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The Healthy Living Partnerships to Prevent Diabetes Study

2-Year Outcomes of a Randomized Controlled Trial

      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 contexts. 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 randomized; 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.

      Trial registration

      This study is registered at Clinicaltrials.gov NCT00631345.
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      References

        • CDC
        National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States, 2011.
        DHHS, Atlanta GA2011
        • Sloan F.A.
        • Bethel M.A.
        • Ruiz Jr, D.
        • Shea A.H.
        • Feinglos M.N.
        The growing burden of diabetes mellitus in the U.S. elderly population. 2008; 168: 192-199
        • Vinicor F.
        Invited commentary: translating diabetes research.
        Arch Intern Med. 2008; 168: 199
        • Knowler W.C.
        • Barrett-Connor E.
        • Fowler S.E.
        • et al.
        Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin.
        N Engl J Med. 2002; 346: 393-403
        • Tuomilehto J.
        • Lindstrom J.
        • Eriksson J.G.
        • et al.
        Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance.
        N Engl J Med. 2001; 344: 1343-1350
        • Ali M.K.
        • Echouffo-Tcheugui J.B.
        • Williamson D.F.
        How effective were lifestyle interventions in real-world settings that were modeled on the Diabetes Prevention Program?.
        Health Aff. 2012; 31: 67-75
        • Whittemore R.
        A systematic review of the translational research on the Diabetes Prevention Program.
        Transl Behav Med. 2011; 1: 480-491
        • Glasgow R.E.
        • Vogt T.M.
        • Boles S.M.
        Evaluating the public health impact of health promotion interventions: the RE-AIM framework.
        Am J Public Health. 1999; 89: 1322-1327
        • Ruggiero L.
        • Castillo A.
        • Quinn L.
        • Hochwert M.
        Translation of the Diabetes Prevention Program's lifestyle intervention: role of community health workers.
        Curr Diab Rep. 2012; 12: 127-137
        • Health Resources and Services Administration, DHHS
        Communty Health Worker National Workforce Study.
        Bureau of Health Professions, 2007
        • Seidel M.C.
        • Powell R.O.
        • Zgibor J.C.
        • Siminerio L.M.
        • Piatt G.A.
        Translating the Diabetes Prevention Program into an urban medically underserved community: a nonrandomized prospective intervention study.
        Diabetes Care. 2008; 31: 684-689
        • Ackermann R.T.
        • Finch E.A.
        • Brizendine E.
        • Zhou H.
        • Marrero D.G.
        • Translating the Diabetes Prevention Program into the community
        The DEPLOY pilot study.
        Am J Prev Med. 2008; 35: 357-363
        • Katula J.A.
        • Vitolins M.Z.
        • Rosenberger E.L.
        • et al.
        One-year results of a community-based translation of the Diabetes Prevention Program: Healthy-Living Partnerships to Prevent Diabetes (HELP PD) Project.
        Diabetes Care. 2011; 34: 1451-1457
        • Mau M.K.
        • Keawe'aimoku Kaholokula J.
        • West M.R.
        • et al.
        Translating diabetes prevention into native Hawaiian and Pacific Islander communities: the PILI 'Ohana Pilot project.
        Prog Community Health Partnersh. 2010; 4: 7-16
        • Ruggiero L.
        • Oros S.
        • Choi Y.K.
        Community-based translation of the Diabetes Prevention Program's lifestyle intervention in an underserved Latino population.
        Diabetes Educ. 2011; 37: 564-572
        • West D.S.
        • Bursac Z.
        • Cornell C.E.
        • et al.
        Lay health educators translate a weight-loss intervention in senior centers: a randomized controlled trial.
        Am J Prev Med. 2011; 41: 385-391
        • Katula J.A.
        • Vitolins M.Z.
        • Rosenberger E.L.
        • et al.
        Healthy Living Partnerships to Prevent Diabetes (HELP PD): design and methods.
        Contemp Clin Trials. 2010; 31: 71-81
        • Blackwell C.S.
        • Foster K.A.
        • Isom S.
        • et al.
        Healthy Living Partnerships to Prevent Diabetes: recruitment and baseline characteristics.
        Contemp Clin Trials. 2011; 32: 40-49
        • American Diabetes Association
        Diagnosis and classification of diabetes mellitus.
        Diabetes Care. 2004; 27: S5-S10
        • Matthews D.R.
        • Hosker J.P.
        • Rudenski A.S.
        • Naylor B.A.
        • Treacher D.F.
        • Turner R.C.
        Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man.
        Diabetologia. 1985; 28: 412-419
        • Katsuki A.
        • Sumida Y.
        • Gabazza E.C.
        • et al.
        Homeostasis model assessment is a reliable indicator of insulin resistance during follow-up of patients with type 2 diabetes.
        Diabetes Care. 2001; 24: 362-365
        • Williamson D.F.
        • Kahn H.S.
        • Worthman C.M.
        • Burnette J.C.
        • Russell C.M.
        Precision of recumbent anthropometry.
        Am J Hum Biol. 1993; 5: 159-167
        • Appel L.J.
        • Clark J.M.
        • Yeh H.C.
        • et al.
        Comparative effectiveness of weight-loss interventions in clinical practice.
        N Engl J Med. 2011; 365: 1959-1968
        • Ross R.
        • Lam M.
        • Blair S.N.
        • et al.
        Trial of prevention and reduction of obesity through active living in clinical settings: a randomized controlled trial.
        Arch Intern Med. 2012; 172: 414-424
        • Wadden T.A.
        • Volger S.
        • Sarwer D.B.
        • et al.
        A two-year randomized trial of obesity treatment in primary care practice.
        N Engl J Med. 2011; 365: 1969-1979