Research article
Translating the Diabetes Prevention Program into the Community: The DEPLOY Pilot Study

https://doi.org/10.1016/j.amepre.2008.06.035Get rights and content

Background

The Diabetes Prevention Program (DPP) found that an intensive lifestyle intervention can reduce the development of diabetes by more than half in adults with prediabetes, but there is little information about the feasibility of offering such an intervention in community settings. This study evaluated the delivery of a group-based DPP lifestyle intervention in partnership with the YMCA.

Methods

This pilot cluster-randomized trial was designed to compare group-based DPP lifestyle intervention delivery by the YMCA to brief counseling alone (control) in adults who attended a diabetes risk-screening event at one of two semi-urban YMCA facilities and who had a BMI ≥24 kg/m2, ≥2 diabetes risk factors, and a random capillary blood glucose of 110–199 mg/dL. Multivariate regression was used to compare between-group differences in changes in body weight, blood pressures, HbA1c, total cholesterol, and HDL-cholesterol after 6 and 12 months.

Results

Among 92 participants, controls were more often women (61% vs 50%) and of nonwhite race (29% vs 7%). After 6 months, body weight decreased by 6.0% (95% CI=4.7, 7.3) in intervention participants and 2.0% (95% CI=0.6, 3.3) in controls (p<0.001; difference between groups). Intervention participants also had greater changes in total cholesterol (–22 mg/dL vs +6 mg/dL controls; p<0.001). These differences were sustained after 12 months, and adjustment for differences in race and gender did not alter these findings. With only two matched YMCA sites, it was not possible to adjust for potential clustering by site.

Conclusions

The YMCA may be a promising channel for wide-scale dissemination of a low-cost approach to lifestyle diabetes prevention.

Introduction

More than 60 million Americans have prediabetes, defined by impaired glucose tolerance (IGT) or impaired fasting glucose (IFG). People with prediabetes are at increased risk for developing diabetes,1, 2, 3, 4, 5 cardiovascular events,6, 7, 8, 9 and other obesity-related adverse health outcomes. Because the prevalence of obesity is increasing in all segments of the population, the burden of prediabetes and diabetes will continue to escalate.10 Identifying strategies to prevent diabetes on a national scale is indeed a public health priority.

The Diabetes Prevention Program (DPP) and other large randomized trials have demonstrated that a structured diet and physical activity intervention achieving modest weight loss in overweight adults with IGT can significantly reduce the progression to diabetes.11, 12 However, the DPP involved enrollment criteria and an intensive lifestyle intervention that are challenging to implement and sustain in busy healthcare settings.13, 14 In this context, there has been an ongoing need for real-world adaptations of the DPP lifestyle intervention that balance fidelity to DPP procedures with new design elements that optimize effectiveness, minimize cost, and improve sustainability.15 Because healthcare settings have a limited capacity to offer intensive behavioral interventions,16 success in achieving this goal is likely to require involvement by community organizations with greater expertise and resources for offering intensive lifestyle programs.

With exceptional reach into diverse U.S. communities and a long history of implementing successful health promotion programs, the YMCA is a capable community partner. Over the past 4 years, the YMCA of greater Indianapolis has participated with researchers at Indiana University School of Medicine (IUSM) to design, implement, and evaluate a group-based adaptation of the highly successful DPP lifestyle intervention. This pilot study was conducted to test the hypotheses that YMCA wellness instructors could be trained to implement a group-based lifestyle intervention with fidelity to the DPP model and that adults at high risk for developing diabetes who were assigned to receive this intervention could achieve changes in body weight comparable to the DPP.

Section snippets

Design

This study, known as Diabetes Education & Prevention with a Lifestyle Intervention Offered at the YMCA (DEPLOY), was a matched-pair, group-randomized pilot intervention trial involving two YMCA facilities in greater Indianapolis. Using data from a 2003 YMCA primary market area analysis of communities surrounding six local YMCAs, two facilities located in semi-urban communities with similar racial and socioeconomic characteristics were selected. These two sites volunteered to partner with the

Baseline Characteristics

A total of 535 adults were assessed during the YMCA-based diabetes risk screening events. Among all people screened, 143 had a high-risk ADA questionnaire and met the glucose-level criteria for the study. After the exclusion of 12 participants because of conditions that might preclude participation in a community-based physical activity program, 131 were eligible and 92 (70%) enrolled (Figure 1). At baseline, intervention and control participants were similar with respect to age, but control

Conclusion

This study found that YMCA wellness instructors can be trained to deliver a group-based DPP lifestyle intervention and achieve changes in body mass after 6 and 12 months that are comparable to the DPP study. This level of effectiveness was observed even in the context of a modest (57%) overall attendance level. This is the first study to demonstrate that the YMCA is a promising vehicle for the dissemination of the DPP lifestyle intervention into the community. In the DPP, 5 kg (about 5%) of

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