Introduction
Translational lifestyle change programs for community and clinical settings have been
available for a decade, yet there are limited data on their comparative effectiveness.
This study examines the effectiveness of a Centers for Disease Control and Prevention–aligned
lifestyle change program relative to usual care in clinical practice.
Methods
This was an electronic health record–based retrospective cohort study conducted in
a community-based healthcare system. Investigators identified adult program participants
and usual-care patients in the electronic health record between 2010 and 2018 and
defined their index date (baseline) as the first lifestyle change program encounter
or a random encounter date, respectively. Participants were matched 1:2 to usual-care
patients on baseline demographics and clinical characteristics using propensity-score
methods. Changes in body weight and blood pressure were examined from baseline through
24 months.
Results
The authors identified 2,833 program participants and 438,432 usual-care patients
meeting study eligibility criteria. A total of 2,833 program participants were matched
to 4,776 usual-care patients; the average age was 54 years, and 80% of the participants
were female. Program participation was associated with a 1.9- and 1.6-fold higher
prevalence of clinically meaningful (≥5%) weight loss at 12- and 24-month follow-up
than usual care and a higher prevalence of blood pressure control at 12 months but
not at 24 months. Patients without type 2 diabetes at baseline had more pronounced
outcomes than those with type 2 diabetes.
Conclusions
This study demonstrates the effectiveness of an evidence-based, Centers for Disease
Control and Prevention–aligned lifestyle change program in reducing cardiometabolic
risk factors compared with usual care in clinical practice, with long-term reductions
in weight and transient reductions in blood pressure.
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REFERENCES
- Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin.N Engl J Med. 2002; 346: 393-403
- Effect of weight loss with lifestyle intervention on risk of diabetes.Diabetes Care. 2006; 29: 2102-2107
- Impact of intensive lifestyle and metformin therapy on cardiovascular disease risk factors in the Diabetes Prevention Program.Diabetes Care. 2005; 28: 888-894
- Translating the Diabetes Prevention Program into the community: the DEPLOY Pilot Study.Am J Prev Med. 2008; 35: 357-363
- Results of a pilot diabetes prevention intervention in East Harlem, New York City: project HEED.Am J Public Health. 2010; 100: S232-S239
- One-year results of a community-based translation of the Diabetes Prevention Program: Healthy-Living Partnerships to Prevent Diabetes (HELP PD) project [published correction appears in Diabetes Care. 2012;35(2):455].Diabetes Care. 2011; 34: 1451-1457
- The Live Well, Be Well study: a community-based, translational lifestyle program to lower diabetes risk factors in ethnic minority and lower-socioeconomic status adults.Am J Public Health. 2012; 102: 1551-1558
- Outcomes of a Latino community-based intervention for the prevention of diabetes: the Lawrence Latino Diabetes Prevention Project.Am J Public Health. 2012; 102: 336-342
- Translating the Diabetes Prevention Program lifestyle intervention for weight loss into primary care: a randomized trial.JAMA Intern Med. 2013; 173: 113-121
- How effective were lifestyle interventions in real-world settings that were modeled on the Diabetes Prevention Program?.Health Aff (Millwood). 2012; 31: 67-75
About the national DPP. Centers for Disease Control and Prevention National Diabetes Prevention Program. https://www.cdc.gov/diabetes/prevention/about.htm. Updated November 15, 2018. Accessed May 26, 2019.
- Evaluation of a community Diabetes Prevention Program delivered by diabetes educators in the United States: one-year follow up.Diabetes Res Clin Pract. 2014; 106: e49-e52
- Reach and effectiveness of a weight loss intervention in patients with prediabetes in Colorado.Prev Chronic Dis. 2010; 7 (Accessed August 11, 2020): A103
- Implementing a state-based cardiovascular disease and diabetes prevention program.Diabetes Care. 2010; 33: 2543-2545
- Lessons from launching the Diabetes Prevention Program in a large integrated health care delivery system: a case study.Popul Health Manag. 2017; 20: 262-270
- Community-based translation of the Diabetes Prevention Program's lifestyle intervention in an underserved Latino population.Diabetes Educ. 2011; 37: 564-572
- Effect of a low-resource-intensive lifestyle modification program incorporating gymnasium-based and home-based resistance training on type 2 diabetes risk in Australian adults.Diabetes Care. 2008; 31: 2244-2250
- A national effort to prevent type 2 diabetes: participant-level evaluation of CDC's National Diabetes Prevention Program.Diabetes Care. 2017; 40: 1331-1341
- Longitudinal weight outcomes from a behavioral lifestyle intervention in clinical practice.Diabetes Educ. 2019; 45: 529-543
- Adapting the Group Lifestyle BalanceTM Program for weight management within a large health care system Diabetes Education Program.Diabetes Educ. 2014; 40: 299-307
- Accessible weight loss: adapting a lifestyle intervention for adults with impaired mobility.Disabil Health J. 2017; 10: 139-144
- Preventing type 2 diabetes in communities across the U.S.: the National Diabetes Prevention Program.Am J Prev Med. 2013; 44: S346-S351
- Modifying an evidence-based lifestyle programme for individuals with traumatic brain injury.Brain Inj. 2017; 31: 1612-1616
- Development and validation of a patient self-assessment score for diabetes risk.Ann Intern Med. 2009; 151: 775-783
- Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries.Am J Epidemiol. 2011; 173: 676-682
- Short-term weight trajectories and long-term weight outcomes from a lifestyle intervention in real-world clinical practice.Transl Behav Med. 2019; (In press. Online August 1, 2019.)
- 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice guidelines [published correction appears in Hypertension. 2018;71(6):e136–e139] [published correction appears in Hypertension. 2018;72(3):e33].Hypertension. 2018; 71: 1269-1324
- An introduction to propensity score methods for reducing the effects of confounding in observational studies.Multivariate Behav Res. 2011; 46: 399-424
- Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples.Stat Med. 2009; 28: 3083-3107
- Evaluating community-based translational interventions using historical controls: propensity score vs. disease risk score approach.Prev Sci. 2019; 20: 598-608
- Impact of a randomized control group on perceived effectiveness of a disease management programme for diabetes type 2.Eur J Public Health. 2012; 22: 625-629
- Rethinking historical controls.Biostatistics. 2001; 2: 383-396
- Stepping back to move forward: evaluating the effectiveness of a diabetes prevention program within a large integrated healthcare delivery system.J Healthc Qual. 2017; 39: 278-293
- 2006 Canadian clinical practice guidelines on the management and prevention of obesity in adults and children [summary].CMAJ. 2007; 176: S1-S13
- Threats to applicability of randomised trials: exclusions and selective participation.J Health Serv Res Policy. 1999; 4: 112-121
- Cardiometabolic risk factor changes observed in diabetes prevention programs in U.S. settings: a systematic review and meta-analysis.PLoS Med. 2016; 13e1002095
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