Health Behavior Change Following Stroke: Recommendations for Adapting the Diabetes Prevention Program–Group Lifestyle Balance Program

2020 ◽  
pp. 155982761989725
Author(s):  
Ryan R. Bailey ◽  
Jennifer L. Stevenson ◽  
Simon Driver ◽  
Evan McShan
Keyword(s):  
Focus Groups ◽  
Prevention Program ◽  
Diabetes Prevention ◽  
Lifestyle Modification ◽  
Recurrent Stroke ◽  
Diabetes Prevention Program ◽  
Health Behavior Change ◽  
Community Dwelling ◽  
Dietary Recommendations ◽  
Care Partners

Objective. History of stroke increases risk for recurrent stroke, which is a significant issue faced by survivors. The Diabetes Prevention Program–Group Lifestyle Balance (DPP-GLB) program is an effective lifestyle modification intervention for ameliorating cardiovascular risk factors but has not been adapted to account for common stroke-related deficits. The purpose of this study was to determine appropriate adaptations to the DPP-GLB for adults with stroke. Design and Methods. In this phenomenological qualitative study, a total of 15 community-dwelling adults with stroke and 10 care-partners participated in 4 focus groups to review DPP-GLB curriculum materials and provide recommendations for adaptation. Focus groups were recorded and transcribed. Inductive content analysis was used to identify key themes. Results. Three themes were identified. First, physical, cognitive, sensory, and psychosocial stroke-related deficits could affect DPP-GLB participation. Second, existing DPP-GLB characteristics could facilitate participation by adults with stroke. Third, stroke-specific adaptations were recommended, including modified session content and format, adapted physical activity and dietary recommendations, and inclusion of care-partners. Conclusion. Current DPP-GLB content and structure may be insufficient to meet the unique needs of adults with stroke. The suggested adaptations should be incorporated into a stroke-specific curriculum and tested for preliminary efficacy for reducing recurrent stroke risk.

scholarly journals Sex Differences in Diabetes Risk and the Effect of Intensive Lifestyle Modification in the Diabetes Prevention Program

Diabetes Care ◽  
2008 ◽  
Vol 31 (7) ◽  
pp. 1416-1421 ◽  
Author(s):  
L. Perreault ◽  
Y. Ma ◽  
S. Dagogo-Jack ◽  
E. Horton ◽  
D. Marrero ◽  
...  
Keyword(s):  
Sex Differences ◽  
Prevention Program ◽  
Diabetes Prevention ◽  
Lifestyle Modification ◽  
Diabetes Prevention Program ◽  
Diabetes Risk

scholarly journals Genetic Modulation of Lipid Profiles following Lifestyle Modification or Metformin Treatment: The Diabetes Prevention Program

PLoS Genetics ◽  
2012 ◽  
Vol 8 (8) ◽  
pp. e1002895 ◽  
Author(s):  
Toni I. Pollin ◽  
Tamara Isakova ◽  
Kathleen A. Jablonski ◽  
Paul I. W. de Bakker ◽  
Andrew Taylor ◽  
...  
Keyword(s):  
Prevention Program ◽  
Diabetes Prevention ◽  
Lifestyle Modification ◽  
Diabetes Prevention Program ◽  
Lipid Profiles ◽  
Metformin Treatment ◽  
Genetic Modulation

scholarly journals LEVERAGING COMMUNITIES AS NETWORKS TO REDUCE MALNUTRITION IN OLDER ADULTS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S226-S227
Author(s):  
Tina Sadarangani ◽  
Jeannette Beasley ◽  
Shannon E Jarrott
Keyword(s):  
Older Adults ◽  
At Risk ◽  
Asian American ◽  
Prevention Program ◽  
Diabetes Prevention ◽  
Diabetes Prevention Program ◽  
Adverse Outcomes ◽  
Community Dwelling ◽  
Community Based ◽  
Community Dwelling Older Adults

Abstract Malnutrition in older adults, while ubiquitous, remains largely underrecognized and undertreated. In community-dwelling older adults, 25% of those at risk of over or under nutrition do not receive any dietary interventions; routine screenings for malnutrition are not typically required in community-based settings. In this interdisciplinary symposium, we explore issues focused on the delivery of evidence-based nutrition interventions to meet the needs of community-dwelling older adults. Using national survey data, we begin by underscoring the importance of treating the complex needs of adults at risk of malnutrition by examining health sequelae, specifically hospitalizations, in community-dwelling adults receiving home-delivered meals. We subsequently examine approaches to malnutrition screening in community-based settings, focusing on the utility of the DETERMINE checklist. We explore barriers and facilitators of providing person-centered nutrition to ethnically diverse Asian American older adults in the adult day healthcare setting. Finally, we shift our focus to overnutrition, discussing the dissemination of a telehealth diabetes prevention program, BRInging the Diabetes prevention program to GEriatric populations (BRIDGE) among older adult meal program recipients. Older adults in community-based health settings are at risk of malnutrition, and among them, those who are prone to social isolation, are at highest risk for adverse outcomes. While congregate settings can facilitate social interaction, honoring food preferences and facilitating choice to address undernutrition, is challenging. Conversely, telehealth interventions may present a feasible approach for addressing overnutrition. We conclude by discussing how current and future research can inform innovative person-centered community-based approaches to identify and treat malnutrition.

Interaction of diabetes genetic risk and successful lifestyle modification in the Diabetes Prevention Program.

2021 ◽  
Author(s):  
Sridharan Raghavan ◽  
Kathleen Jablonski ◽  
Linda M. Delahanty ◽  
Nisa M. Maruthur ◽  
Aaron Leong ◽  
...  
Keyword(s):  
Prevention Program ◽  
Genetic Risk ◽  
Diabetes Prevention ◽  
Lifestyle Modification ◽  
Diabetes Prevention Program

scholarly journals The Association ofENPP1K121Q with Diabetes Incidence Is Abolished by Lifestyle Modification in the Diabetes Prevention Program

2009 ◽  
Vol 94 (2) ◽  
pp. 449-455 ◽  
Author(s):  
Allan F. Moore ◽  
Kathleen A. Jablonski ◽  
Clinton C. Mason ◽  
Jarred B. McAteer ◽  
Richard F. Arakaki ◽  
...  
Keyword(s):  
Prevention Program ◽  
Diabetes Prevention ◽  
Lifestyle Modification ◽  
Diabetes Prevention Program ◽  
Diabetes Incidence

scholarly journals Effect of Metformin and Lifestyle Interventions on Mortality in the Diabetes Prevention Program and Diabetes Prevention Program Outcomes Study

2021 ◽  
Author(s):  
Christine G. Lee ◽  
Brandy Heckman-Stoddard ◽  
Dana Dabelea ◽  
Kishore M. Gadde ◽  
David Ehrmann ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Prevention Program ◽  
Diabetes Prevention ◽  
Lifestyle Modification ◽  
Diabetes Prevention Program ◽  
Lifestyle Interventions ◽  
Program Outcomes ◽  
Specific Mortality ◽  
Outcomes Study

<b>Objective: </b>To determine whether metformin or lifestyle modification can lower rates of all-cause and cause-specific mortality in the Diabetes Prevention Program and Diabetes Prevention Program Outcomes Study. <p><b>Research Design and Methods: </b>From 1996-1999,<b> </b>3234 adults at high risk for type 2 diabetes were randomized to an intensive lifestyle intervention, masked metformin or placebo. Placebo and lifestyle interventions stopped in 2001, and a modified lifestyle program was offered to everyone, but unmasked study metformin continued in those originally randomized.<b> </b>Causes of deaths through December 31, 2018 were adjudicated by blinded reviews. All-cause and cause-specific mortality hazard ratios were estimated from Cox-proportional hazard regression models and Fine-Gray models, respectively.</p> <p><b>Results:</b> Over a median of 21 (IQR 20-21) years, 453 participants died. Cancer was the leading cause of death (n=170), followed by cardiovascular disease (n=131). Compared to placebo, metformin did not influence mortality from all causes (HR 0.99, 95% CI 0.79, 1.25), cancer (HR 1.04, 95% CI 0.72, 1.52) or cardiovascular disease (HR 1.08, 95% CI 0.70, 1.66). Similarly, lifestyle modification did not impact all-cause (HR 1.02, 95% CI 0.81, 1.28), cancer (HR 1.07, 95% CI 0.74, 1.55) or cardiovascular disease (HR 1.18, 95% CI 0.77, 1.81) mortality. Analyses adjusted for diabetes status and duration, body mass index, cumulative glycemic exposure, and cardiovascular risks yielded similar results for all-cause mortality.</p> <p><b>Conclusions: </b>Cancer was the leading cause of mortality among adults at high risk for type 2 diabetes. Although metformin and lifestyle modification prevented diabetes, neither strategy reduced all-cause, cancer, or cardiovascular mortality rates.</p>

scholarly journals An Electronic Health Record Compatible Model to Predict Personalized Treatment Effects from the Diabetes Prevention Program: A Cross-Evidence Synthesis Approach Using Clinical Trial and Real World Data

2021 ◽  
Author(s):  
David M Kent ◽  
Jason Nelson ◽  
Anastassios Pittas ◽  
Francis Colangelo ◽  
Carolyn Koenig ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Electronic Health Record ◽  
Prevention Program ◽  
Diabetes Prevention ◽  
Treatment Effects ◽  
Risk Model ◽  
Lifestyle Modification ◽  
Diabetes Prevention Program ◽  
Health Record ◽  
Lifestyle Recommendations

Background: An intensive lifestyle modification program or metformin pharmacotherapy reduced the risk of developing diabetes in patients at high risk, but are not widely used in the 88 million American adults with prediabetes. Objective: Develop an electronic health record (EHR) based risk tool that provides point-of-care estimates of diabetes risk to support targeting interventions to patients most likely to benefit. Design: Cross-design synthesis: risk prediction model developed and validated in large observational database, treatment effect estimates from risk-based reanalysis of clinical trial data. Setting: Outpatient clinics in US. Patients: Risk model development cohort: 1.1 million patients with prediabetes from the OptumLabs Data Warehouse (OLDW); validation cohort: distinct sample of 1.1 million patients in OLDW. Randomized clinical trial cohort: 3081 people from the Diabetes Prevention Program (DPP) study. Interventions: Randomization in the DPP: 1) an intensive program of lifestyle modification; 2) standard lifestyle recommendations plus 850 mg metformin twice daily; or 3) standard lifestyle recommendations plus placebo twice daily. Results: Eleven variables reliably obtainable from the EHR were used to predict diabetes risk. This model validated well in the OLDW (c-statistic = 0.76; observed 3-year diabetes rate was 1.8% in lowest-risk quarter and 19.6% in highest-risk quarter). In the DPP, the hazard ratio for lifestyle modification was constant across all levels of risk (HR = 0.43, 95% CI 0.35 to 0.53); while the HR for metformin was highly risk-dependent (HR HR = 1.1 [95% CI: 0.61 to 2.0] in the lowest risk quarter vs. HR=0.45 [95% CI: 0.35 to 0.59] in the highest risk quarter). Fifty-three percent of the benefits of population wide dissemination of the DPP lifestyle modification, and 76% of the benefits of population wide metformin therapy can be obtained targeting the highest risk quarter of patients. Limitations: Differences in variable definitions and in missingness across observational and trial settings may introduce estimation error in risk based treatment effects. Conclusion: An EHR compatible risk model might support targeted diabetes prevention to more efficiently realize the benefits of the DPP interventions.

scholarly journals Comprehensive Lifestyle Improvement Program for Prostate Cancer (CLIPP): Protocol for a Feasibility and Exploratory Efficacy Study in Men on Androgen Deprivation Therapy (Preprint)

2018 ◽  
Author(s):  
Amit Algotar ◽  
Chiu-Hsieh Hsu ◽  
HH Sherry Chow ◽  
Shona Dougherty ◽  
Hani Babiker ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Prostate Cancer ◽  
Prevention Program ◽  
Diabetes Prevention ◽  
Cardiometabolic Risk ◽  
Lifestyle Modification ◽  
Diabetes Prevention Program ◽  
Markers Of Inflammation ◽  
Modification Intervention

BACKGROUND Androgen deprivation therapy (ADT) for prostate cancer is associated with adverse cardiometabolic effects such as reduced libido, hot flashes, metabolic syndrome, diabetes, myocardial infarction, and stroke. This reduces quality of life and potentially increases mortality. Several large clinical trials have demonstrated improvements in cardiometabolic risk with comprehensive multimodality lifestyle modification. However, there is a lack of data for such interventions in men on ADT for prostate cancer, and existing studies have used non-standardized interventions or lacked data on metabolic risk factors. OBJECTIVE The Comprehensive Lifestyle Improvement Project for Prostate Cancer (CLIPP) is designed to address these gaps by using an intervention modeled on the Diabetes Prevention Program, a standardized multicomponent intervention with demonstrated effectiveness in reducing cardiometabolic risk factors that has been successfully adapted for multiple disease types including breast cancer. METHODS A single-arm unblinded clinical trial will be conducted to determine the feasibility of conducting a 24-week comprehensive lifestyle modification intervention that targets weight loss and increased physical activity modeled on the Diabetes Prevention Program in 30 men on ADT for prostate cancer. Secondary aims are to determine the effect of the intervention on cardiometabolic markers and quality of life. The tertiary aim is to determine the effect of the intervention on markers of inflammation and angiogenesis, important mechanisms for prostate cancer progression. Participants will be recruited from the University of Arizona Cancer Center and the surrounding community. The intervention will be delivered weekly in person and over the phone for 16 weeks. For Weeks 16-24, participants receive weekly phone calls from the study health coach to motivate them to continue their lifestyle modification. Questionnaire and biological data are collected at baseline, 12 weeks, and 24 weeks. Body composition using dual-energy x-ray absorptiometry scans will be performed at baseline and end of study. RESULTS Based on a sample size of 30, the two-sided 95% confidence interval will not be wider than 0.373 standard deviations for the adherence rate and will not be wider than 0.374 for the retention rate. In addition, the study will have a power of 80% to detect a change of 0.47 standard deviations from baseline for each of the markers investigated in the secondary and tertiary aims assuming a within-subject correlation of 0.20 at a significance level of 5%. The recruitment period is from October 2018 to April 2019. CONCLUSIONS The aim of CLIPP is to determine the feasibility of conducting a Diabetes Prevention Program–style comprehensive lifestyle modification intervention in men with ADT for prostate cancer and its effects on cardiometabolic adverse effects, quality of life, as well as markers of inflammation and angiogenesis. Results will inform the development of future clinical trials in this population. INTERNATIONAL REGISTERED REPOR DERR1-10.2196/12579

Consulting consumers to develop marketing and recruitment strategies for a diabetes prevention program

2009 ◽  
Vol 15 (2) ◽  
pp. 173 ◽  
Author(s):  
Dianne Berryman ◽  
Marie Gill ◽  
Jonathan Pietsch ◽  
Hannah Halloran
Keyword(s):  
Risk Factors ◽  
Type 2 Diabetes ◽  
Focus Groups ◽  
Prevention Program ◽  
Diabetes Prevention ◽  
Diabetes Prevention Program ◽  
Recruitment Strategies ◽  
Knowledge And Beliefs ◽  
Marketing Messages

Recruitment of participants to health education programs is a challenge often encountered in community health care settings. This paper outlines the process used to identify what strategies, approaches and messages raise community awareness of risk factors for type 2 diabetes and elicit action on the part of individuals to address risk factors. Consumer focus groups were conducted to explore people’s concerns, knowledge and beliefs around prevention of diabetes and with an aim to identify marketing messages and strategies for engaging participants in a diabetes prevention program. Findings from the focus groups were used to develop marketing messages that were then tested in further consumer consultations. They identified commonalities and differences between cultural groups. The key common point in relation to the marketing messages was the need to emphasise the consequences of type 2 diabetes and the individual relevance of risk factors. The importance of receiving information from trusted health professionals and the need to personalise messages of risk and encourage individual action was also highlighted in the research and incorporated into marketing and recruitment strategies.

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