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One-Year Results of a Community-Based Translation of the Diabetes Prevention Program: Healthy-Living Partnerships to Prevent Diabetes (HELP PD) Project

Author:
Katula, Jeffrey A., Vitolins, Mara Z., Rosenberger, Erica L., Blackwell, Caroline S., Morgan, Timothy M., Lawlor, Michael S., Goff, David C. Jr.
Source:
Diabetes care 2011 v.34 no.7 pp. 1451-1457
ISSN:
0149-5992
Subject:
adiposity, blood glucose, body mass index, community health workers, education, fasting, glucose, homeostasis, insulin, insulin resistance, lifestyle, nationalities and ethnic groups, noninsulin-dependent diabetes mellitus, overweight, patients, waist circumference, weight loss
Abstract:
OBJECTIVE: Although 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 METHODS: We 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. RESULTS: Compared 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). CONCLUSIONS: This 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.
Agid:
297515