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In low-income settings, diabetes prevention programs face challenges
Barriers to the implementation of diabetes prevention programs in low-income primary care settings include issues with effective patient identification, recruitment and retention, according to study findings.
“The standard of care for prediabetes is to offer referral to effective behavior change programs such as the Diabetes Prevention Program … Not commonly addressed, however, is the fact that only about 2% to 3% of those potentially eligible actually enroll in a Diabetes Prevention Program,” the researchers wrote.
In the mixed methods process analysis of a pragmatic two-group pilot comparative effectiveness study of a community-developed Healthy Living Program and a Diabetes Prevention Program, Jennifer Carroll, MD, MPH, of the University of Colorado, and colleagues evaluated 1,215 adults treated at one of four inner city primary care practices in the Rochester, New York areas. These four sites collaborated on the study with the University of Rochester’s Center for Community Health and the Rochester YMCA.
Study participants were identified and recruited by chart or electronic health record review and clinician identification of patients. Eligible patients were at least 18 years of age, were overweight or obese (BMI or 25 kg/m2 or higher) and prediabetic. The researchers defined prediabetes as HbA1c less than 6.5% and greater than or equal to 5.7%, fasting plasma glucose less than 126 mg/dL but greater than or equal to 100 mg/dL, or oral glucose tolerance test greater than or equal to 140 mg/dL but less than 200 mg/dL. The overall sample was 82.6% female, 61.9% had public insurance and 60.5% earned less than $20,000 per year.
Upon enrollment, participants were randomly assigned to the Diabetes Prevention Program or the Healthy Living Program.
The Health Living Program is a 12-week, 24-session program with biweekly, 90-minute sessions. Each session entails 45 minutes of supervised physical activity and 45 minutes of interactive group instruction focusing on nutritional subjects.
The Diabetes Preventions program consisted of three group meetings and one individual meeting per month, led by a dietician or physical activity counselor.
The researchers found that 51% of participants did not meet the criteria eligibility. Of the 512 remaining participants, 130 declined to participate and 382 did not complete enrollment/randomization. A total of 92 participants (7% of the original total) were randomized, 42 to the Healthy Living Program and 50 to the Diabetes Prevention Program. Of the 92 randomized, 58 completed the baseline evaluation and 31 completed the entire intervention (13 in the Healthy Living Program and 18 in the Diabetes Prevention Program).
The lack of retention was primarily related to the life situation of the participants, including job security issues, competing life issues and logistical barriers.
According to the researchers, the “major finding” of the study was the challenge faced by clinical staff in identifying and enrolling eligible participants in diabetes prevention programs.
“In order to develop primary care’s capacity to deliver diabetes prevention programs, robust partnerships and new models of teamwork involving clinical, community and research skill and resources are needed,” the researchers wrote. “Addressing the key challenges to feasibility and the social determinants of health are required for successful translation of evidence-based programs to community settings.” - by Jen Byrne
Disclosure: The researchers report no relevant financial disclosures.