The Diabetes Prevention Program (DPP) demonstrated that an intensive lifestyle intervention resulting in modest weight loss and increased physical activity can delay or prevent the development of type 2 diabetes in adults with pre-diabetes. Unfortunately, the DPP lifestyle intervention was not designed for delivery on a public health scale. Because glucose tests to identify pre-diabetes are best performed in clinical settings, evidence-based DPP translation will require partnerships between primary care clinics and community organizations that are equipped to implement and sustain an intensive lifestyle intervention. We have been collaborating with primary care clinics and YMCA administrators for over 3 years to design and pre-test a practical model to identify, counsel, and refer high-risk primary care patients for access to a group-based adaptation of the DPP lifestyle intervention in YMCA facilities. Preliminary data from two R34 planning grants provides strong support that pre-diabetes screening and brief counseling is feasible in primary care and that the YMCA can implement a group-based DPP lifestyle intervention and achieve weight loss that is comparable to the original DPP model (-6.0%;95% CI -4.6 to - 7.4%). We have designed the proposed study to evaluate the costs and effectiveness of a collaborative approach to identify adults with pre-diabetes in primary care settings, deliver brief advice for diabetes prevention, and provide access to a group-based adaptation of the DPP lifestyle intervention at community-based YMCA branch facilities. The study will involve 8 primary care clinics, 6 YMCA sites, and a 2-year intervention and follow-up period and will employ a mix of qualitative and qualitative methods to evaluate the reach, adoption, implementation, and maintenance of intervention activities across primary care and community organizations, as well as a practical randomized effectiveness trial to evaluate the adoption, maintenance, and effectiveness of this partnered intervention to achieve and maintain modest weight loss in adult primary care patients with pre-diabetes. Should our study find this partnered intervention strategy to be effective and sustainable, the results will be pivotal to the timely and efficient dissemination of this approach as a nationwide diabetes prevention model.
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