Translating the Diabetes Prevention Program: a comprehensive model for prevention training and program delivery. The healthy living partnerships to prevent diabetes and the diabetes prevention program: a comparison of year 1 and 2 intervention results Translating the Diabetes Prevention Program into the community. The DEPLOY Pilot Study. Translating the Diabetes Prevention Program into an Online Social Network Implementing a diabetes prevention program in a rural African-American church. A Randomized Comparative Effectiveness Trial for Preventing Type 2 Diabetes. Community-Based Translation of the Diabetes Prevention Program’s Lifestyle Intervention in an Underserved Latino Population One-Year Results of a Community-Based Translation of the Diabetes Prevention Program First versus repeat treatment with a lifestyle intervention program: attendance and weight loss outcomes Translating the Diabetes Prevention Program lifestyle intervention for weight loss into primary care: a randomized trial. Design of a cluster-randomized controlled trial of a diabetes prevention program within African-American churches: The Fit Body and Soul study. Long-term effects of a community-based lifestyle intervention to prevent type 2 diabetes: the DEPLOY extension pilot study The Healthy Living Partnerships to Prevent Diabetes study: 2-year outcomes of a randomized controlled trial. Healthy Living Partnerships to Prevent Diabetes (HELP PD): design and methods. Two-Year Results of Translating the Diabetes Prevention Program Into an Urban, Underserved Community Comparison of Commercial and Self-Initiated Weight Loss Programs in People With Prediabetes: A Randomized Control Trial. Sex Differences in Diabetes Risk and the Effect of Intensive Lifestyle Modification in the Diabetes Prevention Program
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 setting s. 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 nonr and omized prospect i ve 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 > or=25 kg/m(2 ) 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 A number of research studies have attempted to translate the behavioral lifestyle intervention delivered in the Diabetes Prevention Program ( DPP ) . To compare the active interventions of two trials , Diabetes Prevention Program DPP and Healthy Living Partnerships to Prevent Diabetes ( HELP PD ) , after 1 and 2 years of intervention . DPP included 3234 adults with prediabetes r and omized to intensive lifestyle intervention , metformin , troglitazone , or placebo .  The lifestyle intervention , professionally delivered to individuals in a clinical setting , focused on diet and increased physical activity . HELP PD , a community-based translation of DPP , included 301 adults r and omized to receive intensive lifestyle intervention or enhanced usual care .  Mean weight-losses at 1 year ( 6.9 kg in DPP , 6.4 kg in HELP PD ) and 2 years ( 5.5 kg in DPP , 4.4 kg in HELP PD ) were similar across studies . Reductions in glucose were also similar across studies at both time points ( 5.2 mg/dL in DPP and 4.1 mg/dL in HELP PD at 1 year ; 1.8 mg/dL and 1.6 mg/dL at 2 years ) . HELP PD participants achieved larger reductions in triglycerides at 1 and 2 years ( 38.4 mg/dL and 34.9 mg/dL , respectively ) than DPP participants ( 24.8 mg/dL and 22.4 mg/dL ) . High-density lipoprotein decreased in HELP PD participants at year 1 ( −0.6 mg/dL ) and increased in DPP ( 1.2 mg/dL ) but there were no significant differences in year 2 . HELP PD , a community model for diabetes prevention , was similar to DPP in reducing body weight and lowering blood glucose , both important risk factors that should be controlled to reduce risk for developing type 2 diabetes BACKGROUND The Diabetes Prevention Program ( DPP ) found that an intensive lifestyle intervention can reduce the development of diabetes by more than half in adults with prediabetes , but there is little information about the feasibility of offering such an intervention in community setting s. This study evaluated the delivery of a group-based DPP lifestyle intervention in partnership with the YMCA . METHODS This pilot cluster-r and omized trial was design ed to compare group-based DPP lifestyle intervention delivery by the YMCA to brief counseling alone ( control ) in adults who attended a diabetes risk-screening event at one of two semi-urban YMCA facilities and who had a BMI > or=24 kg/m2 , > or=2 diabetes risk factors , and a r and om capillary blood glucose of 110 - 199 mg/dL. Multivariate regression was used to compare between-group differences in changes in body weight , blood pressures , HbA1c , total cholesterol , and HDL-cholesterol after 6 and 12 months . RESULTS Among 92 participants , controls were more often women ( 61 % vs 50 % ) and of nonwhite race ( 29 % vs 7 % ) . After 6 months , body weight decreased by 6.0 % ( 95 % CI=4.7 , 7.3 ) in intervention participants and 2.0 % ( 95 % CI=0.6 , 3.3 ) in controls ( p<0.001 ; difference between groups ) . Intervention participants also had greater changes in total cholesterol ( -22 mg/dL vs + 6 mg/dL controls ; p<0.001 ) . These differences were sustained after 12 months , and adjustment for differences in race and gender did not alter these findings . With only two matched YMCA sites , it was not possible to adjust for potential clustering by site . CONCLUSIONS The YMCA may be a promising channel for wide-scale dissemination of a low-cost approach to lifestyle diabetes prevention Purpose The purpose of this study was to evaluate the efficacy of Prevent , an online social network-based translation of the Diabetes Prevention Program ( DPP ) lifestyle intervention , against the Centers for Disease Control and Prevention ( CDC ) Diabetes Prevention and Recognition Program ( DPRP ) outcome st and ards and weight loss outcomes of other DPP translations . Methods Two hundred twenty participants previously diagnosed with prediabetes were recruited online and enrolled in Prevent , a DPP-based group lifestyle intervention that integrates a private online social network , weekly lessons , health coaching , and a wireless scale and pedometer . Participants underwent a core 16-week intensive lifestyle change intervention and were then offered to continue with a post-core lifestyle change maintenance intervention , with the entire intervention ( core plus post-core ) totaling 12 months . Results One hundred eighty-seven participants met inclusion criteria for the core program and achieved an average of 5.0 % and 4.8 % weight loss at 16 weeks and 12 months , respectively . They also had a 0.37 % reduction in their A1C level at final measurement . One hundred forty-four of these same participants also met inclusion criteria for the post-core program and achieved an average of 5.4 % and 5.2 % weight loss at 16 weeks and 12 months , respectively , and a 0.40 % reduction in A1C at final measurement . Conclusion Results indicate that Prevent meets CDC DPRP outcome st and ards for diabetes prevention programs and performs favorably to other DPP translations . Considering national initiatives to address the obesity and diabetes epidemics , online delivery platforms like Prevent offer an effective and scalable solution OBJECTIVES The purpose of this study was to determine the feasibility of implementing a diabetes prevention program ( DPP ) in a rural African-American church . METHODS A six-session DPP , modeled after the successful National Institutes of Health ( NIH ) DPP , was implemented in a rural African-American church . Adult members of the church identified as high risk for diabetes , based on results of a risk question naire , were screened with a fasting glucose . Persons with prediabetes , a fasting glucose of 100 - 125 mg/dL , participated in the six-session , Lifestyle Balance Church DPP . The primary outcomes were attendance rates and changes in fasting glucose , weight and body mass index measured at baseline , six- and 12-month follow-up . RESULTS Ninety-nine adult church members were screened for diabetes risk . Eleven had impaired fasting glucose .  Ten of 11 participated in the six-session intervention , for an attendance rate of 78 % . After the intervention and 12-month follow-up , there was a mean weight loss of 7.9 lbs and 10.6 lbs , respectively . CONCLUSIONS This pilot project suggests that a modified six-session DPP can be translated to a group format and successfully implemented in a church setting . Further r and omized studies are needed to determine the effectiveness of such an intervention OBJECTIVES We evaluated the weight loss effectiveness of a YMCA model for the Diabetes Prevention Program ( DPP ) lifestyle intervention . METHODS Between July 2008 and November 2010 , we individually r and omized 509 overweight or obese , low-income , nondiabetic adults with elevated blood glucose in Indianapolis , Indiana , to receive st and ard care plus brief lifestyle counseling or be offered a group-based YMCA adaptation of the DPP ( YDPP ) . Primary outcome was mean weight loss difference at 12 months . In our intention-to-treat analyses , we used longitudinal linear or logistic regression , multiply imputing missing observations . We used instrumental variables regression to estimate weight loss effectiveness among participants completing 9 or more intervention lessons . RESULTS In the YDPP arm , 161 ( 62.6 % ) participants attended ≥ 1 lesson and 103 ( 40.0 % ) completed 9 or more lessons . In intention-to-treat analysis , mean 12-month weight loss was 2.3 kilograms ( 95 % confidence interval [ CI ] = 1.1 , 3.4 kg ) more for the YDPP arm than for st and ard care participants . In instrumental variable analyses , persons attending 9 or more lessons had a 5.3-kilogram ( 95 % CI = 2.8 , 7.9 kg ) greater weight loss than did those with st and ard care alone . CONCLUSIONS The YMCA model for DPP delivery achieves meaningful weight loss at 12 months among low-income adults Purpose The objective was to take prevention from the clinic to the community by including a high-risk group and working with the community to tailor , enhance , deliver , and evaluate a community-based version of the Diabetes Prevention Program ’s ( DPP ) clinic-based lifestyle intervention . Methods This was a nonr and omized prospect i ve study using a single-group design . Study eligibility included a screening glucose value in the normal to prediabetes range with no current diagnosis of diabetes , overweight , not pregnant nor planning to become pregnant during study period , aged 18 to 65 , Latino , living in the study target communities , and no reported medical restrictions related to the program goals . A total of 69 individuals participated . The Healthy Living Program ( HLP ) was based on the DPP ’s 1-year intensive lifestyle program , was tailored and enhanced for a Latino community , and was delivered by community health workers . Anthropometric and paper and pencil measures were administered to examine program outcome at 6 months and 12 months . Results In general , results indicate statistically significant improvements in anthropometrics and many behavioral outcomes , particularly at 6 months . Participants demonstrated forward movement through the stages of change during the program . Conclusions Results support the effectiveness of the intervention and show that delivery of the translated version of the DPP ’s lifestyle intervention in the community by community residents holds promise as one strategy to reach people at increased risk of developing diabetes . Use of this translation model , including collaboration with community health workers , offers diabetes educators an opportunity to extend their reach into underserved communities 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 setting s 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 r and omly 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 setting s , administered through a DEP , and delivered by CHWs holds great promise for the prevention of diabetes by significantly decreasing glucose , insulin , and adiposity Objective : Following unblinding of the Diabetes Prevention Program ( DPP ) results , a 16-session lifestyle intervention program was offered to all study participants , including those who had initially been r and omized to lifestyle treatment . This study compares the effects of the lifestyle program between participants who had previous exposure and those who had not . Design : A 16-session behavioral intervention was conducted in groups at each of the 27 DPP sites during a transitional ( bridge ) period from the DPP trial to the DPP Outcomes Study ( DPPOS ) . Session participation for this 6-month behavioral weight loss program was confirmed by originally r and omized treatment groups . Subjects and measurements : Independently assessed weight measurements were available within a 7-month period before and after the program for 2808 ethnically diverse participants . Results : Participants from the lifestyle group in the DPP were the least likely to attend a repeat offering of a 16-session behavioral weight loss program conducted in groups . Weight loss during the transitional lifestyle program was strongly related to the duration of attendance in the three groups that were participating in the program for the first time ( metformin , placebo and troglitazone ) , but not related to amount of earlier weight loss . Conclusion : Individuals who were naive to the behavioral program  lost a greater amount of weight and this was strongly related to their degree of participation . A second exposure to a behavioral weight loss program result ed in unsatisfactory low attendance rates and weight loss BACKGROUND The Diabetes Prevention Program ( DPP ) lifestyle intervention reduced the incidence of type 2 diabetes mellitus ( DM ) among high-risk adults by 58 % , with weight loss as the dominant predictor . However , it has not been adequately translated into primary care . METHODS We evaluated 2 adapted DPP lifestyle interventions  among overweight or obese adults who were recruited from 1 primary care clinic and had pre-DM and /or metabolic syndrome . Participants were r and omized to ( 1 ) a coach-led group intervention ( n = 79 ) , ( 2 ) a self-directed DVD intervention ( n = 81 ) , or ( 3 ) usual care ( n = 81 ) . During a 3-month intensive intervention phase , the DPP-based behavioral weight-loss curriculum was delivered by lifestyle coach-led small groups or home-based DVD . During the maintenance phase , participants in both interventions received lifestyle change coaching and support remotely-through secure email within an electronic health record system and the American Heart Association Heart360 website for weight and physical activity goal setting and self-monitoring . The primary outcome was change in body mass index ( BMI ) ( calculated as weight in kilograms divided by height in meters squared ) from baseline to 15 months . RESULTS At baseline , participants had a mean ( SD ) age of 52.9 ( 10.6 ) years and a mean BMI of 32.0 ( 5.4 ) ; 47 % were female ; 78 % , non-Hispanic white ; and 17 % , Asian/Pacific Isl and er . At month 15 , the mean ± SE change in BMI from baseline was -2.2 ± 0.3 in the coach-led group vs -0.9 ± 0.3 in the usual care group ( P < .001 ) and -1.6 ± 0.3 in the self-directed group vs usual care ( P = .02 ) . The percentages of participants who achieved the 7 % DPP-based weight-loss goal were 37.0 % ( P = .003 ) and 35.9 % ( P = .004 ) in the coach-led and self-directed groups , respectively , vs 14.4 % in the usual care group . Both interventions also achieved greater net improvements in waist circumference and fasting plasma glucose level . CONCLUSION Proven effective in a primary care setting , the 2 DPP-based lifestyle interventions are readily scalable and exportable with potential for substantial clinical and public health impact . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00842426 Evidence from varied community setting s has shown that the Group Lifestyle Balance ( GLB ) Program and other adaptations of the Diabetes Prevention Program ( DPP ) intervention are effective in lowering diabetes risk . Most DPP data originated from studies of pre-diabetic whites , with only sparse evidence of the effect of DPP in African Americans ( AAs ) in community setting s. This paper describes the design , methods , baseline characteristics and cost effective measures , of a single-blinded , cluster-r and omized trial of a faith-based adaptation of the GLB program , Fit Body and Soul ( FBAS ) . The major aims are to test efficacy and cost utility of FBAS in twenty AA churches . R and omization occurred at the church level and 604 AA overweight/obese ( BMI ≥25kg/m(2 ) ) adults with fasting plasma glucose range from normal to pre-diabetic received either FBAS or a health-education comparison program . FBAS is a group-based , multi-level intervention delivered by trained church health advisors ( health professionals from within the church ) , with the goal of ≥7 % weight loss , achieved through increasing physical activity , healthy eating and behavior modification . The primary outcome is weight change at 12weeks post intervention . Secondary outcomes include hemoglobin A1C , fasting plasma glucose , waist circumference , blood pressure , physical activity level , quality of life measures , and cost-effectiveness . FBAS is the largest known cohort of AAs enrolled in a faith-based DPP translation . Reliance on health professionals from within the church for program implementation and the cost analysis are unique aspects of this trial . The design provides a model for faith-based DPPs and holds promise for program sustainability and widespread dissemination Objective : The US Diabetes Prevention Program ( DPP ) and other large trials internationally have shown that an intensive lifestyle intervention can reduce the development of type 2 diabetes  . We evaluated long-term effects of a lower cost , group-based adaption of the DPP lifestyle intervention offered by the YMCA . Methods : Participants were adults with BMI ≥24 kg/m2 and r and om capillary blood glucose 6.1–11.1 mmol/L who had been previously enrolled in a cluster-r and omized trial comparing a group-based DPP lifestyle intervention versus brief advice alone . Four to 12 months after completion of the initial trial , 72 % of 92 participants enrolled in an extension study , and all were offered a group lifestyle maintenance program at the YMCA . Paired t-tests were used to assess within-group changes ; ANCOVA with adjustment was used for between-group comparisons . Results : At 28 months , after both arms were offered the same 8-month lifestyle maintenance intervention , both arms had statistically significant weight losses compared to baseline ( brief advice controls : −3.6 % ; 95 % CI : −5.8 to −1.4 ; intensive lifestyle : −6.0 % ; 95 % CI : −8.8 to −3.2 ) . Participants initially assigned to the DPP also experienced significant improvements in blood pressure and total cholesterol . Discussion : The YMCA is a promising channel for dissemination of a low-cost model for lifestyle diabetes prevention . Future studies are needed to verify these findings BACKGROUND Since the Diabetes Prevention Project ( DPP ) demonstrated that lifestyle weight-loss interventions can reduce the incidence of diabetes by 58 % , several studies have translated the DPP methods to public health-friendly context s. Although these studies have demonstrated short-term effects , no study to date has examined the impact of a translated DPP intervention on blood glucose and adiposity beyond 12 months of follow-up . PURPOSE To examine the impact of a 24-month , community-based diabetes prevention program on fasting blood glucose , insulin , insulin resistance as well as body weight , waist circumference , and BMI in the second year of follow-up . DESIGN An RCT comparing a 24-month lifestyle weight-loss program ( LWL ) to an enhanced usual care condition ( UCC ) in participants with prediabetes ( fasting blood glucose=95 - 125 mg/dL ) . Data were collected in 2007 - 2011 ; analyses were conducted in 2011 - 2012 . SETTING / PARTICIPANTS 301 participants with prediabetes were r and omized ; 261 completed the study . The intervention was held in community-based sites . INTERVENTION The LWL program was led by community health workers and sought to induce 7 % weight loss at 6 months that would be maintained over time through decreased caloric intake and increased physical activity . The UCC received two visits with a registered dietitian and a monthly newsletter . MAIN OUTCOME MEASURES The main measures were fasting blood glucose , insulin , insulin resistance , body weight , waist circumference , and BMI . RESULTS Intent-to-treat analyses of between-group differences in the average of 18- and 24-month measures of outcomes ( controlling for baseline values ) revealed that the LWL participants experienced greater decreases in fasting glucose ( -4.35 mg/dL ) ; insulin ( -3.01 μU/ml ) ; insulin resistance ( -0.97 ) ; body weight ( -4.19 kg ) ; waist circumference ( -3.23 cm ) ; and BMI ( -1.40 ) , all p-values < 0.01 . CONCLUSIONS A diabetes prevention program administered through an existing community-based system and delivered by community health workers is effective at inducing significant long-term reductions in metabolic indicators and adiposity Although the Diabetes Prevention Program ( DPP ) developed a lifestyle weight loss intervention that has been demonstrated to prevent type 2 diabetes in high-risk individuals , it has yet to be widely adopted at the community level . The Healthy Living Partnership to Prevent Diabetes study ( HELP PD ) was design ed to translate the DPP approach for use in community setting s as a cost-effective intervention led by Community Health Workers ( CHW 's ) and administered through a Diabetes Care Center ( DCC ) . Approximately 300 overweight and obese ( BMI 25 - 40 kg/m(2 ) ) individuals with prediabetes ( fasting blood glucose 95 - 124 mg/dl ) were r and omly assigned to either a lifestyle weight loss intervention ( LW ) or an enhanced usual care comparison condition ( UC ) . The goal of LW is > or=7 % weight loss achieved through increases in physical activity ( 180 min/wk ) and decreases in caloric intake ( approximately 1500 kcal/day ) . The intervention consists of CHW-led group-mediated cognitive behavioral meetings that occur weekly for 6 months and monthly thereafter for 18 months . UC consists of 2 individual meetings with a registered dietitian and a monthly newsletter . The primary outcome is change in fasting blood glucose . Secondary outcomes include cardiovascular risk factors , health-related quality of life , and social cognitive variables . Outcomes are masked and are collected every 6 months . The cost-effectiveness of the program will also be assessed . A community-based program that is administered through local DCC 's and that harnesses the experience of community members ( CHW 's ) may be a promising strategy for the widespread dissemination of interventions effective at preventing type 2 diabetes in high risk individuals Purpose The purpose of the study was to examine the long-term effect of a Group Lifestyle Balance ( GLB ) program on weight , impaired fasting glucose , hypertension , and hyperlipidemia in an urban , medically underserved community . Methods This study was a single-arm prospect i ve intervention study that was design ed to test the effectiveness of a community-based GLB intervention . In sum , 638 residents from 11 targeted neighborhoods were screened for body mass index ≥ 25 kg/m2 and metabolic syndrome . Eligible individuals took part in a 12-week GLB intervention ( n = 105 ) that addressed weight loss and physical activity . Subjects were followed for 24 months . Results The probability of being at risk for diabetes and cardiovascular disease was significantly reduced by 25.7 % over the long-term follow-up . Of the participants who lost at least 5 % of their body weight following the intervention , 52.6 % maintained the 5 % weight loss at their last follow-up time , weighing about 20 lb less than they did at baseline . Conclusion Risk reduction and weight loss maintenance are possible following a GLB intervention and have substantial potential for future public health impact OBJECTIVES To determine if a widely available weight-management program ( Weight Watchers ) could achieve sufficient weight loss in persons with prediabetes compared with a Diabetes Prevention Program-based individual counseling program supported by National Diabetes Education Program material s. METHODS We conducted an individual , r and omized intervention trial in Indianapolis , Indiana , in 2013 to 2014 , in 225 persons with prediabetes . We compared the Weight Watchers weight-management program ( n = 112 ) with Your Game Plan to Prevent Type 2 Diabetes , a program developed by the National Diabetes Education Program . Outcomes were weight and metabolic markers measured at baseline , 6 months , and 12 months . RESULTS Intervention participants lost significantly more weight than controls at 6 months ( 5.5 % vs 0.8 % ) and 12 months ( 5.5 % vs 0.2 % ; both P < .001 ) . The intervention group also had significantly greater improvements in hemoglobin A1c and high-density lipoprotein cholesterol level than did controls . CONCLUSIONS A large weight-management program is effective for achieving lifestyle changes associated with diabetes prevention . Such programs could significantly increase the availability of diabetes prevention programs worldwide making an immediate and significant public health impact OBJECTIVE —In participants of the Diabetes Prevention Program ( DPP ) r and omized to intensive lifestyle modification ( ILS ) , meeting ILS goals strongly correlated with prevention of diabetes in the group as a whole . Men met significantly more ILS goals than women but had a similar incidence of diabetes . Therefore , we explored sex differences in risk factors for diabetes and the effect of ILS on risk factors . RESEARCH DESIGN AND METHODS —Baseline risk factors for diabetes and percent change in risk factors over the first year in men versus women were compared using Wilcoxon 's rank-sum tests . RESULTS —At baseline , men were older and had a larger waist circumference ; higher fasting plasma glucose concentration , caloric intake , and blood pressure ; and lower HDL cholesterol and corrected insulin response than women , who were less physically active and had a higher BMI ( P < 0.01 for all comparisons ) . Over the first year of the DPP , no sex difference in risk factors for diabetes was observed for those who lost <3 % body weight . Weight loss of 3–7 % body weight yielded greater decreases in 2-h glucose ( P < 0.01 ) , insulin concentration ( P < 0.04 ) , and insulin resistance ( P < 0.03 ) in men than in women . Weight loss of > 7 % body weight result ed in greater decreases in 2-h glucose ( P < 0.01 ) , triglyceride level ( P < 0.01 ) , and A1C ( P < 0.03 ) in men than in women . CONCLUSIONS —Weight loss > 3 % body weight yielded greater reduction in risk factors for diabetes in men than in women . Despite the more favorable effects of ILS in men , baseline risk factors were more numerous in men and likely obscured any sex difference in incident diabetes
Findings are subject to incomplete reporting and heterogeneity of studies included , and confounding because most included studies used pre-post study design s. CONCLUSIONS DPP lifestyle modification programs achieved clinical ly meaningful weight and cardiometabolic health improvements .
Together , these data suggest that additional value is gained from these programs , reinforcing that they are likely very cost-effective
BACKGROUND The Diabetes Prevention Program ( DPP ) study showed that weight loss in high-risk adults lowered diabetes incidence and cardiovascular disease risk .
No prior analyses have aggregated weight and cardiometabolic risk factor changes observed in studies implementing DPP interventions in non research setting s in the United States .