Weight Management in Diabetes Prevention

BACKGROUND In 1999, type 2 diabetes (T2DM) was labeled an emerging epidemic in youth and racial and ethnic minority youth were identified at highest risk. Two decades later, there remains no gold standard T2DM prevention intervention for youth. OBJECTIVE This research protocol aims to test the efficacy of a telehealth diabetes prevention intervention for African American (AA) families with children at risk for T2DM. Concurrently, investigators aim to evaluate a multifaceted implementation strategy for the uptake of the intervention within the pediatric weight management clinic at the University of Mississippi Medical Center (UMMC). METHODS This single arm trial will enroll 20 parents with overweight or obesity of children (8- to 11-years) with overweight or obesity, both of whom are at risk for T2DM. Parents will meet in small groups (5 parents per group) weekly for 11-weeks and then monthly for 4 monthly maintenance sessions via videoconference using Wi-Fi-enabled tablets with cellular connectivity. The intervention will be adapted from the National Diabetes Prevention Program and Power to Prevent, a diabetes prevention program tailored for AA families. The same lifestyle intervention facilitated by a racially concordant Lifestyle Coach trained in the Diabetes Prevention Program will be delivered to all groups (n=4). Participants will be recruited in-person during patient encounters at the pediatric weight management clinic. Sessions will consist of dietary and physical activity behavior change strategies, problem-solving, and goal setting. The implementation strategy has two targets: the pediatric weight management clinic site and clinical team; and parents of children at risk for T2DM engaged in intensive obesity treatment for the prevention of T2DM. The multifacted implementation protocol includes four discrete strategies: creating a new clinical team; changing the service site; intervening with families; and organizational readiness for change. RESULTS Recruitment and enrollment will begin in December 2020 and the intervention is scheduled to be delivered to the first wave of parents in January 2021. Results are expected to be submitted for publication beginning in November 2021 through 2022. The primary outcome measure for the pilot trial will include change from baseline to 12- and 30-weeks in child body mass index (BMI) z-score (index participant and parent BMI. The implementation evaluation will include multiple measures of feasibility, acceptability, appropriateness, fidelity, and efficacy. This protocol has been approved by the UMMC’s Institutional Review Board (#2020V0249). CONCLUSIONS The proposed intervention approach is supported by the scientific literature and is scalable given current and future health care subsidies for telehealth. Findings from this pilot study will begin to address critical barriers to defining a gold standard lifestyle intervention for AA families with children at risk for T2DM. If effective, the intervention could be feasibly disseminated to treat obesity and prevent T2DM in high-risk, AA pediatric populations. CLINICALTRIAL ClinicalTrials.gov: https://clinicaltrials.gov/ct2/show/NCT04618458

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Development of a Videoconference-Adapted Version of the Community Diabetes Prevention Program, and Comparison of Weight Loss With In-Person Program Delivery

Military Medicine ◽

10.1093/milmed/usz069 ◽

2019 ◽

Vol 184 (11-12) ◽

pp. 647-652 ◽

Cited By ~ 1

Author(s):

Amy Taetzsch ◽

Cheryl H Gilhooly ◽

Asma Bukhari ◽

Sai Krupa Das ◽

Edward Martin ◽

...

Keyword(s):

Weight Loss ◽

Body Weight ◽

Weight Management ◽

Prevention Program ◽

Diabetes Prevention ◽

Diabetes Prevention Program ◽

Healthy Weight ◽

Community Group ◽

Delivery Times ◽

Percent Body Weight

Abstract Introduction Effective, standardized, and easily accessible weight management programs are urgently needed for military beneficiaries. Videoconference interventions have the potential for widespread scaling, and can provide both real time interaction and flexibility in delivery times regardless of location, but there is little information on their effectiveness and acceptability. Materials and Methods This study as part of a larger weight loss trial describes the videoconference adaption of Group Lifestyle Balance (GLB) program, a community group-based Diabetes Prevention Program intervention, and provides a comparison of weight loss and meeting attendance between in-person and videoconference delivery modes over 12 weeks in adult family members of military service members. Forty-three participants were enrolled from two military installations and received either the videoconference-adapted or an in-person GLB program in a non-randomized trial design. Differences in program attendance and percent weight lost at 12 weeks were compared by independent samples t-tests and nonparametric methods. Group differences in the percentage of weight lost over the 12-week period were analyzed using a linear mixed model. Results All GLB intervention components were successfully delivered by videoconference with minor adaptations for the different delivery mechanism. Participant retention was 70% and 96% in the in-person and videoconference groups, respectively (p = 0.04). Completing participants in both groups lost a significant percent body weight over the 12 week intervention (p < 0.001) and there was no difference in percent body weight after 12 weeks of intervention (6.2 ± 3.2% and 5.3 ± 3.4% for in-person and videoconference at 12 weeks, respectively; p = 0.60). Conclusion This study describes the first videoconference adaption of the GLB program for use in military families. Attrition was lower in the videoconference group, and there were a similar levels of weight loss in both groups regardless of delivery modality. Videoconference weight loss interventions are effective and feasible for scaling to support healthy weight management in military as well as civilian populations.

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Does the NHS Diabetes Prevention Programme prevent diabetes? A population-based matched cohort study

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.1184 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

V Nguyen ◽

R Aldridge ◽

R Blackburn ◽

A Hayward ◽

F Greaves ◽

...

Keyword(s):

Cohort Study ◽

High Risk ◽

Weight Management ◽

Diabetes Prevention ◽

Prevention Programme ◽

Short Term ◽

Face To Face ◽

Diabetes Prevention Programme ◽

Intermediate Outcomes ◽

The Impact

Abstract Background To reduce the incidence of type 2 diabetes (T2DM) in England, the National Health Service piloted the Diabetes Prevention Programme (DPP). The DPP aims to prevent T2DM by providing high-risk adults with access to 13 face-to-face sessions over nine months that focus on diet and weight management. The DPP has been shown to improve intermediate outcomes for T2DM prevention (weight loss and glycated haemoglobin (HbA1c) reduction). However, there is a lack of evidence examining incident T2DM as the outcome. Methods We conducted a retrospective observational cohort study using linked electronic health records from primary (Clinical Practice Research Datalink) and secondary (Hospital Episode Statistics) care for June 2016 to January 2019. We compared rates of new T2DM diagnoses among eligible adults who were referred to the DPP with rates for propensity score-matched (ratio of 1:4) controls who were eligible for the DPP but were not invited. DPP eligibility was defined as having HbA1c levels of 42-47 mmol/mol or fasting plasma glucose (FPG) levels of 5.5-6.9 mmol/L. Adults with pre-existing T2DM were excluded. Time to the first record of T2DM was modelled using Cox regression with age, alcohol intake, body mass index, ethnicity, sex, HbA1c, index of multiple deprivation and smoking status included as covariates. Results We identified 2205 individuals who participated in the DPP and 8820 matched controls with a similar breakdown in age, sex, HbA1c and FPG. During the 2.5-year study period, 4.13% of DPP individuals developed T2DM vs 6.42% of controls. Our results indicate that DPP referrals were associated with a 59% reduction T2DM incidence rates [adjusted hazard ratio=0.41;95%CI=0.38-0.44]. Conclusions This is the first study to investigate the impact of the DPP on T2DM, relative to usual care. Our results provide support for the effectiveness of DPP in preventing T2DM onset and are compatible with findings for similar interventions in other settings. Key messages The evidence suggests that providing consistent face-to-face sessions which concentrate on diet and weight management can reduce short-term T2DM incidences in high-risk adults. With a 59% reduction in T2DM rates in DPP referees relative to eligible adults who were not referred, the DPP is effective in reducing short-term T2DM incidences in high-risk adults.

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