A National Effort to Prevent Type 2 Diabetes: Participant-Level Evaluation of CDC's National Diabetes Prevention Program

Abstract

Objective: To assess participant-level results from the first 4 years of implementation of the National Diabetes Prevention Program (National DPP), a national effort to prevent type 2 diabetes in those at risk through structured lifestyle change programs.

Research design and methods: Descriptive analysis was performed on data from 14,747 adults enrolled in year-long type 2 diabetes prevention programs during the period February 2012 through January 2016. Data on attendance, weight, and physical activity minutes were summarized and predictors of weight loss were examined using a mixed linear model. All analyses were performed using SAS 9.3.

Results: Participants attended a median of 14 sessions over an average of 172 days in the program (median 134 days). Overall, 35.5% achieved the 5% weight loss goal (average weight loss 4.2%, median 3.1%). Participants reported a weekly average of 152 min of physical activity (median 128 min), with 41.8% meeting the physical activity goal of 150 min per week. For every additional session attended and every 30 min of activity reported, participants lost 0.3% of body weight (P < 0.0001).

Conclusions: During the first 4 years, the National DPP has achieved widespread implementation of the lifestyle change program to prevent type 2 diabetes, with promising early results. Greater duration and intensity of session attendance resulted in a higher percent of body weight loss overall and for subgroups. Focusing on retention may reduce disparities and improve overall program results. Further program expansion and investigation is needed to continue lowering the burden of type 2 diabetes nationally.

Figure 1

Flowchart of study inclusion/exclusion criteria.

Figure 2

A: Number of eligible participants enrolled in the lifestyle change program, by number of months in the program. Median number of months attended was 5. B: Number of eligible participants enrolled in the lifestyle change program, by number of sessions attended. Median number of sessions attended was 14. A participant’s eligibility was based on the results of a blood-based test (A1C, FBG, or OGTT), their score on the CDC’s or the ADA’s prediabetes risk test, or a history of GDM. Participants must have been enrolled between February 2012 and January 2015 in a program that held sessions for at least 12 months after their enrollment and attended at least one session. Number of months in the program is calculated as the number of days from first session attended to last session attended, divided by 365, multiplied by 12, and rounded. A person attending only the first session offered is said to have attended only month 1 of the program.

Figure 3

A: Median percent weight change (among participants with at least two recorded weights [94.2%]) by number of sessions attended for eligible participants enrolled in a lifestyle change program. B: Median number of weekly physical activity minutes (among participants who reported physical activity minutes [87.7%]) by number of sessions attended for eligible participants enrolled in a lifestyle change program. A participant’s eligibility was based on the results of a blood-based test (A1C, FBG, or OGTT), their score on the CDC’s or the ADA’s prediabetes risk test, or a history of GDM. Participants must have been enrolled between February 2012 and January 2015 in a program that held sessions for at least 12 months after their enrollment and attended at least one session. ‖, the vertical reference line indicates the 5% weight loss goal (A) and 150-min physical activity goal (B).