Natalie D Ritchie1,2, Peter G Kaufmann3, R Mark Gritz4, Katherine A Sauder5, Jodi Summers Holtrop6. 1. 1 Ambulatory Care Services, Denver Health and Hospital Authority, Denver, CO, USA. 2. 2 Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA. 3. 3 College of Nursing, University of Colorado, Aurora, CO, USA. 4. 4 Division of Health Care Policy and Research, University of Colorado School of Medicine, Aurora, CO, USA. 5. 5 Department of Pediatrics-Nutrition, University of Colorado School of Medicine, Aurora, CO, USA. 6. 6 Department of Family Medicine and Adult and Child Consortium for Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO, USA.
Abstract
PURPOSE: The National Diabetes Prevention Program (NDPP) is a widely disseminated lifestyle intervention. Attendance is problematic, leading to suboptimal weight loss, especially among racial/ethnic minority participants. We conducted a novel "presession" protocol to improve engagement of diverse NDPP candidates, comparing NDPP participants who attended a presession to those who did not on attendance and weight loss outcomes. DESIGN: Longitudinal cohort study. SETTING: A safety net health-care system. PARTICIPANTS: A total of 1140 patients with diabetes risks (58.9% Hispanic, 19.8% non-Hispanic black, 61.8% low income). INTERVENTION: The NDPP has been delivered in a Denver, Colorado health-care system since 2013. The program included 22 to 25 sessions over 1 year. Beginning September 2016, individuals were required to attend a presession before enrollment that focused on (1) increasing risk awareness, (2) motivational interviewing to participate in the NDPP, and (3) problem-solving around engagement barriers. MEASURES: Duration and intensity of NDPP attendance and weight loss. ANALYSIS: Outcomes of 75 presession participants who enrolled in the NDPP were compared to 1065 prior participants using analysis of covariance and multivariable logistic regression. RESULTS: Presession participants stayed in the NDPP 99.8 days longer ( P < .001) and attended 14.3% more sessions ( P < .001) on average than those without a presession. Presession participants lost 2.0% more weight ( P < .001) and were 3.5 times more likely to achieve the 5% weight loss target ( P < .001). CONCLUSION: Presessions may improve NDPP outcomes for individuals from diverse backgrounds. A full-scale trial is needed to determine whether presessions reliably improve NDPP effectiveness.
PURPOSE: The National Diabetes Prevention Program (NDPP) is a widely disseminated lifestyle intervention. Attendance is problematic, leading to suboptimal weight loss, especially among racial/ethnic minority participants. We conducted a novel "presession" protocol to improve engagement of diverse NDPP candidates, comparing NDPPparticipants who attended a presession to those who did not on attendance and weight loss outcomes. DESIGN: Longitudinal cohort study. SETTING: A safety net health-care system. PARTICIPANTS: A total of 1140 patients with diabetes risks (58.9% Hispanic, 19.8% non-Hispanic black, 61.8% low income). INTERVENTION: The NDPP has been delivered in a Denver, Colorado health-care system since 2013. The program included 22 to 25 sessions over 1 year. Beginning September 2016, individuals were required to attend a presession before enrollment that focused on (1) increasing risk awareness, (2) motivational interviewing to participate in the NDPP, and (3) problem-solving around engagement barriers. MEASURES: Duration and intensity of NDPP attendance and weight loss. ANALYSIS: Outcomes of 75 presession participants who enrolled in the NDPP were compared to 1065 prior participants using analysis of covariance and multivariable logistic regression. RESULTS: Presession participants stayed in the NDPP 99.8 days longer ( P < .001) and attended 14.3% more sessions ( P < .001) on average than those without a presession. Presession participants lost 2.0% more weight ( P < .001) and were 3.5 times more likely to achieve the 5% weight loss target ( P < .001). CONCLUSION: Presessions may improve NDPP outcomes for individuals from diverse backgrounds. A full-scale trial is needed to determine whether presessions reliably improve NDPP effectiveness.
Entities:
Keywords:
disparities; prevention; retention; type 2 diabetes; weight loss
Authors: Danielle E Jake-Schoffman; Susan D Brown; Michael Baiocchi; Jessica L Bibeau; Jennifer Daubenmier; Assiamira Ferrara; Maren N Galarce; Wendy Hartogensis; Frederick M Hecht; Monique M Hedderson; Patricia J Moran; Sherry L Pagoto; Ai-Lin Tsai; Molly E Waring; Michaela Kiernan Journal: Am J Prev Med Date: 2021-10 Impact factor: 6.604