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Kim SH. Reframing prediabetes: A call for better risk stratification and intervention. J Intern Med 2024; 295:735-747. [PMID: 38606904 DOI: 10.1111/joim.13786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
Prediabetes is an intermediate state of glucose homeostasis whereby plasma glucose concentrations are above normal but below the threshold of diagnosis for diabetes. Over the last several decades, criteria for prediabetes have changed as the cut points for normal glucose concentration and diagnosis of diabetes have shifted. Global consensus does not exist for prediabetes criteria; as a result, the clinical course and risk for type 2 diabetes vary. At present, we can identify individuals with prediabetes based on three glycemic tests (hemoglobin A1c, fasting plasma glucose, and 2-h plasma glucose during an oral glucose tolerance test). The majority of individuals diagnosed with prediabetes meet only one of these criteria. Meeting one, two, or all glycemic criteria changes risk for type 2 diabetes, but this information is not widely known and does not currently guide intervention strategies for individuals with prediabetes. This review summarizes current epidemiology, prognosis, and intervention strategies for individuals diagnosed with prediabetes and suggests a call for more precise risk stratification of individuals with prediabetes as elevated (one prediabetes criterion), high risk (two prediabetes criteria), and very high risk (three prediabetes criteria). In addition, the roles of oral glucose tolerance testing and continuous glucose monitoring in the diagnostic criteria for prediabetes need reassessment. Finally, we must reframe our goals for prediabetes and prioritize intensive interventions for those at high and very high risk for type 2 diabetes.
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Affiliation(s)
- Sun H Kim
- Division of Endocrinology, Gerontology and Metabolism, Stanford University School of Medicine, Stanford, California, USA
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Haseldine C, O'Donoghue G, Kearney PM, Riordan F, Kerins C, Kirby L, Humphreys M, McHugh S. Factors influencing participation in an online national diabetes prevention programme: A qualitative study with attenders and educators. Diabet Med 2024; 41:e15277. [PMID: 38150286 DOI: 10.1111/dme.15277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 12/14/2023] [Accepted: 12/15/2023] [Indexed: 12/28/2023]
Abstract
AIM To explore factors affecting participation in the pilot of the synchronous online national diabetes prevention programme (NDPP) in Ireland from the perspectives of those who attended and the educators who recruited for and delivered the programme. METHODS A qualitative study involving semi-structured interviews and focus groups with NDPP attenders (attended the assessment and at least one session) and educators (dietitians) on the programme. The Framework Method using the Theoretical Domains Framework (TDF) guided the analysis. RESULTS Thirteen attenders took part in two online focus groups and five online or phone interviews. Eight educators took part. Four themes which cut across the TDF domains were identified as factors influencing participation; (i) lack of awareness of prediabetes and fear of diabetes, relating to attenders' fear of diabetes and lack of knowledge of prediabetes and diabetes prevention; (ii) perceived need for programme support to change health behaviour, concerning attenders' and educators' recognition of the need for the NDPP; (iii) trust in healthcare professionals (HCPs), relating to trust in HCPs to convey the seriousness of prediabetes and the value of diabetes prevention programmes (DPPs) and (iv) practical and personal ease of joining online, relating to the flexibility and accessibility of the synchronous online group format, the IT skills of attenders and educators and apprehension about group education. CONCLUSIONS Raising awareness of prediabetes and the need for prevention programmes should be a priority for health services and HCPs. The synchronous online group format was seen as less daunting to join than a face-to-face programme and may be a useful option to encourage participation.
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Affiliation(s)
- Clair Haseldine
- University College Cork, School of Public Health, Cork, Ireland
| | - Grainne O'Donoghue
- University College Dublin, School of Public Health, Physiotherapy and Sports Science, Dublin, Ireland
| | | | - Fiona Riordan
- University College Cork, School of Public Health, Cork, Ireland
| | - Claire Kerins
- University College Cork, School of Public Health, Cork, Ireland
| | - Liz Kirby
- Health Service Executive, Diabetes Prevention Programme, Cork, Ireland
| | | | - Sheena McHugh
- University College Cork, School of Public Health, Cork, Ireland
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Jacobs SR, Glasgow L, Amico P, Farris KD, Rutledge G, Smith BD. Integrating the Consolidated Framework for Implementation Research (CFIR) into a Culturally Responsive Evaluation (CRE) Approach to Conduct Mixed-Method Evaluations of Diabetes Prevention and Management Programs Reaching Underresourced Populations and Communities. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024; 25:46-55. [PMID: 36947309 PMCID: PMC11073471 DOI: 10.1007/s11121-023-01509-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2023] [Indexed: 03/23/2023]
Abstract
Diabetes is a significant population health threat. Evidence-based interventions, such as the Centers for Disease Control and Prevention's National Diabetes Prevention Program and diabetes self-management education and support programs, can help prevent, delay, or manage the disease. However, participation is suboptimal, especially among populations who are at an increased risk of developing diabetes. Evaluations of programs reaching populations who are medically underserved or people with lower incomes can help elucidate how best to tailor evidence-based interventions, but it is also important for evaluations to account for cultural and contextual factors. Culturally responsive evaluation (CRE) is a framework for centering an evaluation in the culture of the programs being evaluated. We integrated CRE with implementation and outcome constructs from the Adapted Consolidated Framework for Implementation Research (CFIR) to ensure that the evaluation produced useful evidence for putting evidence-based diabetes interventions to use in real-world settings, reaching populations who are at an increased risk of developing diabetes. The paper provides an overview of how we integrated CRE and CFIR approaches to conduct mixed-methods evaluations of evidence-based diabetes interventions.
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Affiliation(s)
| | | | | | | | - Gia Rutledge
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Bryce D Smith
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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Haseldine C, O'Donoghue G, Kearney PM, Riordan F, Cotterill S, McHugh S. Healthcare workers' perspectives on barriers and facilitators to referral and recruitment to diabetes prevention programmes: a systematic review protocol. HRB Open Res 2024; 6:23. [PMID: 38601792 PMCID: PMC11004599 DOI: 10.12688/hrbopenres.13702.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2024] [Indexed: 04/12/2024] Open
Abstract
Background Diabetes is a growing global health problem. International guidelines recommend identification, screening, and referral to behavioural programmes for those at high risk of developing type 2 diabetes. Diabetes prevention programmes (DPPs) can prevent type 2 diabetes in those at high risk, however many eligible participants are not referred to these programmes. Healthcare workers (HCWs) are pivotal to the referral and recruitment processes. This study aims to identify, appraise and synthesise the evidence on barriers and facilitators to referral and recruitment to DPPs from the perspective of HCWs. Methods A "best fit" framework synthesis method will synthesise qualitative, quantitative, and mixed methods evidence on factors that affect HCWs referral and recruitment to DPPs, with the Theoretical Domains Framework (TDF) as the a priori framework. MEDLINE, EMBASE, CINAHL, PsychINFO, Web of Science and Scopus will be searched for primary studies published in English. Year of publication will be restricted to the last 26 years (1997-2023). Quality will be assessed using the Mixed Methods Appraisal Tool. A mix of deductive coding using the TDF and inductive coding of data that does not fit the TDF will be synthesised into themes representing the whole dataset. The relationships between the final set of themes will be explored to create a new model to understand HCWs' perspectives on referral and recruitment to DPPs. Sensitivity analysis will be carried out on this conceptual model. Confidence in the synthesised findings will be assessed using the GRADE-CERQual approach. One author will screen, extract, appraise the literature while a second author will independently verify a 20% sample at each stage. Discussion Participation in DPPs is key for programme impact. HCWs typically identify those at risk and refer them to DPPs. Understanding HCWs' perspectives on the barriers and facilitators to referral and recruitment will inform future implementation of DPPs.
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Affiliation(s)
- Clair Haseldine
- School of Public Health, University College Cork, Cork, Ireland
| | - Gráinne O'Donoghue
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Patricia M Kearney
- School of Public Health, University College Cork, Cork, Ireland
- Health Service Executive, Cork, Ireland
| | - Fiona Riordan
- School of Public Health, University College Cork, Cork, Ireland
| | - Sarah Cotterill
- School of Health Sciences, University of Manchester, Manchester, UK
| | - Sheena McHugh
- School of Public Health, University College Cork, Cork, Ireland
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Luna A, Elleson N, Forfia A. Diabetes Prevention Program Enrichment Through Video: A Tool to Improve Engagement in Hard-to-Reach Populations. ADCES IN PRACTICE 2024; 12:8-13. [PMID: 38464398 PMCID: PMC10921551 DOI: 10.1177/2633559x241227647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
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Lewey J, Beckie TM, Brown HL, Brown SD, Garovic VD, Khan SS, Miller EC, Sharma G, Mehta LS. Opportunities in the Postpartum Period to Reduce Cardiovascular Disease Risk After Adverse Pregnancy Outcomes: A Scientific Statement From the American Heart Association. Circulation 2024; 149:e330-e346. [PMID: 38346104 PMCID: PMC11185178 DOI: 10.1161/cir.0000000000001212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
Adverse pregnancy outcomes are common among pregnant individuals and are associated with long-term risk of cardiovascular disease. Individuals with adverse pregnancy outcomes also have an increased incidence of cardiovascular disease risk factors after delivery. Despite this, evidence-based approaches to managing these patients after pregnancy to reduce cardiovascular disease risk are lacking. In this scientific statement, we review the current evidence on interpregnancy and postpartum preventive strategies, blood pressure management, and lifestyle interventions for optimizing cardiovascular disease using the American Heart Association Life's Essential 8 framework. Clinical, health system, and community-level interventions can be used to engage postpartum individuals and to reach populations who experience the highest burden of adverse pregnancy outcomes and cardiovascular disease. Future trials are needed to improve screening of subclinical cardiovascular disease in individuals with a history of adverse pregnancy outcomes, before the onset of symptomatic disease. Interventions in the fourth trimester, defined as the 12 weeks after delivery, have great potential to improve cardiovascular health across the life course.
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Formagini T, Teruel Camargo J, Perales-Puchalt J, Drees BM, Fracachan Cabrera M, Ramírez M. A culturally and linguistically adapted text-message Diabetes Prevention Program for Latinos: Feasibility, acceptability, and preliminary effectiveness. Transl Behav Med 2024; 14:138-147. [PMID: 37715986 DOI: 10.1093/tbm/ibad053] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2023] Open
Abstract
Despite the general positive outcomes of the Diabetes Prevention Program (DPP), the program's reach, adherence, and effectiveness among Latinos are still suboptimal. Text-message DPP can potentially overcome barriers and improve DPP outcomes for this group. We aimed to assess the feasibility, acceptability, and preliminarily effectiveness of a culturally and linguistically adapted text-message DPP for Latinos. We enrolled 26 eligible Spanish-speaking Latino adults at risk of developing type 2 diabetes (A1c = 5.7%-6.4%, body mass index ≥25) in a 6-month culturally and linguistically adapted text-message DPP. Participants received (i) two to three daily automated text-messages about healthy eating, physical activity, problem-solving skills, lifestyle change motivation, and logistics, (ii) on-demand keyword-driven messages, and (iii) on-demand chat messages with a DPP coach. Outcomes included feasibility (e.g. adherence), acceptability (e.g. satisfaction), and preliminary effectiveness (e.g. weight loss). Twenty-four participants completed the program and follow-up assessments. Participants' mean body weight changed from 191.2 to 186.7 pounds (P = .004); 45.8% of participants lost ≥3%, and 29.2% lost ≥5% of body weight. Body mass index and waist circumference were also reduced [0.9 kg/m2 (P = .003) and 1.1 cm (P = .03), pre-post]. Self-reported physical activity frequency was increased (P = .003). No statistically significant changes in diet quality were found. Most participants were satisfied with the program and perceived it to help prevent diabetes. Our pilot study of an innovative text-message DPP for Latinos demonstrated the program was acceptable, feasible, and potentially effective. Using text-message for DPP can reduce barriers to in-person participation by increasing the program's reach without compromising fidelity and effectiveness.
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Affiliation(s)
- Taynara Formagini
- Department of Family Medicine, University of California San Diego, San Diego, CA, USA
- School of Social Work, University of Central Florida, Orlando, FL, USA
| | - Juliana Teruel Camargo
- Minority Health and Health Disparities Population Laboratory, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
- Department of Urology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Jaime Perales-Puchalt
- Department of Neurology, University of Kansas Alzheimer's Disease Research Center, Kansas City, KS, USA
| | - Betty M Drees
- University of Missouri Kansas City School of Medicine, Kansas City, MO, USA
- The Graduate School of the Stowers Institute for Medical Research, Kansas City, MO, USA
| | - Monica Fracachan Cabrera
- Juntos Center for Advancing Latino Health, Department of Population Health, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Mariana Ramírez
- Juntos Center for Advancing Latino Health, Department of Population Health, University of Kansas School of Medicine, Kansas City, KS, USA
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Ritchie ND, Turk MT, Holtrop JS, Durfee MJ, Dickinson LM, Kaufmann PG. A virtual recruitment protocol promotes enrollment of underrepresented groups in a diabetes prevention trial. J Clin Transl Sci 2024; 8:e26. [PMID: 38384920 PMCID: PMC10879998 DOI: 10.1017/cts.2024.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 01/08/2024] [Accepted: 01/12/2024] [Indexed: 02/23/2024] Open
Abstract
Strategies are needed to ensure greater participation of underrepresented groups in diabetes research. We examined the impact of a remote study protocol on enrollment in diabetes research, specifically the Pre-NDPP clinical trial. Recruitment was conducted among 2807 diverse patients in a safety-net healthcare system. Results indicated three-fold greater odds of enrolling in remote versus in-person protocols (AOR 2.90; P < 0.001 [95% CI 2.29-3.67]). Priority populations with significantly higher enrollment included Latinx and Black individuals, Spanish speakers, and individuals who had Medicaid or were uninsured. A remote study design may promote overall recruitment into clinical trials, while effectively supporting enrollment of underrepresented groups.
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Affiliation(s)
- Natalie D. Ritchie
- Center for Health Systems Research, Denver Health and
Hospital Authority, Denver, CO,
USA
- Department of Psychiatry, University of Colorado School of
Medicine, Aurora, CO, USA
| | | | - Jodi Summers Holtrop
- Adult & Child Center for Outcomes Research & Delivery Science,
University of Colorado Anschutz Medical Campus,
Aurora, CO, USA
- Department of Family Medicine, University of Colorado
Anschutz Medical Campus, Aurora, CO,
USA
| | - Michael Josh Durfee
- Center for Health Systems Research, Denver Health and
Hospital Authority, Denver, CO,
USA
| | - L. Miriam Dickinson
- Department of Family Medicine, University of Colorado
Anschutz Medical Campus, Aurora, CO,
USA
| | - Peter G. Kaufmann
- Integrated Health Sciences, University of Nevada Las
Vegas, Las Vegas, NV, USA
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Williams PA, Rotunda W, Porterfield D, Skeete RA, Smith AD, Proia KK. Implementation of Session Zero as a Recruitment Strategy in the National Diabetes Prevention Program's Lifestyle Change Program. Sci Diabetes Self Manag Care 2024; 50:74-86. [PMID: 38158815 PMCID: PMC10995983 DOI: 10.1177/26350106231215767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
PURPOSE The purpose of the study was to understand the extent to which organizations offering the Centers for Disease Control and Prevention's (CDC) National Diabetes Prevention Program (National DPP) lifestyle change program implement session zero (a pre-enrollment session designed to recruit, engage, and enroll participants in programs), the stated purpose(s) for offering session zero, the content of session zero, and best practices for using session zero for recruitment. METHODS Researchers conducted a survey of all organizations offering the National DPP lifestyle change program that were registered with the CDC's Diabetes Prevention Recognition Program and their affiliated delivery locations. RESULTS Most (79.5%) delivery locations reported implementing session zero; of these, most used session zero as a recruitment strategy (81.1%) and orientation session (72.8%), whereas few (17.7%) used session zero solely to complete participant enrollment paperwork. Most (60.7%) delivery locations that implement session zero offer all their sessions at the same location, offer one session per upcoming participant cohort (66.7%), and use a consistent agenda (83.0%). Out of a list of activities informed by behavior change theory, the most common was offering an opportunity to enroll in the year-long lifestyle change program at the end of session zero (71.1%). CONCLUSIONS Most National DPP delivery locations implement session zero as a recruitment and orientation session. Most delivery locations reported including some activities informed by behavior change theory, but delivery locations could offer more theoretically informed activities during their session zero. The findings provide practice-based considerations for implementing session zero for recruitment into lifestyle change programs.
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Affiliation(s)
| | - Wendi Rotunda
- RTI International, Research Triangle Park, North Carolina
| | | | | | - Akimi D Smith
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Krista K Proia
- Centers for Disease Control and Prevention, Atlanta, Georgia
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Gholami M, Jackson NJ, Loeb T, Chung UYR, Ramm K, Shedd K, Soetenga S, Elashoff D, Hamilton AB, Mangione CM, Duru OK, Moin T. Twelve-Month Reach and Effectiveness of a University-Based Diabetes Prevention Initiative. Am J Prev Med 2024; 66:299-306. [PMID: 37741423 PMCID: PMC10842474 DOI: 10.1016/j.amepre.2023.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 09/15/2023] [Accepted: 09/18/2023] [Indexed: 09/25/2023]
Abstract
INTRODUCTION The University of California (UC) implemented the Diabetes Prevention Program (DPP) to address diabetes and obesity risk. This project examined the reach and effectiveness of this university-based DPP delivery approach. METHODS This project compared 12-month weight change among three groups of UC beneficiaries with overweight/obesity: (1) those who received invitation letters and enrolled in UC DPP, (2) those mailed invitation letters but did not enroll, and (3) those who were not mailed letters and did not enroll (controls). Using 2012-2022 EHR, administrative and DPP cohort data, an interrupted time series was conducted in 2022-2023 to compare group differences in rate of weight change. RESULTS Among 6,231 beneficiaries (132 UC DPP aware enrollees, 1,750 DPP aware non-enrollees, 4,349 controls), UC DPP enrollees were older (mean age 49), mostly women (76%), and more diverse (33% Asian, 8% Black, 20% Hispanic, 4% Multi/Other). Over 12 months of follow-up, UC DPP enrollee postenrollment rate of weight loss was -0.68 lbs./month. UC DPP enrollees had significantly greater weight change from pre- to post-enrollment than DPP aware non-enrollees (adjusted Δ-1.02 vs. Δ-0.07 lbs./month, difference= -0.95, p<0.001). Weight change among all participants who received letters with/without DPP enrollment was similar to controls. CONCLUSIONS UC DPP reached a diverse group and was effective for weight loss at 12-month follow-up. However, UC DPP invitation letters to raise prediabetes and DPP awareness were not associated with significant weight change in the absence of DPP enrollment. University-based approaches to DPP delivery are effective and may enhance reach of DPP among at-risk adults.
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Affiliation(s)
- Maryam Gholami
- Altman Clinical and Translational Research Institute, University of California, San Diego, California
| | - Nicholas J Jackson
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, California
| | - Tamra Loeb
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, California
| | - Un Young Rebecca Chung
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, California
| | - Kate Ramm
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, California
| | - Kelly Shedd
- Human Resources, University of California, Irvine, California
| | - Samantha Soetenga
- Campus Recreation, University of California, Los Angeles, California
| | - David Elashoff
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, California
| | - Alison B Hamilton
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, California; VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Carol M Mangione
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, California; Fielding School of Public Health, University of California, Los Angeles, California
| | - O Kenrik Duru
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, California
| | - Tannaz Moin
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, California; VA Greater Los Angeles Healthcare System, Los Angeles, California.
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Formagini T, Brooks JV, Roberts A, Bullard KM, Zhang Y, Saelee R, O'Brien MJ. Prediabetes prevalence and awareness by race, ethnicity, and educational attainment among U.S. adults. Front Public Health 2023; 11:1277657. [PMID: 38164446 PMCID: PMC10758124 DOI: 10.3389/fpubh.2023.1277657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/20/2023] [Indexed: 01/03/2024] Open
Abstract
Introduction Racial and ethnic minority groups and individuals with limited educational attainment experience a disproportionate burden of diabetes. Prediabetes represents a high-risk state for developing type 2 diabetes, but most adults with prediabetes are unaware of having the condition. Uncovering whether racial, ethnic, or educational disparities also occur in the prediabetes stage could help inform strategies to support health equity in preventing type 2 diabetes and its complications. We examined the prevalence of prediabetes and prediabetes awareness, with corresponding prevalence ratios according to race, ethnicity, and educational attainment. Methods This study was a pooled cross-sectional analysis of the National Health and Nutrition Examination Survey data from 2011 to March 2020. The final sample comprised 10,262 U.S. adults who self-reported being Asian, Black, Hispanic, or White. Prediabetes was defined using hemoglobin A1c and fasting plasma glucose values. Those with prediabetes were classified as "aware" or "unaware" based on survey responses. We calculated prevalence ratios (PR) to assess the relationship between race, ethnicity, and educational attainment with prediabetes and prediabetes awareness, controlling for sociodemographic, health and healthcare-related, and clinical characteristics. Results In fully adjusted logistic regression models, Asian, Black, and Hispanic adults had a statistically significant higher risk of prediabetes than White adults (PR:1.26 [1.18,1.35], PR:1.17 [1.08,1.25], and PR:1.10 [1.02,1.19], respectively). Adults completing less than high school and high school had a significantly higher risk of prediabetes compared to those with a college degree (PR:1.14 [1.02,1.26] and PR:1.12 [1.01,1.23], respectively). We also found that Black and Hispanic adults had higher rates of prediabetes awareness in the fully adjusted model than White adults (PR:1.27 [1.07,1.50] and PR:1.33 [1.02,1.72], respectively). The rates of prediabetes awareness were consistently lower among those with less than a high school education relative to individuals who completed college (fully-adjusted model PR:0.66 [0.47,0.92]). Discussion Disparities in prediabetes among racial and ethnic minority groups and adults with low educational attainment suggest challenges and opportunities for promoting health equity in high-risk groups and expanding awareness of prediabetes in the United States.
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Affiliation(s)
- Taynara Formagini
- Department of Family Medicine, University of California San Diego, San Diego, CA, United States
- Department of Population Health, University of Kansas School of Medicine, Kansas City, KS, United States
| | - Joanna Veazey Brooks
- Department of Population Health, University of Kansas School of Medicine, Kansas City, KS, United States
- University of Kansas Cancer Center, Kansas City, KS, United States
- Division of Palliative Medicine, University of Kansas School of Medicine, Kansas City, KS, United States
| | - Andrew Roberts
- Department of Population Health, University of Kansas School of Medicine, Kansas City, KS, United States
- Aetion Inc., New York, NY, United States
| | - Kai McKeever Bullard
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA, United States
| | - Yan Zhang
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA, United States
| | - Ryan Saelee
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA, United States
| | - Matthew James O'Brien
- Department of Medicine, Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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Ely EK, Ng BP, Cannon MJ. Delivering the National Diabetes Prevention Program: Assessment of Outcomes in In-Person and Virtual Organizations. J Diabetes Res 2023; 2023:8894593. [PMID: 37928892 PMCID: PMC10622599 DOI: 10.1155/2023/8894593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/20/2023] [Accepted: 10/10/2023] [Indexed: 11/07/2023] Open
Abstract
The Centers for Disease Control and Prevention's Diabetes Prevention Recognition Program (DPRP) has helped organizations deliver the National Diabetes Prevention Program (National DPP) lifestyle change program for over 10 years. Four delivery modes are now approved: in person, online (self-paced, asynchronous delivery), distance learning (remote, synchronous delivery), and combination (hybrid delivery using more than one delivery mode). We assessed outcomes using data from 333,715 participants who started the 12-month program between January 1, 2012, and December 31, 2018. The average number of sessions attended was highest for in-person participants (15.0), followed by online (12.9), distance learning (12.2), and combination (10.7). The average number of weeks in the program was highest for in-person participants (28.1), followed by distance learning (20.1), online (18.7), and combination (18.6). The average difference between the first and last reported weekly physical activity minutes reflected an increase for in person (42.0), distance learning (27.1), and combination (15.0), but a decrease for online (-19.8). Among participants retained through session 6 or longer, average weekly physical activity minutes exceeded the program goal of 150 for all delivery modes. Average weight loss (percent of body weight) was greater for in person (4.4%) and distance learning (4.7%) than for online (2.6%) or combination (2.9%). Average participant weight loss increased gradually by session for all delivery modes; among participants who remained in the program for 22 sessions, average weight loss exceeded the program goal of 5% for all delivery modes. In summary, if participants stay in the program, most have positive program outcomes regardless of delivery mode; they have some outcome improvement even if they leave early; and their outcomes improve more the longer they stay. This highlights the benefits of better retention and increased enrollment in the National DPP lifestyle change programs, as well as enhancements to online delivery.
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Affiliation(s)
- Elizabeth K. Ely
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Boon Peng Ng
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- College of Nursing and Disability, Aging, And Technology Cluster, University of Central Florida, Orlando, Florida, USA
| | - Michael J. Cannon
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Ritchie ND, Seely EW, Nicklas JM, Levkoff SE. Effectiveness of the National Diabetes Prevention Program After Gestational Diabetes. Am J Prev Med 2023; 65:317-321. [PMID: 36918133 PMCID: PMC10363236 DOI: 10.1016/j.amepre.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 03/06/2023] [Accepted: 03/06/2023] [Indexed: 03/14/2023]
Abstract
INTRODUCTION Women with previous gestational diabetes are at high risk of developing Type 2 diabetes. The National Diabetes Prevention Program (NDPP) is a widely disseminated lifestyle intervention to prevent Type 2 diabetes. Although NDPP programs are open to adults of any age, participants are usually older adults. Effectiveness among younger women with previous gestational diabetes is largely unknown. METHODS The NDPP was delivered by lifestyle coaches in a large network of Federally Qualified Health Centers. Reach, retention, physical activity, and weight loss outcomes were compared between women aged <40 years with previous gestational diabetes and all other participants. Data were collected from 2013 to 2019 and analyzed in 2022. RESULTS Among 2,865 enrollees who agreed to start the yearlong NDPP, 63.3% were Latinx, 18.8% were non-Latinx Black, and 16.4% were non-Latinx White. Younger women with previous gestational diabetes represented <4% (n=107) of participants. There was no significant difference in the frequency of attending ≥1 NDPP session between these women and all other participants (37.4% vs 44.6%; p=0.146). However, among those attending ≥1 session (n=1,265), younger women with previous gestational diabetes attended more (11.27 ± 1.27 vs 8.50 ± 0.22 sessions, p=0.021) and had greater weight loss (3.04% ± 0.59 vs. 1.49% ± 0.11, p=0.010) in covariate-adjusted models than other participants. CONCLUSIONS Diverse younger women with previous gestational diabetes attending the NDPP had one third greater attendance and twice as much weight loss as other NDPP participants but represented a much smaller proportion of enrollees. Thus, the NDPP appears to be a beneficial but underutilized resource for this high-risk population.
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Affiliation(s)
- Natalie D Ritchie
- Office of Research, Denver Health, Denver, Colorado; Department of Psychiatry, University of Colorado School of Medicine, Aurora, Colorado.
| | - Ellen W Seely
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Jacinda M Nicklas
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Sue E Levkoff
- College of Social Work, University of South Carolina, Columbia, South Carolina; Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
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Herman WH, Villatoro C, Joiner KL, McEwen LN. Retention and outcomes of National Diabetes Prevention Program enrollees and non-enrollees with prediabetes: The University of Michigan experience. J Diabetes Complications 2023; 37:108527. [PMID: 37459781 PMCID: PMC10928673 DOI: 10.1016/j.jdiacomp.2023.108527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 05/31/2023] [Accepted: 06/01/2023] [Indexed: 08/04/2023]
Abstract
AIMS To evaluate retention and outcomes of insured adults with prediabetes who enrolled or did not enroll in National Diabetes Prevention Programs (NDPPs). METHODS Between 2015 and 2019, 776 University of Michigan employees, dependents, and retirees with prediabetes and overweight or obesity enrolled in one-year NDPPs. RESULTS Enrollees attended a median of 18 sessions. Median retention was 38 weeks. Retention was associated with older age, greater initial weight loss, and physical activity. At both 1- and 2-years, body mass index, triglycerides, and HbA1c were significantly improved among enrollees. After adjusting for age group, sex, and race, the odds of developing diabetes based on HbA1c ≥6.5 % was 40 % lower at 1-year and 20 % lower at 2-years, and the odds of self-reported diabetes was 57 % lower at 1-year and 46 % lower at 2-years in enrollees compared to non-enrollees. Enrollees who disenrolled before completing the core curriculum had higher odds and enrollees who completed the NDPP had lower odds of developing diabetes that non-enrollees. CONCLUSIONS In this population with prediabetes, NDPP retention was generally good, risk factors were improved, and diabetes was delayed or prevented for up to two years.
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Affiliation(s)
- William H Herman
- Department of Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI, USA; Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
| | - Claudia Villatoro
- Department of Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI, USA
| | - Kevin L Joiner
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Laura N McEwen
- Department of Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI, USA
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Gregg EW, Patorno E, Karter AJ, Mehta R, Huang ES, White M, Patel CJ, McElvaine AT, Cefalu WT, Selby J, Riddle MC, Khunti K. Use of Real-World Data in Population Science to Improve the Prevention and Care of Diabetes-Related Outcomes. Diabetes Care 2023; 46:1316-1326. [PMID: 37339346 PMCID: PMC10300521 DOI: 10.2337/dc22-1438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 04/11/2023] [Indexed: 06/22/2023]
Abstract
The past decade of population research for diabetes has seen a dramatic proliferation of the use of real-world data (RWD) and real-world evidence (RWE) generation from non-research settings, including both health and non-health sources, to influence decisions related to optimal diabetes care. A common attribute of these new data is that they were not collected for research purposes yet have the potential to enrich the information around the characteristics of individuals, risk factors, interventions, and health effects. This has expanded the role of subdisciplines like comparative effectiveness research and precision medicine, new quasi-experimental study designs, new research platforms like distributed data networks, and new analytic approaches for clinical prediction of prognosis or treatment response. The result of these developments is a greater potential to progress diabetes treatment and prevention through the increasing range of populations, interventions, outcomes, and settings that can be efficiently examined. However, this proliferation also carries an increased threat of bias and misleading findings. The level of evidence that may be derived from RWD is ultimately a function of the data quality and the rigorous application of study design and analysis. This report reviews the current landscape and applications of RWD in clinical effectiveness and population health research for diabetes and summarizes opportunities and best practices in the conduct, reporting, and dissemination of RWD to optimize its value and limit its drawbacks.
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Affiliation(s)
- Edward W. Gregg
- School of Population Health, RRCSI University of Medicine and Health Sciences, Dublin, Ireland
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, U.K
| | - Elisabetta Patorno
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Andrew J. Karter
- Division of Research, Kaiser Permanente, Oakland, CA
- Department of Health Systems and Population Health, University of Washington, Seattle, WA
| | - Roopa Mehta
- Metabolic Research Unit (UIEM), Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Medicas y Nutricion, Salvador Zubiran (INCMNSZ), Mexico City, Mexico
| | - Elbert S. Huang
- Section of General Internal Medicine, Center for Chronic Disease Research and Policy (CDRP), The University of Chicago, Chicago, IL
| | - Martin White
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, U.K
| | - Chirag J. Patel
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA
| | | | - William T. Cefalu
- Division of Diabetes, Endocrinology, and Metabolic Diseases, National Institute of Diabetes, Digestive, and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Joseph Selby
- Patient-Centered Outcomes Institute, Washington, DC
| | - Matthew C. Riddle
- Division of Endocrinology, Diabetes, and Clinical Nutrition, Oregon Health & Science University, Portland, OR
| | - Kamlesh Khunti
- Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, U.K
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Graham SA, Auster-Gussman LA, Lockwood KG, Branch OH. Weight Loss in a Digital Diabetes Prevention Program for People in Health Professional Shortage and Rural Areas. Popul Health Manag 2023. [PMID: 37115532 DOI: 10.1089/pop.2022.0278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
Individuals with prediabetes living in hard-to-reach and underserved areas experience barriers to accessing traditional in-person preventive health services. The National Diabetes Prevention Program (DPP) is a preventive health care program designed to reduce the risk of developing type 2 diabetes. Although there have been increasing numbers of remote DPPs accessible, there are little data on the clinical outcomes of digital DPPs for members living in hard-to-reach and underserved areas. This study assessed whether living in a designated Health Professional Shortage Area (HPSA) and a rural versus urban area impacted the weight loss of N = 7266 members of a fully digital program called Lark DPP. Secondary analyses included between-group comparisons of program retention and member characteristics, demographics, and socioeconomics. Percent weight loss did not differ by HPSA (P = 0.16) or rural/urban status (P = 0.15), despite greater potential barriers for members residing in HPSAs (eg, highest starting body mass index, lowest income, lowest education). Mean percent weight loss for members residing in an HPSA and rural area was mean (M) = 4.75%, standard error (SE) = 0.09; for members in a non-HPSA, rural area M = 4.96%, SE = 0.16; for members in an HPSA, urban area M = 4.55%, SE = 0.13; and for members in a non-HPSA, urban area M = 4.77%, SE = 0.13. Members of a fully digital DPP achieved weight loss that did not differ by HPSA or urban/rural designation. Fully digital programs offer a solution to reduce the risk of type 2 diabetes in areas where residents may not otherwise have access to diabetes prevention services.
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Haseldine C, O'Donoghue G, Kearney PM, Riordan F, Cotterill S, McHugh S. Healthcare workers’ perspectives on barriers and facilitators to referral and recruitment to diabetes prevention programmes: a systematic review protocol. HRB Open Res 2023. [DOI: 10.12688/hrbopenres.13702.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Abstract
Background: Diabetes is a growing global health problem. International guidelines recommend identification, screening, and referral to behavioural programmes for those at high risk of developing type 2 diabetes. Diabetes prevention programmes (DPPs) can prevent type 2 diabetes in those at high risk, however many eligible participants are not referred to these programmes. Healthcare workers (HCWs) are pivotal to the referral and recruitment processes. This study aims to identify, appraise and synthesise the evidence on barriers and facilitators to referral and recruitment to DPPs from the perspective of HCWs. Methods: A “best fit” framework synthesis method will synthesise qualitative, quantitative, and mixed methods evidence on factors that affect HCWs referral and recruitment to DPPs, with the Theoretical Domains Framework (TDF) as the a priori framework. MEDLINE, EMBASE, CINAHL, PsychINFO, Web of Science and Scopus will be searched for primary studies published in English. Year of publication will be restricted to the last 25 years (1997–2022). Quality will be assessed using the Mixed Methods Appraisal Tool. A mix of deductive coding using the TDF and inductive coding of data that does not fit the TDF will be synthesised into themes representing the whole dataset. The relationships between the final set of themes will be explored to create a new model to understand HCWs’ perspectives on referral and recruitment to DPPs. Sensitivity analysis will be carried out this conceptual model. Confidence in the synthesised findings will be assessed using the GRADE-CERQual approach. One author will screen, extract, appraise the literature while a second author will independently verify a 20% sample at each stage. Discussion: Participation in DPPs is key for programme impact. HCWs typically identify those at risk and refer them to DPPs. Understanding HCWs’ perspectives of the barriers and facilitators to referral and recruitment will inform future implementation of DPPs.
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Formagini T, Saint Onge JM, O’Brien MJ, Ramírez M, Brooks JV. The Experience of Spanish-Speaking Latinos in Maintaining Dietary and Physical Activity Changes after the National Diabetes Prevention Program. AMERICAN JOURNAL OF HEALTH EDUCATION 2023. [DOI: 10.1080/19325037.2023.2187487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
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Type 2 Diabetes Prevention Programs-From Proof-of-Concept Trials to National Intervention and Beyond. J Clin Med 2023; 12:jcm12051876. [PMID: 36902668 PMCID: PMC10003211 DOI: 10.3390/jcm12051876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 02/19/2023] [Accepted: 02/21/2023] [Indexed: 03/08/2023] Open
Abstract
The prevention of type 2 diabetes (T2D) in high-risk people with lifestyle interventions has been demonstrated by several randomized controlled trials. The intervention effect has sustained up to 20 years in post-trial monitoring of T2D incidence. In 2000, Finland launched the national T2D prevention plan. For screening for high T2D risk, the non-laboratory Finnish Diabetes Risk Score was developed and widely used, also in other countries. The incidence of drug-treated T2D has decreased steadily since 2010. The US congress authorized public funding for a national diabetes prevention program (NDPP) in 2010. It was built around a 16-visit program that relies on referral from primary care and self-referral of persons with either prediabetes or by a diabetes risk test. The program uses a train-the-trainer program. In 2015 the program started the inclusion of online programs. There has been limited implementation of nationwide T2D prevention programs in other countries. Despite the convincing results from RCTs in China and India, no translation to the national level was introduced there. T2D prevention efforts in low-and middle-income countries are still limited, but results have been promising. Barriers to efficient interventions are greater in these countries than in high-income countries, where many barriers also exist. Health disparities by socioeconomic status exist for T2D and its risk factors and form a challenge for preventive interventions. It seems that a stronger commitment to T2D prevention is needed, such as the successful WHO Framework Convention on Tobacco Control, which legally binds the countries to act.
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