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Strategies needed to engage younger women with National Diabetes Prevention Program
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Women aged 39 years or younger with prediabetes or past gestational diabetes are half as likely to enroll in a National Diabetes Prevention Program and less likely to attend at least one session vs. women aged at least 40 years, according to findings published in the American Journal of Preventive Medicine.
“Efforts to reduce material obesity and diabetes risk during pregnancy have been largely ineffective, and there is a growing consensus that delivering lifestyle interventions during pregnancy may be ‘too little, too late,’” Natalie D. Ritchie, PhD, of the department of psychiatry at the University of Colorado School of Medicine in Aurora, and colleagues wrote. “Effective prevention efforts are needed prior to conception and subsequent pregnancies to halt the transgenerational cycle of obesity and diabetes.”
Ritchie and colleagues analyzed data from 1,422 women participating in the CDC standardized delivery model of the National Diabetes Prevention Program (NDPP), conducted in an urban health care system. Recruited patients were English- and Spanish-speaking with BMI of at least 24 kg/m² and prediabetes (defined as HbA1c between 5.7% and 6.4%), past gestational diabetes or a positive screen on a risk questionnaire. Pregnant women were excluded. The NDPP consisted of 16 weekly to biweekly sessions for 6 months, followed by six or more monthly sessions for 6 months, with 22 to 24 total sessions. Goals included 5% weight loss through diet and activity changes. Enrollment was defined as agreeing to attend at least one class. Attendance was defined by attendance at one or more sessions, the proportion of classes attended and program completion (defined by the CDC as attending 9 classes during months 1 to 6 and 3 classes during months 7 to 12). Researchers compared enrollment, attendance and weight loss for women aged 18 to 39 years (n = 403) vs. women aged at least 40 years (n = 1,019). Data were collected between 2013 and 2016, and analyses were conducted in 2017.
Researchers found that women of child-bearing age were nearly half as likely to enroll as older women in adjusted models (OR = 0.58; 95% CI, 0.49-0.69). Additionally, younger enrollees were less likely to attend at least one session vs. older enrollees (OR = 0.77; 95% CI, 0.61-0.99). Younger women attended fewer sessions vs. older women (30.7% of classes attended vs. 32.2%) and were less likely to complete the program (14.3% vs. 18.7%); however, the differences were not statistically significant.
There were no between-group differences for weight-loss outcomes; both groups lost an average of 3% body weight. Researchers also observed that white women were more likely to attend classes regardless of age compared with Latina or black women (OR = 1.47; 95% CI, 1.01-2.15).
“A woman’s health status before and during pregnancy has long-term implications for her own health and the health of her baby,” Katherine Sauder, PhD, assistant professor of pediatrics-nutrition at the University of Colorado School of Medicine, told Endocrine Today. “Lifestyle modification during pregnancy is challenging for a number of reasons, and it may be both easier and more effective to improve health behaviors and reduce chronic disease risk before conception. Our work shows that the National DPP is effective for women of child-bearing age, and suggests that this may be a viable strategy to improve maternal health prior to pregnancy. “
Sauder says there is a need to understand why younger women are not participating in the National DPP.
“Is it because they do not know about the program? Are not interested? Cannot make it to in-person classes? Feel out of place because most participants are older?” Sauder said. “Once we identify the barriers to them participating, we can start addressing these barriers so that more young women benefit from this program.” – by Regina Schaffer
Disclosures: The authors report no relevant financial disclosures.
Perspective
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The findings of Ritchie and colleagues highlight a common obstacle for the provision of preconception care: gaining the attention of women long before they become pregnant, when the benefits of prevention efforts are greatest. The negative consequences of uncontrolled or unrecognized diabetes during pregnancy are well known, and while the NDPP is a confirmed methodology for diabetes prevention, its participants are more often older individuals. The recruitment strategies for the NDPP at this urban health care system yielded a significantly lower enrollment rate in the younger cohort (aged 18 to 39 years). As noted by the researchers, efforts to further tailor recruitment messaging to issues pertinent to younger woman are key, perhaps emphasizing the positive impact of diabetes risk reduction on future pregnancies. The women of childbearing age not only enrolled less often, but those who participated were also less likely to participate in at least one or more program sessions as intended. The NDPP is designed to be delivered longitudinally over 1 year, with more intensive instruction occurring in the first 6 months. This particular site offered the program through live class sessions, and gaining further understanding of the barriers to participation that may have been unique to this age group (eg, childcare, work schedules) could assist program providers in developing alternate delivery modalities to meet the needs of this specific population. Overall, it is quite encouraging to note that the women who participated, regardless of age, achieved similar benefits in terms of weight loss, an important component of overall preconception health.
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