Research article
Translating the Diabetes Prevention Program: A Comprehensive Model for Prevention Training and Program Delivery

https://doi.org/10.1016/j.amepre.2009.07.020Get rights and content

Background

The Diabetes Prevention Program (DPP) demonstrated that lifestyle intervention reduces risk for type 2 diabetes and the metabolic syndrome. A universal framework for translation of multiple aspects of the DPP intervention, including training, support, and evaluation is needed to enhance treatment fidelity in a variety of settings.

Purpose

This study aims to develop a comprehensive model for diabetes prevention translation using a modified DPP lifestyle intervention.

Methods

The DPP lifestyle intervention was adapted to a 12-session group-based program called Group Lifestyle Balance for implementation in the community setting. A model for training and support mirroring that of the DPP was developed for prevention professionals administering the program. The process of training/support and program implementation was evaluated for feasibility and effectiveness using a nonrandomized prospective design in two phases (N=51, Phase 1: 2005–2006; N=42, Phase 2: 2007–2009; data analysis completed 2008–2009). A total of 93 nondiabetic individuals with BMI ≥25 kg/m2 and the metabolic syndrome or prediabetes participated. Measures were collected at baseline and post-intervention for all and 6 and 12 months post-intervention for Phase 2.

Results

Significant decreases in weight, waist circumference, and BMI were noted in both phases from baseline. Participants in Phase 2 also demonstrated decreases in total cholesterol, non-HDL cholesterol, and systolic and diastolic blood pressure that were maintained at 12 months. Average combined weight loss for both groups over the course of the 3-month intervention was 7.4 pounds (3.5% relative loss, p<0.001); 23.8% and 52.2% of those who completed the program reached 7% and 5% weight loss, respectively. More than 80% of those achieving 7% weight loss in the Phase-2 group maintained their weight loss at 6 months.

Conclusions

A comprehensive diabetes prevention model for training, intervention delivery, and support was shown to be successful and was effective in reducing diabetes and cardiovascular disease risk factors in this group of high-risk individuals.

Introduction

It is estimated that more than 57 million adults in the U.S. have prediabetes and are therefore at increased risk for developing type 2 diabetes and cardiovascular disease (CVD).1 The metabolic syndrome, a clustering of risk factors including insulin resistance, dyslipidemia, obesity, and hypertension, has also been associated with elevated risk for both conditions.2, 3, 4, 5, 6

Lifestyle intervention clearly reduces the risk for type 2 diabetes.7, 8, 9, 10 The Diabetes Prevention Program (DPP) demonstrated that lifestyle intervention was highly successful in reducing risk for type 2 diabetes in all groups regardless of ethnicity, age, or gender.11 In addition, the DPP lifestyle intervention was effective in reducing risk factors for CVD12 and components of the metabolic syndrome.13 Recent research has focused on translating the DPP intervention to a variety of settings, including YMCAs,14 churches,15 primary care practice settings,16 and healthcare locales.17, 18, 19 Currently, there are few models developed for training and support for delivery of adapted DPP interventions. One training model has been described for implementation in the YMCA; however, this has not been applied in other settings.20 A universal framework for translation of multiple aspects of the DPP intervention, including training, support, and evaluation, as well as updated program materials, is needed in order to enhance treatment fidelity in a variety of settings.

The objective of this project was to develop a comprehensive model for real-world diabetes prevention intervention for application in multiple settings that includes (1) updated diabetes prevention curriculum and behavioral lifestyle materials; (2) a standardized training for healthcare professionals with support in the delivery of the intervention; and (3) ongoing evaluation of the implementation of the intervention. This manuscript describes the first two components of this model and provides an evaluation of the process demonstrated in one type of community venue, the healthcare setting.

Section snippets

Intervention

The original individually administered DPP Lifestyle Intervention was developed at the University of Pittsburgh by the DPP Lifestyle Resource Core and has been described elsewhere.21 Based on cost estimates from the DPP,22 several members of the DPP Lifestyle Resource Core modified the DPP lifestyle intervention to the Group Lifestyle Balance program for group rather than individual delivery. While maintaining the goals and key learning objectives of the DPP curriculum, the number of sessions

Results

Baseline characteristics are shown in Table 2. Both groups were comprised of primarily middle-aged white women and had a mean BMI ≥30 kg/m2. In Phase 1, a total of 31 participants (61%) attended at least half of the 12 intervention sessions (mean number of sessions attended was 6.5). In Phase 2, a total of 40 participants (95.2%) attended at least half (mean number of sessions attended was 10.0). Participants who were over the median age (58 years) had better attendance than younger

Discussion

The findings of this project provide evidence that a comprehensive diabetes prevention model for training, intervention delivery, and support can be successful. The Group Lifestyle Balance program was administered to prevention professionals via training and support provided by the Diabetes Prevention Support Center, who, in turn, delivered the program to individuals at risk for diabetes and CVD. The program significantly reduced key components of risk for type 2 diabetes and CVD in high-risk

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