One-Year Results of a Community-Based Translation of the Diabetes Prevention Program

• DOI: 10.2337/dc10-2115
• Publication Date: 2011-05-19T04:16:58Z
• Authors: Jeffrey A. Katula; Mara Z. Vitolins; Erica L. Rosenberger; Caroline S. Black...; Timothy M. Morgan; Michael S. Lawlor; David C. Goff
• Keywords: Blood Glucose; Community Health Workers; Male; 2. Zero hunger; Health Promotion; Middle Aged; 16. Peace & justice; 3. Good health; Prediabetic State; 03 medical and health sciences; Diabetes Mellitus, Type 2; Patient Education as Topic; Weight Loss; Humans; Female; Obesity; Insulin Resistance; 0305 other medical science; Life Style; Original Research; Aged

OBJECTIVEAlthough the Diabetes Prevention Program (DPP) and the Finnish Diabetes Prevention Study (FDPS) demonstrated that weight loss from lifestyle change reduces type 2 diabetes incidence in patients with prediabetes, the translation into community settings has been difficult. The objective of this study is to report the first-year results of a community-based translation of the DPP lifestyle weight loss (LWL) intervention on fasting glucose, insulin resistance, and adiposity.RESEARCH DESIGN AND METHODSWe randomly assigned 301 overweight and obese volunteers (BMI 25–40 kg/m2) with fasting blood glucose values between 95 and 125 mg/dL to a group-based translation of the DPP LWL intervention administered through a diabetes education program (DEP) and delivered by community health workers (CHWs) or to an enhanced usual-care condition. CHWs were volunteers with well-controlled type 2 diabetes. A total of 42.5% of participants were male, mean age was 57.9 years, 26% were of a race/ethnicity other than white, and 80% reported having an education beyond high school. The primary outcome is mean fasting glucose over 12 months of follow-up, adjusting for baseline glucose.RESULTSCompared with usual-care participants, LWL intervention participants experienced significantly greater decreases in blood glucose (−4.3 vs. −0.4 mg/dL; P < 0.001), insulin (−6.5 vs. −2.7 μU/mL; P < 0.001), homeostasis model assessment of insulin resistance (−1.9 vs. −0.8; P < 0.001), weight (−7.1 vs. −1.4 kg; P < 0.001), BMI (−2.1 vs. −0.3 kg/m2; P < 0.001), and waist circumference (−5.9 vs. −0.8 cm; P < 0.001).CONCLUSIONSThis translation of the DPP intervention conducted in community settings, administered through a DEP, and delivered by CHWs holds great promise for the prevention of diabetes by significantly decreasing glucose, insulin, and adiposity.