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Healthy Living Partnerships to
Prevent Diabetes: A Community
Translation of the Diabetes
Prevention Program.
David C. Goff, Jr., MD, PhD
Dean and Professor
Colorado School of Public Health
Credits and Disclosures
Co-Investigators: Jeffrey Katula, Jorge Calles, Mark Espeland, Michael Lawlor, Tim Morgan, Carolyn Pedley, Mara Vitolins
Staff: Caroline Blackwell, Kara Foster, Scott Isom, Alexander Lucas, Eileen Searson, Wesley Roberson, Erica Rosenberger, Terry Tembreull.
Wake Forest University & Wake Forest University School of Medicine
NIDDK R18 DK069901
Goff CME presentation at a symposium in Sweden funded by Merck
DSMB member for trial funded by Takeda
Objectives
Review the evidence base regarding
diabetes prevention
Present the HELP PD study as an example
of implementation research moving into
dissemination research
Save time for discussion of D&I research
and DIRH study section
Diabetes: The American Population
Prevalence of diagnosed and undiagnosed diabetes in the United States, all ages, 2007
Total: 23.6 million people or 7.8% of the population have diabetes.
Diagnosed: 17.9 million people
Undiagnosed: 5.7 million people
2007 National Diabetes Fact Sheet.
http://www.cdc.gov/diabetes/pubs/estimates07.htm#1
Consequences of Diabetes Damage to nerves and blood vessels, which
leads to:
heart disease heart attacks
chronic heart failure
stroke
blindness
kidney disease, including dialysis
nerve problems
amputation
gum infections
What is Pre-Diabetes?
Blood glucose levels higher than normal but not high enough to be diagnosed as diabetes
Fasting plasma glucose between 100-125 mg/dL
High risk for type 2 diabetes within 10 years (~10% per year).
~57 million people in the US
http://www.diabetes.org/diabetes-basics/prevention/pre-diabetes/
CDC’s Division of Diabetes Translation. National Diabetes Surveillance System
available at http://www.cdc.gov/diabetes/statistics
Obesity (BMI≥30) Diabetes
<4.5% Missing data
4.5 - 5.9% 6.0 - 7.4%
7.5 - 8.9% ≥9.0% 18.0 -21.9%
<14.0% Missing Data
14.0 - 17.9%
22.0 - 25.9% ≥26.0%
Age-adjusted Percentage of U.S. Adults Who Were Obese or
Who Had Diagnosed Diabetes
1994
CDC’s Division of Diabetes Translation. National Diabetes Surveillance System
available at http://www.cdc.gov/diabetes/statistics
Obesity (BMI≥30) Diabetes
<4.5% Missing data
4.5 - 5.9% 6.0 - 7.4%
7.5 - 8.9% ≥9.0% 18.0 -21.9%
<14.0% Missing Data
14.0 - 17.9%
22.0 - 25.9% ≥26.0%
Age-adjusted Percentage of U.S. Adults Who Were Obese or
Who Had Diagnosed Diabetes
1995
CDC’s Division of Diabetes Translation. National Diabetes Surveillance System
available at http://www.cdc.gov/diabetes/statistics
Obesity (BMI≥30) Diabetes
<4.5% Missing data
4.5 - 5.9% 6.0 - 7.4%
7.5 - 8.9% ≥9.0% 18.0 -21.9%
<14.0% Missing Data
14.0 - 17.9%
22.0 - 25.9% ≥26.0%
Age-adjusted Percentage of U.S. Adults Who Were Obese or
Who Had Diagnosed Diabetes
1996
CDC’s Division of Diabetes Translation. National Diabetes Surveillance System
available at http://www.cdc.gov/diabetes/statistics
Obesity (BMI≥30) Diabetes
<4.5% Missing data
4.5 - 5.9% 6.0 - 7.4%
7.5 - 8.9% ≥9.0% 18.0 -21.9%
<14.0% Missing Data
14.0 - 17.9%
22.0 - 25.9% ≥26.0%
Age-adjusted Percentage of U.S. Adults Who Were Obese or
Who Had Diagnosed Diabetes
1997
CDC’s Division of Diabetes Translation. National Diabetes Surveillance System
available at http://www.cdc.gov/diabetes/statistics
Obesity (BMI≥30) Diabetes
<4.5% Missing data
4.5 - 5.9% 6.0 - 7.4%
7.5 - 8.9% ≥9.0% 18.0 -21.9%
<14.0% Missing Data
14.0 - 17.9%
22.0 - 25.9% ≥26.0%
Age-adjusted Percentage of U.S. Adults Who Were Obese or
Who Had Diagnosed Diabetes
1998
CDC’s Division of Diabetes Translation. National Diabetes Surveillance System
available at http://www.cdc.gov/diabetes/statistics
Obesity (BMI≥30) Diabetes
<4.5% Missing data
4.5 - 5.9% 6.0 - 7.4%
7.5 - 8.9% ≥9.0% 18.0 -21.9%
<14.0% Missing Data
14.0 - 17.9%
22.0 - 25.9% ≥26.0%
Age-adjusted Percentage of U.S. Adults Who Were Obese or
Who Had Diagnosed Diabetes
1999
CDC’s Division of Diabetes Translation. National Diabetes Surveillance System
available at http://www.cdc.gov/diabetes/statistics
Obesity (BMI≥30) Diabetes
<4.5% Missing data
4.5 - 5.9% 6.0 - 7.4%
7.5 - 8.9% ≥9.0% 18.0 -21.9%
<14.0% Missing Data
14.0 - 17.9%
22.0 - 25.9% ≥26.0%
Age-adjusted Percentage of U.S. Adults Who Were Obese or
Who Had Diagnosed Diabetes
2000
CDC’s Division of Diabetes Translation. National Diabetes Surveillance System
available at http://www.cdc.gov/diabetes/statistics
Obesity (BMI≥30) Diabetes
<4.5% Missing data
4.5 - 5.9% 6.0 - 7.4%
7.5 - 8.9% ≥9.0% 18.0 -21.9%
<14.0% Missing Data
14.0 - 17.9%
22.0 - 25.9% ≥26.0%
Age-adjusted Percentage of U.S. Adults Who Were Obese or
Who Had Diagnosed Diabetes
2001
CDC’s Division of Diabetes Translation. National Diabetes Surveillance System
available at http://www.cdc.gov/diabetes/statistics
Obesity (BMI≥30) Diabetes
<4.5% Missing data
4.5 - 5.9% 6.0 - 7.4%
7.5 - 8.9% ≥9.0% 18.0 -21.9%
<14.0% Missing Data
14.0 - 17.9%
22.0 - 25.9% ≥26.0%
Age-adjusted Percentage of U.S. Adults Who Were Obese or
Who Had Diagnosed Diabetes
2002
CDC’s Division of Diabetes Translation. National Diabetes Surveillance System
available at http://www.cdc.gov/diabetes/statistics
Obesity (BMI≥30) Diabetes
<4.5% Missing data
4.5 - 5.9% 6.0 - 7.4%
7.5 - 8.9% ≥9.0% 18.0 -21.9%
<14.0% Missing Data
14.0 - 17.9%
22.0 - 25.9% ≥26.0%
Age-adjusted Percentage of U.S. Adults Who Were Obese or
Who Had Diagnosed Diabetes
2003
CDC’s Division of Diabetes Translation. National Diabetes Surveillance System
available at http://www.cdc.gov/diabetes/statistics
Obesity (BMI≥30) Diabetes
<4.5% Missing data
4.5 - 5.9% 6.0 - 7.4%
7.5 - 8.9% ≥9.0% 18.0 -21.9%
<14.0% Missing Data
14.0 - 17.9%
22.0 - 25.9% ≥26.0%
Age-adjusted Percentage of U.S. Adults Who Were Obese or
Who Had Diagnosed Diabetes
2004
CDC’s Division of Diabetes Translation. National Diabetes Surveillance System
available at http://www.cdc.gov/diabetes/statistics
Obesity (BMI≥30) Diabetes
<4.5% Missing data
4.5 - 5.9% 6.0 - 7.4%
7.5 - 8.9% ≥9.0% 18.0 -21.9%
<14.0% Missing Data
14.0 - 17.9%
22.0 - 25.9% ≥26.0%
Age-adjusted Percentage of U.S. Adults Who Were Obese or
Who Had Diagnosed Diabetes
2005
CDC’s Division of Diabetes Translation. National Diabetes Surveillance System
available at http://www.cdc.gov/diabetes/statistics
Obesity (BMI≥30) Diabetes
<4.5% Missing data
4.5 - 5.9% 6.0 - 7.4%
7.5 - 8.9% ≥9.0% 18.0 -21.9%
<14.0% Missing Data
14.0 - 17.9%
22.0 - 25.9% ≥26.0%
Age-adjusted Percentage of U.S. Adults Who Were Obese or
Who Had Diagnosed Diabetes
2006
CDC’s Division of Diabetes Translation. National Diabetes Surveillance System
available at http://www.cdc.gov/diabetes/statistics
Obesity (BMI≥30) Diabetes
<4.5% Missing data
4.5 - 5.9% 6.0 - 7.4%
7.5 - 8.9% ≥9.0% 18.0 -21.9%
<14.0% Missing Data
14.0 - 17.9%
22.0 - 25.9% ≥26.0%
Age-adjusted Percentage of U.S. Adults Who Were Obese or
Who Had Diagnosed Diabetes
2007
CDC’s Division of Diabetes Translation. National Diabetes Surveillance System
available at http://www.cdc.gov/diabetes/statistics
Obesity (BMI≥30) Diabetes
<4.5% Missing data
4.5 - 5.9% 6.0 - 7.4%
7.5 - 8.9% ≥9.0% 18.0 -21.9%
<14.0% Missing Data
14.0 - 17.9%
22.0 - 25.9% ≥26.0%
Age-adjusted Percentage of U.S. Adults Who Were Obese or
Who Had Diagnosed Diabetes
2008
CDC’s Division of Diabetes Translation. National Diabetes Surveillance System
available at http://www.cdc.gov/diabetes/statistics
Obesity (BMI≥30 kg/m2) Diabetes
<4.5% Missing data
4.5 - 5.9% 6.0 - 7.4%
7.5 - 8.9% ≥9.0% 18.0 -21.9%
<14.0% Missing Data
14.0 - 17.9%
22.0 - 25.9% ≥26.0%
Age-adjusted Percentage of U.S. Adults Who Were Obese or
Who Had Diagnosed Diabetes
2009
Diabetes Prevention
Current research shows that these lifestyle
changes can help prevent or delay
diabetes:
• Physical activity (30 minutes a day,
at least 5 days per week)
• Nutrition (low fat, low calorie)
• PA + healthy diet = weight loss
Evidence Base on Diabetes
Prevention for HELP PD
Finnish Diabetes Prevention Study
Diabetes Prevention Program
Finnish Diabetes Prevention Study
522 overweight people with IGT
Interventions Diet and exercise (reduce weight 5%)
○ Low fat (< 30%kcal)
○ High fiber diet (>/= 15 g/ 1000 kcal)
○ 30 minutes moderate physical activity/day
Usual Care ○ Brochure
Tuomilehto J, et al. NEJM 2001;344:1343-1350.
Finnish Diabetes Prevention Study
Diet and exercise Nutritionist
○ 7 sessions in first year
○ Quarterly thereafter
Individual guidance on activity: walking, jogging, swimming, skiing, etc.
Supervised, progressive, individually tailored, circuit type resistance training ○ (50-85% across clinics)
Tuomilehto J, et al. NEJM 2001;344:1343-1350.
Finnish Diabetes Prevention Study: Success in
Achieving the Goals of the Intervention by One
Year.
Goal Intervention Group (%)
Control Group (%)
P value
Weight reduction > 5%
43 13 0.001
Fat intake < 30% energy
47 26 0.001
SFA intake < 10% energy
26 11 0.001
Fiber inatke > 15 g/1000 kcal
25 12 0.001
Exercise > 4 hr/wk
86 71 0.001
Tuomilehto J, et al. NEJM 2001;344:1343-1350.
0
20
40
60
80
Control (n=250) Diet intervention (n=256)
Inc
ide
nc
e o
f d
iab
ete
s
(ca
se
s/1
00
0 p
ers
on
-ye
ars
)
Tuomilehto et al. N Engl J Med. 2001;344:1343.
58%
The Finnish Diabetes Prevention
Study: Lifestyle Modifications
US Diabetes Prevention Program
3,234 people with IGT
Interventions Diet and exercise (reduce weight 7%, via low fat
diet and 150 minutes of exercise/week)
Metformin (850 mg bid)
Usual Care plus placebo, 10% developed DM per year
Troglitazone arm stopped due to liver toxicity
DPP. NEJM 2002;346:393-403.
US Diabetes Prevention Program
Diet and exercise 16 lesson curriculum: diet, exercise, behavior
modification
Case managers ○ One-on-one for 24 weeks
○ Subsequent monthly sessions (group and individual)
DPP. NEJM 2002;346:393-403.
Diabetes Prevention Program:
Achievement of Study Goals
Average follow-up of 2.8 years
Goal % Achieving Goal
Lifestyle modifications Week 24 Last visit
Weight loss 7% 50% 38%
Physical activity 150 74% 58%
(min/wk)
Pharmacologic intervention Placebo Metformin
Compliance 80% 77% 72%
Full dose 2 tablets/d 97% 84%
DPP. NEJM 2002;346:393-403.
Diabetes Prevention Program:
Progression to Type 2 Diabetes
0
2
4
6
8
10
12
Placebo Metformin Intensive
lifestyle
Ca
se
s/1
00
pe
rso
n-y
ea
rs
Average follow-up of 2.8 years
31%*
58%*
*All pairwise comparisons significantly different by
group; sequential log-rank test.
DPP. NEJM 2002;346:393-403.
Conclusions
Physical inactivity, poor diet and obesity increase the risk of DM.
Interventions to reduce adiposity via increased physical activity and dietary changes reduce risk of DM.
Translation into the community a major challenge.
Diabetes Prevention & Translation Studies
Author Year Study N
Treatment condition and
setting
Comparison
Condition Follow-up
Weight loss
Effect
Glucose
Effect
Tuomilehto 2001 FDPS 522 Individualized counseling
Dietary
Information 3.2 years -4.2 kg (4.7%) -5 mg/dl
Knowler 2002 DPP 3234
Individual lifestyle
modification program,
metformin Placebo 2.8 years -4.5 kg (4.9%) -4 mg/dl
Boltri 2008
Diabetes
Prevention in a
Faith-based
setting 26 Group-based, churches NA 6, 12 months -5.6 lb, -1.0 lb -6.4 mg/dl
Ackerman 2008 DEPLOY 92 Group-based, YMCA
Brief
counseling 6, 12 months -6%, -2%
-0.1%
HbA1c,
NS
McBride 2008 ALL 37
Group-based, cardiac
rehabilitation NA 3, 12 months
-5.0 kg, -4.3
kg NR
Kramer 2009
Group Lifestyle
Balance 93
Group-based, primary
care NA 3, 12 months -4.9%, -4.5%
-1.5 mg/dl
NS
Whittemore 2009 DPP NP 58
Group-based, nurse
practitioners
Enhanced
standard
care 9.3 months
25% lost 5%
weight vs
11% NR
McTigue 2009 WiLLoW 166
Group-based, primary
care NA 10-14 months -5.19 kg NR
Amundson 2009
MT Diabetes
Control
Program 355
Group-based, health-care
facilities NA 4 months -6.7 kg (6.7%) NR
HELP PD Design Randomized trial of a community based translation of DPP
Testing a group-based behavioral lifestyle change strategy for weight loss and diabetes prevention versus usual care
Fasting glucose is the primary outcome
Delivered via local DCC with RD’s and Community Health Workers (CHWs)
301 overweight or obese persons (BMI 25-40) with pre-diabetes (glucose 95-125)
Participants receive health evaluations every 6 months at the GCRC
Initial participation in the study lasts for two years
Extended follow-up has been funded
Katula J. et al. Contemp Clin Trials. 2009 Sep 13. PMID: 19758580.
HELP PD Interventions Participants randomized into two groups:
Lifestyle Weight loss (LWL)
3 sessions with a registered dietitian during the first 6 months
Group meetings led by lay CHWs focused on weight loss, physical activity, and nutrition
○ One per week for 6 month intensive phase
○ Monthly thereafter for 18 month maintenance phase
Enhanced Usual Care (EUC)
2 sessions with a registered dietitian during the first 3 months
Monthly newsletters about community resources for weight loss
Katula J. et al. Contemp Clin Trials. 2009 Sep 13. PMID: 19758580.
Lifestyle Weight Loss Intervention Located in ADA-recognized DM education program
Managed by RD/CDEs trained by the research team
Delivered by lay CHWs, trained by the RD/CDEs and
further supported by DVDs
Patients with DM who had completed DM education, made lifestyle
change and judged to have personality/competency to lead groups
Supported by the research team that includes dietitians,
exercise physiologist, behavioral specialist, physicians
Intervention goals (intensive phase)
Deficit of 500-1000 calories per day
Increase to at least 180 minutes per week (usually brisk walking)
1-2 pounds lost per week
7% weight loss
42
Katula J. et al. Contemp Clin Trials. 2009 Sep 13. PMID: 19758580.
Participant Characteristics
Variable N (%) or Mean +/- SD
Number 301
Gender
Male 128 (42.5%)
Female 173 (57.5%)
Race
African American 74 (24.6%)
White 222 (73.8%)
Other 5 (1.6%)
Age (yrs) 57.8 +/- 9.5
Weight (kg) 94.1 +/- 15.6
BMI (kg/m2) 32.8 +/- 4.0
Glucose (mg/dl) 105.5 +/- 11.3
Insulin (μU/ml) 16.7 +/- 9.8
HOMA IR 4.4 +/- 2.9
Clinical Follow-up
Visit Usual Care Lifestyle
Baseline 150 151
Month 6 141 (94%) 139 (92%)
Month 12 138 (92%) 135 (89%)
Month 18 132 (88%) 125 (83%)
Month 24 134 (89%) 127 (84%)
Intervention Adherence
Interval # visits
planned
Attended
session
N (%)
Made up
session
N (%)
Missed
session
N (%)
Phase 1
(Months 1-6)
3624 2615 (72.2) 561 (15.5) 448 (12.4)
Phase 2
(Months 7-24)
2718 1098 (40.4) 622 (22.9) 998 (36.7)
Total 6342 3713 (58.6) 1183 (18.7) 1446 (22.8)
45
Katula JA, at al. Am J Prev Med. 2013 Apr;44(4 Suppl
4):S324-32. doi: 10.1016/j. PubMed PMID: 23498294.
Body Weight: 24 months
46
Baseline to 12
month change:
LWL: -7.1 kg
EUC: -1.5 kg
p<0.001
Baseline to 24
month change:
LWL: -5.34 kg
EUC: -1.16 kg
p<0.001
Katula JA, at al. Am J Prev Med. 2013 Apr;44(4 Suppl
4):S324-32. doi: 10.1016/j. PubMed PMID: 23498294.
Percent Weight Loss: 24 months
47
Baseline to 12
month change:
LWL: -7.3%
EUC: -1.4%
p<0.001
Baseline to 24
month change:
LWL: -5.1%
EUC: -0.6%
p<0.001
Katula JA, at al. Am J Prev Med. 2013 Apr;44(4 Suppl
4):S324-32. doi: 10.1016/j. PubMed PMID: 23498294.
Fasting Blood Glucose: 24 months
48
Baseline to 12
month change:
LWL: -4.2 mg/dl
EUC: -0.3 mg/dl
p = 0.002
Baseline to 24
month change:
LWL: -2.2 mg/dl
EUC: 2.1 mg/dl
p = 0.002
Katula JA, at al. Am J Prev Med. 2013 Apr;44(4 Suppl
4):S324-32. doi: 10.1016/j. PubMed PMID: 23498294.
Adverse Events and Incident Diabetes
Lifestyle Weight
Loss
Usual Care P value
Adverse Events
Month 6 7 13 0.21
Month 12 11 15 0.46
Serious Adverse
Events
Month 6 3 5 0.51
Month 12 5 5 0.98
Diabetes*
Month 6 2 5 0.29
Month 12 2 7 0.12
*Fasting glucose > 126 or using diabetes medications at visit
P-values are based on a Poisson regression model using the #
of events as the outcome and testing the difference between
randomization groups at months 6 and 12 independently.
HELP Prevent Diabetes Excellent weight loss, greater than 7% during first year
and 5% at 2 years, with decrease in waist size, ~5cm.
Meaningful net reduction in glucose (4 mg/dl).
Low frequency of AEs, SAEs, and incident DM.
All achieved with lay community health workers and
community based systems with high potential for
dissemination.
Dissemination Aspects:
Community Health Workers (CHWs),
Diabetes Care Centers (DCCs), and
NC HELP PD
Community Health Workers
11 originally recruited • 1 did not complete training
• 2 completed training but did not complete 24 month intervention
• 8 remaining after 24 months
Of remaining 8: • 3 led one group each
• 5 led two groups each
CHWs were willing to fill in for each other when necessary
Community Health Workers
Demographics (of 10 who completed training)
All had DM and had completed diabetes education
Sex: 2 male, 8 female
Age: mean 57.2 yrs (47-74, at time of enrollment)
Education: 8 beyond HS, 3 more than college
Marital Status: 7 married, 2 divorced, 1 widow
Race: 7 Black, 3 White
7 currently employed (other than as a CHW)
CHW Time and Compensation
CHWs contributed approximately 10
hours per week during Intensive Phase,
and between 10 and 20 hours per month
during Maintenance Phase
CHWs compensated $100/week during
Intensive Phase and $200/month during
Maintenance Phase
Diabetes Care Centers (DCCs)
We surveyed all ADA recognized DCCs
in NC and a sample nationally (n = 87).
Over 95% reported they had the
personnel, space, and technology
needed to implement this program.
Also had significant capacity and
interest.
NC HELP PD Goals
56
Overarching Goal: Reduce incidence, burden, and health disparities associated
with diabetes by implementing diabetes prevention programs throughout NC
Phase 1 Establish collaborative partnership
Identify and recruit patients at-risk for diabetes (prediabetes)
Implement Diabetes Prevention Program ○ 12-months
○ Increase physical activity, reduce caloric intake
○ Induce 7% weight loss at 12 months
○ Reduce fasting blood glucose (-3 mg/dl) at 12 months
○ Collect data
Prepare for Phase 2 (Expand reach and access through CHWs)
NCHELP PD: Phase 1
Train staff (RDs, CDEs)
Conduct 12-month demonstration
project
Weight loss intervention delivered by center
staff
Participants with prediabetes
Evaluation: changes in weight, CVD risk
Earn CDC Diabetes Prevention Program
Recognition for each center
58
NCHELP PD: Phase 2
Include Community Health Workers
Center staff train CHWs
CHWs lead weight loss groups
Program evaluation
59
Role of County Health Departments
Dedicate staff time to project
Receive training
Recruit participants
Conduct weight loss groups
Manage participants/monitor program
Collect data
Communicate with Coordinating Center
(WFSM)/Monthly conference calls
60
Role of Coordinating Center
Funding
Provide technical assistance and training
On-going support
Facilitate communication between health
departments
Monitor program
Program evaluation
61
Staff Training
Recruiting participants
Intervention materials
Group Facilitation
Managing participants
Individual visits
Data collection
Approximately 16 hours
CE offered
Held in March 2012, Winston-Salem, NC
62
Participant Recruitment
Target Prediabetes
○ Risk assessment questionnaire (from CDC)
○ Blood-based diagnostic test within the last year for at least 50% of participants enrolled:
Fasting plasma glucose 100-125 mg/dL
OGTT 140-199 mg/dL
HbA1c of 5.7-6.4%
Self-reported history of GDM (no time limit)
No contraindications for weight loss or exercise
• Simplification of criteria used in HELP PD study for program implementation
63
Monitoring the Intervention
Body weight
Attendance
Data entered into web-based system
Reviewed by Coordinating Center
Reviewed with sites monthly
Problem-solving approach
64
Program evaluation
Baseline, 6-months, 12-months
Key Measures
Taken at clinic
Body Weight
Fasting glucose
BMI
Blood pressure
65
Progress to Date
82 participants enrolled at 5 sites 84% female
28% minority
Mean age: 45 years
Mean BMI: 36.3 kg/m2
Groups began in June-July 2012
Mean weight loss across all participants at all sites is currently 13 lbs (-5.9%) at 9 months (6-month intensive phase completed, 3 months maintenance)
Lifestyle Management of Pre-Diabetes Obesity epidemic fueling epidemics of diabetes,
metabolic syndrome and pre-diabetes. Threatening progress to prevent heart disease, stroke
and other conditions.
Diabetes preventable through lifestyle change to promote weight loss.
Professional and CHW approaches effective.
A Diabetes Prevention Training Center could disseminate strategy widely and rapidly to DM education programs.
We really need food and activity policy and environmental change.
D&I critique of HELP PD initiative
Demonstration project aspects, but
theoretical frameworks for D&I
incorporated.
Absence of testing potential alternative
models for implementation or
dissemination.
Process evaluation key for generating
more generalizable knowledge
regarding D&I science.
Diabetes Prevention & Translation Studies
Author Year Study N
Treatment condition and
setting
Comparison
Condition Follow-up
Weight loss
Effect
Glucose
Effect
Tuomilehto 2001 FDPS 522 Individualized counseling
Dietary
Information 3.2 years -4.2 kg (4.7%) -5 mg/dl
Knowler 2002 DPP 3234
Individual lifestyle
modification program,
metformin Placebo 2.8 years -4.5 kg (4.9%) -4 mg/dl
Boltri 2008
Diabetes
Prevention in a
Faith-based
setting 26 Group-based, churches NA 6, 12 months -5.6 lb, -1.0 lb -6.4 mg/dl
Ackerman 2008 DEPLOY 92 Group-based, YMCA
Brief
counseling 6, 12 months -6%, -2%
-0.1%
HbA1c,
NS
McBride 2008 ALL 37
Group-based, cardiac
rehabilitation NA 3, 12 months
-5.0 kg, -4.3
kg NR
Kramer 2009
Group Lifestyle
Balance 93
Group-based, primary
care NA 3, 12 months -4.9%, -4.5%
-1.5 mg/dl
NS
Whittemore 2009 DPP NP 58
Group-based, nurse
practitioners
Enhanced
standard
care 9.3 months
25% lost 5%
weight vs
11% NR
McTigue 2009 WiLLoW 166
Group-based, primary
care NA 10-14 months -5.19 kg NR
Amundson 2009
MT Diabetes
Control
Program 355
Group-based, health-care
facilities NA 4 months -6.7 kg (6.7%) NR
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