to be an acceptable method for assessing the risk of diabetes using opportunistic health checks in community pharmacies.
    BMC Public Health 11/2014; 14(1):1227. · 2.32 Impact Factor
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    ABSTRACT: Aims and objectives. To explore the effectiveness and acceptability of a nurse-led Māori diabetes programme run by Te Hauora O Ngāti Rārua for their clients. Background. Nurses have a key role in diabetes management, but little is known about nurse-led services for indigenous populations. The Te Hauora O Ngāti Rārua programme consisted of an education course, case management and support services. Design and methods. An embedded case study evaluation was used. Data sources included: i) documentation, ii) interviews with clients (n=7) and health practitioners (n=5), iii) pre and post-course physiological, knowledge and lifestyle behaviour client data, and iv) researcher observation. Results were triangulated and organised using the Wagner Chronic Care Model. Results. The programme successfully addressed all elements of the Chronic Care Model. It was culturally appropriate, supportive and beneficial to the clients in meeting their health objectives. Staff demonstrated high levels of goodwill and commitment to clients and the organisation. Relaxed interpersonal relationships, especially the use of humour encouraged clients to remain engaged with the service and to make lifestyle changes. A high prevalence of co-morbidities impacted on clients’ ability to self-manage their diabetes. Four clients had short term improvements in health outcomes, but were unable to maintain these when programme support reduced. All clients gained new knowledge and awareness related to diabetes and how to make personal changes. Conclusions. This study confirms the importance of providing ‘culturally appropriate’ health services delivered by specialist Māori nurses. Targeted diabetes programmes need to recognise the complexity of clients’ day-to-day lives and co-morbidities as part of increasing client self-management. Clients need both short and long term professional and peer-group support to make and sustain changes. Relevance to clinical practice. The findings can be used by nurses to assist people with diabetes to make sustainable changes to improve their health outcomes.
    Nursing praxis in New Zealand inc 11/2014; 30(3):6-18.
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    ABSTRACT: Twenty-six million U.S. adults have diabetes, and 79 million have prediabetes. A 2002 Diabetes Prevention Program research study proved the effectiveness of a lifestyle intervention that yielded a 58% reduction in conversion to type 2 diabetes. However, cost per participant was high, complicating efforts to scale up the program.PurposeUnitedHealth Group (UHG) and the YMCA of the USA, in collaboration with the CDC, sought to develop the infrastructure and business case to scale the congressionally authorized National Diabetes Prevention Program nationwide. Emphasis was placed on developing a model that maintained fidelity to the original 2002 Diabetes Prevention Program research study and could be deployed for a lower cost per participant while yielding similar outcomes.DesignThe UHG created the business case and technical and operational infrastructure necessary for nationwide dissemination of the YMCA's Diabetes Prevention Program (YMCA's DPP), as part of the National Diabetes Prevention Program. The YMCA's DPP is a group-based model of 16 core sessions with monthly follow-up delivered by trained lifestyle coaches.Setting/participantsA variety of mechanisms were used to identify, screen, and encourage enrollment for people with prediabetes into the YMCA's DPP.InterventionSubstantial investments were made in relationship building, business planning, technology, development, and operational design to deliver an effective and affordable 12-month program. The program intervention was conducted July 2010–December 2011. Data were collected on the participants over a 15-month period between September 2010 and December 2011. Data were analyzed in February 2012.Main outcome measuresThe main outcome measures were infrastructure (communities involved and personnel trained); engagement (screening and enrollment of people with prediabetes); program outcomes (attendance and weight loss); and service delivery cost of the intervention.ResultsIn less than 2 years, the YMCA's DPP was effectively scaled to 46 communities in 23 states. More than 500 YMCA Lifestyle Coaches were trained. The program enrolled 2369 participants, and 1723 participants completed the core program at an average service-delivery cost of about $400 each. For those individuals completing the program, average weight loss was about 5%. UHG anticipates that within 3 years, savings from reduced medical spending will outweigh initial costs.Conclusions Large-scale prevention efforts can be scalable and sustainable with collaboration, health information technology, community-based delivery of evidence-based interventions, and novel payment structures that incentivize efficiency and outcomes linked to better health and lower future costs.
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