BACKGROUND: The Diabetes Prevention Program (DPP) lifestyle intervention reduced the incidence of type 2 diabetes mellitus (DM) among high-risk adults by 58%, with weight loss as the dominant predictor. However, it has not been adequately translated into primary care. METHODS: We evaluated 2 adapted DPP lifestyle interventions among overweight or obese adults who were recruited from 1 primary care clinic and had pre-DM and/or metabolic syndrome. Participants were randomized to (1) a coach-led group intervention (n = 79), (2) a self-directed DVD intervention (n = 81), or (3) usual care (n = 81). During a 3-month intensive intervention phase, the DPP-based behavioral weight-loss curriculum was delivered by lifestyle coach-led small groups or home-based DVD. During the maintenance phase, participants in both interventions received lifestyle change coaching and support remotely-through secure email within an electronic health record system and the American Heart Association Heart360 website for weight and physical activity goal setting and self-monitoring. The primary outcome was change in body mass index (BMI) (calculated as weight in kilograms divided by height in meters squared) from baseline to 15 months. RESULTS: At baseline, participants had a mean (SD) age of 52.9 (10.6) years and a mean BMI of 32.0 (5.4); 47% were female; 78%, non-Hispanic white; and 17%, Asian/Pacific Islander. At month 15, the mean ± SE change in BMI from baseline was -2.2 ± 0.3 in the coach-led group vs -0.9 ± 0.3 in the usual care group (P < .001) and -1.6 ± 0.3 in the self-directed group vs usual care (P = .02). The percentages of participants who achieved the 7% DPP-based weight-loss goal were 37.0% (P = .003) and 35.9% (P = .004) in the coach-led and self-directed groups, respectively, vs 14.4% in the usual care group. Both interventions also achieved greater net improvements in waist circumference and fasting plasma glucose level. CONCLUSION: Proven effective in a primary care setting, the 2 DPP-based lifestyle interventions are readily scalable and exportable with potential for substantial clinical and public health impact. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00842426.
RCT Entities:
BACKGROUND: The Diabetes Prevention Program (DPP) lifestyle intervention reduced the incidence of type 2 diabetes mellitus (DM) among high-risk adults by 58%, with weight loss as the dominant predictor. However, it has not been adequately translated into primary care. METHODS: We evaluated 2 adapted DPP lifestyle interventions among overweight or obese adults who were recruited from 1 primary care clinic and had pre-DM and/or metabolic syndrome. Participants were randomized to (1) a coach-led group intervention (n = 79), (2) a self-directed DVD intervention (n = 81), or (3) usual care (n = 81). During a 3-month intensive intervention phase, the DPP-based behavioral weight-loss curriculum was delivered by lifestyle coach-led small groups or home-based DVD. During the maintenance phase, participants in both interventions received lifestyle change coaching and support remotely-through secure email within an electronic health record system and the American Heart Association Heart360 website for weight and physical activity goal setting and self-monitoring. The primary outcome was change in body mass index (BMI) (calculated as weight in kilograms divided by height in meters squared) from baseline to 15 months. RESULTS: At baseline, participants had a mean (SD) age of 52.9 (10.6) years and a mean BMI of 32.0 (5.4); 47% were female; 78%, non-Hispanic white; and 17%, Asian/Pacific Islander. At month 15, the mean ± SE change in BMI from baseline was -2.2 ± 0.3 in the coach-led group vs -0.9 ± 0.3 in the usual care group (P < .001) and -1.6 ± 0.3 in the self-directed group vs usual care (P = .02). The percentages of participants who achieved the 7% DPP-based weight-loss goal were 37.0% (P = .003) and 35.9% (P = .004) in the coach-led and self-directed groups, respectively, vs 14.4% in the usual care group. Both interventions also achieved greater net improvements in waist circumference and fasting plasma glucose level. CONCLUSION: Proven effective in a primary care setting, the 2 DPP-based lifestyle interventions are readily scalable and exportable with potential for substantial clinical and public health impact. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00842426.
Authors: Lawrence J Appel; Jeanne M Clark; Hsin-Chieh Yeh; Nae-Yuh Wang; Janelle W Coughlin; Gail Daumit; Edgar R Miller; Arlene Dalcin; Gerald J Jerome; Steven Geller; Gary Noronha; Thomas Pozefsky; Jeanne Charleston; Jeffrey B Reynolds; Nowella Durkin; Richard R Rubin; Thomas A Louis; Frederick L Brancati Journal: N Engl J Med Date: 2011-11-15 Impact factor: 91.245
Authors: X R Pan; G W Li; Y H Hu; J X Wang; W Y Yang; Z X An; Z X Hu; J Lin; J Z Xiao; H B Cao; P A Liu; X G Jiang; Y Y Jiang; J P Wang; H Zheng; H Zhang; P H Bennett; B V Howard Journal: Diabetes Care Date: 1997-04 Impact factor: 19.112
Authors: J Tuomilehto; J Lindström; J G Eriksson; T T Valle; H Hämäläinen; P Ilanne-Parikka; S Keinänen-Kiukaanniemi; M Laakso; A Louheranta; M Rastas; V Salminen; M Uusitupa Journal: N Engl J Med Date: 2001-05-03 Impact factor: 91.245
Authors: William C Knowler; Elizabeth Barrett-Connor; Sarah E Fowler; Richard F Hamman; John M Lachin; Elizabeth A Walker; David M Nathan Journal: N Engl J Med Date: 2002-02-07 Impact factor: 91.245
Authors: Anna Peeters; Jan J Barendregt; Frans Willekens; Johan P Mackenbach; Abdullah Al Mamun; Luc Bonneux Journal: Ann Intern Med Date: 2003-01-07 Impact factor: 25.391
Authors: Dina Hafez; Allison Fedewa; Margaret Moran; Matthew O'Brien; Ronald Ackermann; Jeffrey T Kullgren Journal: Curr Diab Rep Date: 2017-02 Impact factor: 4.810
Authors: Meghan C Halley; John Petersen; Catherine Nasrallah; Nina Szwerinski; Robert Romanelli; Kristen M J Azar Journal: J Gen Intern Med Date: 2020-04-06 Impact factor: 5.128
Authors: Lisa G Rosas; Kristen M J Azar; Nan Lv; Lan Xiao; Jeremy D Goldhaber-Fiebert; Mark B Snowden; Elizabeth M Venditti; Megan M Lewis; Andrea N Goldstein-Piekarski; Jun Ma Journal: Am J Prev Med Date: 2020-02-14 Impact factor: 5.043
Authors: Jun Ma; Peg Strub; Lan Xiao; Philip W Lavori; Carlos A Camargo; Sandra R Wilson; Christopher D Gardner; A Sonia Buist; William L Haskell; Nan Lv Journal: Ann Am Thorac Soc Date: 2015-01
Authors: Leslea Peirson; James Douketis; Donna Ciliska; Donna Fitzpatrick-Lewis; Muhammad Usman Ali; Parminder Raina Journal: CMAJ Open Date: 2014-10-01