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National DPP: Promising early results, but challenges remain
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In the first 4 years since the National Diabetes Prevention Program was implemented, approximately one-third of participants were successful in reaching the 5% weight-loss goal; those who remained in the program for at least 7 months were most likely to be successful, according to a participant-level evaluation conducted by the CDC.
“These results show encouraging success in the implementation of community-based lifestyle change programs to prevent type 2 diabetes across a large number of delivery organizations nationwide,” Elizabeth K. Ely, MS, a statistician with the division of diabetes translation at the CDC, and colleagues wrote. “Attainment of program goals appears to hinge on intensity and duration of participation. Challenges remain in identifying, engaging and retaining those at risk, and further expansion, investigation and refinement of the program are needed to continue to lower the burden of type 2 diabetes nationally.”
Ely and colleagues analyzed data from 14,747 adults enrolled in 435 yearlong type 2 diabetes prevention programs across 40 states and the District of Columbia (including organizations in both pending and full recognition status) from February 2012 to January 2016 (80.3% women; 56% aged 45-64 years; 44.9% white). Researchers analyzed participants’ attendance, weight and duration of physical activity, and used a mixed linear effects model to examine predictors of weight loss. Included participants were enrolled in programs with sessions delivered for at least 12 months after their enrollment.
Within the cohort, 86.6% met the threshold of attending at least four sessions; participants attended a median of 14 sessions during an average of 172 days in the program (median, 134 days). The most common duration was 4 months (15.8%), followed by 1 month (14.8%) and at least 12 months (13.2%). Overall average weight loss for the cohort was 4.2%, with 33.5% of participants achieving the 5% weight-loss goal. Of the 87.7% of participants reporting physical activity information, 41.8% achieved the physical activity goal of 150 minutes per week (weekly average, 152 minutes; median, 128 minutes).
In regression analyses, researchers observed a positive relationship between the number of sessions attended and percent weight loss. For every session attended, participants lost 0.31% of body weight (P < .0001). In addition, average reported physical activity minutes also had a positive relationship with weight loss, with a loss of 0.3% for every 30 minutes of additional physical activity each week, according to the researchers.
The researchers noted that most participants did not participate fully in the maintenance portion of the program; whereas nearly 87% attended at least four sessions, only 43% completed 16 sessions, compared with 95% in the original DPP trial, and nearly all of the sessions attended took place during the first 6 months. The researchers aim to improve attendance with further exploration into organizational metrics and interviews with participants.
“The findings add to the evidence that the NIH DPP research study can be successfully translated and implemented at scale in a wide range of community settings to help reach the 86 million people with prediabetes,” Ely told Endocrine Today. “We plan to look more closely at the impact of delivery mode (in-person vs online vs distance learning) on participant success with respect to attendance and weight loss as more data become available.”– by Regina Schaffer
Disclosure: The National DPP is funded by the CDC.
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