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Modifications to DPP may yield cost savings without compromising effectiveness
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Potential cost-saving adaptions to the Diabetes Prevention Program do not appear to diminish the effectiveness of the program in terms of weight loss or BMI reduction, according to recent findings.
Anne K. Sebert Kuhlmann, PhD, MPH, of the College for Public Health and Social Justice at Saint Louis University, and colleagues analyzed data from a previous systematic literature review of the Diabetes Prevention Program (DPP) and extracted data from 28 articles that reported on cultural adaptations to the program. Researchers collected data on weight, BMI and five categories of cultural modifications, including format of sessions, frequency and timeline of DPP classes, setting of delivery, implementing staff, and program timeline and contents.
Anne K. Sebert Kuhlmann
Researchers found that of the 28 interventions assessed only one utilized individual sessions as in the original DPP trial, while all others adapted the format by implementing group sessions (n = 24), self study (n = 1) or a combination of group and individual sessions (n = 2). Nearly half of the interventions (n = 13) consolidated the program’s timeline or decreased the number of sessions from that of the original DPP trial. Implementation staffs were largely comparable to that of the original DPP trial, entailing health care professionals (n = 21) whereas some strategies utilized community lay workers (n = 5) or a combination of the two (n = 2). Cultural adaptation of program content was indicated in 12 of the interventions. Consistent with the original DPP trial, nine interventions provided their programming in a clinical setting whereas others provided interventions in community setting (n = 11), churches (n = 4), worksites (n = 3) or online (n = 1).
No statistically significant difference was seen in adapting any of the five major areas of cultural adaptations or program translation strategies from the DPP or in having a maintenance component and identifying a significant decrease in weight or BMI. Programs with fewer adaptations (less than two strategies) had greater BMI and weight reductions at all time points, with the exception of BMI at 6 months post-intervention. However, this difference reached statistical significance only for weight at 12 months after intervention (P < .01) and at the furthest time point analyzed (P = .02). Additionally, programs with a maintenance aspect had a higher degree of BMI and weight reduction at 6 and 12 months post-intervention. However, this trend was statistically significant only for weight measured at the furthest time period (P = .02).
“The findings suggest that diabetes educators can still support patients to achieve significant reductions in weight and BMI even when modifying the DPP to different settings and to diverse populations,” the researchers wrote. “This includes modifications for resource-limited settings, with changes such as reductions in the number of sessions and delivery by lay health workers.” – by Jennifer Byrne
Disclosure: The researchers report no relevant financial disclosures.
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