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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© 2013 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
