National Diabetes Prevention Program Effective and Evolving

Participating in a structured lifestyle program with regularly attended sessions promotes improved eating habits and commitment to exercise forestallling diabetes risks.

With Elizabeth K. Ely, MS, and Elena Christofides, MD

Results from the first four years of the National Diabetes Prevention Program (NDPP) showed that persistence and intensity in both attendance at meetings and exercise lead to reduced body weight.1

“The results confirm what we believed to be true—that the combination of program intensity and duration are important factors in achieving the desired weight loss goal of 5-7%,” lead study author Elizabeth K. Ely, MS, a statistician at the Centers for Disease Control and Prevention in Atlanta told EndocrineWeb.

“Participants who remained in the program during the maintenance phase lost more weight than those who only completed the first 6 months of the program,” Elizabeth Ely added; the findings1 were published online in Diabetes Care.

National Diabetes Prevention Program effective in reducing diabetes risk.

Focused Lifestyle Changes May Lessen Diabetes Risks

The NDPP is a structured curriculum oriented to guide participants in making changes to their lifestyle that will promote modest weight loss and moderate increases in physical activity. The program consists of a series of sessions over the course of one year.

In these sessions, a trained lifestyle coach delivered information from an approved curriculum, recommended physical activities to do at home between sessions, and provided feedback to participants to improve behavioral changes.

The minimum threshold for program participation was four sessions over one year as it was the minimum number of sessions deemed necessary to elicit lifestyle and body weight changes that could affect the prevention or development of type 2 diabetes (T2D).2  The researchers defined participation intensity is the total number of sessions attended in the course of one year.

“From a clinical guidance perspective, the National Diabetes Prevention Program is geared toward people who are at risk for diabetes, who have already had risk factors or risk score calculators or labs that are abnormal, which is, unfortunately, most of the U.S. right now,” Elena A. Christofides, MD, FACE, an endocrinologist at Endocrinology Associates, Inc., in Columbus, OH, told EndocrineWeb. Decreasing the national burden of T2D is critical, and the NDPP is a good resource for addressing this significant medical concern.

Overview of National Diabetes Prevention Program preliminary results:1

  • 14,747 adults from 220 organizations participated between February 2012 and January 2016
  • 86.6% of those participating met the threshold of four or more sessions in one year
  • Attendance of median 14 sessions
  • Average of 172 days in the program (median 134 days)
  • Over one-third (35.5%) lost at least 5% weight
  • 80.3% of participants were female
  • Odds of meeting 5% weight loss significantly lower among:
  • Non-Hispanic black and participants in the other race/ethnicity category than non-Hispanic whites
  • Younger participants than older participants
  • Females than males
  • Average weight loss of 4.2%
  • Average physical activity of 152 minutes/week
  • 41.8% of participants met physical activity goal of 150 minutes/week

“Every additional session attended and every 30 minutes of reported exercise associated with additional 0.3% weight loss,” said Ms. Ely. The increased weight loss correlated with higher participation intensity is perhaps not surprising. Sessions allow the prevention of diabetes to be integrated into a social context.

“What’s really interesting and important about the study findings is that it basically proves that humans are social creatures, and the more social we are, the better we respond to stimuli,” said Dr. Christofides. “The more socially engaged a person is, the more likely that person is to succeed at anything, and it’s truly about movement and engagement. The best programs for diabetes prevention are structured around that,” she said.

Program Expansion Using Virtual Meetings

To expand enrollment, the NDPP began a virtual program in February 2015.

“We expect virtual programs to attract younger participants. Early results from data submitted from virtual programs indicate this to be the case,” said Ms. Ely. The gender bias toward female participation in onsite attendance is switched in the virtual implementation in the NDPP: “In addition, we are seeing more men enrolling through virtual programs than through in-person programs,” she continued.

Obstacles and Opportunities in Underserved Communities

While non-Hispanic White participants experienced an adjusted percent weight loss of 4.6%, non-Hispanic Black participants experienced the lowest adjusted percent weight loss, 3.2%, when compared with all other racial and ethnic groups.

“Our data have consistently shown that participants who stay in the program longer and attend more sessions lose more body weight. We have also seen that non-Hispanic Black participants attend fewer sessions and stayed in the program for shorter periods of time than non-Hispanic White participants. Therefore, it is felt that this difference in weight loss is related to retention more than anything else. Why retention is more of an issue among non-Hispanic Black participants is beyond the scope of this study,” Ms. Ely told EndocrineWeb.

Cultural differences in non-Hispanic Blacks, such as a stronger sense of community-based around church and family, could mean that these participants are less likely to seek validation and engagement outside of known communities, resulting in lower rates of participation in the NDPP,” said Dr. Christofides. She also suggests that “society as a whole needs better solutions for real, meaningful change in preventative healthcare, particularly in socioeconomically underprivileged areas. “

“How do we make sure that people have access to the time they need to be physically active to prevent diabetes and decrease their risk?” asked Dr. Christofides. Such issues, she said, will not have universal solutions but rather solutions specific to each situation and differing circumstances within the United States.

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