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.

Agency
National Institute of Health (NIH)
Institute
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Type
Research Demonstration and Dissemination Projects (R18)
Project #
5R18DK079855-05
Application #
8103855
Study Section
Special Emphasis Panel (ZDK1-GRB-1 (O1))
Program Officer
Garfield, Sanford A
Project Start
2007-09-24
Project End
2012-02-05
Budget Start
2011-07-01
Budget End
2012-02-05
Support Year
5
Fiscal Year
2011
Total Cost
$160,180
Indirect Cost
Name
Indiana University-Purdue University at Indianapolis
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
603007902
City
Indianapolis
State
IN
Country
United States
Zip Code
46202
Ackermann, Ronald T; Liss, David T; Finch, Emily A et al. (2015) A Randomized Comparative Effectiveness Trial for Preventing Type 2 Diabetes. Am J Public Health 105:2328-34
Knowler, William C; Ackermann, Ronald T (2014) Response to comment on knowler et Al. Preventing diabetes in american Indian communities. Diabetes care 2013;36:1820-1822. Diabetes Care 37:e37
Ackermann, Ronald T; Finch, Emily A; Schmidt, Karen K et al. (2014) Rationale, design, and baseline characteristics of a community-based comparative effectiveness trial to prevent type 2 diabetes in economically disadvantaged adults: the RAPID Study. Contemp Clin Trials 37:1-9
Knowler, William C; Ackermann, Ronald T (2013) Preventing diabetes in American Indian communities. Diabetes Care 36:1820-2
Finch, Emily A; Kelly, Melinda S; Marrero, David G et al. (2009) Training YMCA wellness instructors to deliver an adapted version of the Diabetes Prevention Program lifestyle intervention. Diabetes Educ 35:224-8, 232