Type 2 diabetes and its complications disproportionately affect the patient population served by the Department of Veteran's Affairs (VA). Recent lifestyle interventions, including the multi-center Diabetes Prevention Program (DPP), have demonstrated that weight-loss achieved through reductions in caloric intake and increases in physical activity can prevent or delay the onset of diabetes. The Healthy-Living Partnerships to Prevent Diabetes (HELP PD) successfully translated the DPP lifestyle intervention into a group format led by trained community health workers (CHWs) and achieved more than a 7% weight loss at 6 months. In the Healthy Living Partnerships to Prevent Diabetes in Veterans (HELP PD Vets), we propose to test the feasibility of further translating the HELP PD lifestyle intervention, tailored for use in the Veteran population, in the Winston-Salem Community-Based Outpatient Clinic operated by the VA. We will recruit 50 overweight or obese Veterans at high risk for developing diabetes from the existing patient population to participate in a 6- month weight loss intervention led by CHWs. These CHWs will be recruited, trained, and monitored by local clinic staff, who will in turn be trained and monitored by investigators at Wake Forest School of Medicine. We will evaluate our ability to recruit participants and CHWs, train staff and CHWs to deliver the lifestyle intevention, assess participants' ability to adhere to the intervention, evaluate changes in laboratory and anthropometric measures using existing data in the medical record, and pilot a cost analysis to estimate the relative cost of intervention implementation in the clinical setting. As VA outpatient clinics have the requisite infrastructure to identify, screen, and enroll participants and access to CHWs from within their patient populations, we believe that they are ideal potential homes for diabetes prevention programming. We will use the data gathered during this planning grant to develop a large-scale R18 proposal to test implementing the HELP PD Vets intervention in a larger segment of the Veteran poulation.
Diabetes and obesity are both major public health concerns and the prevalance of diabetes is even higher in the patient population of the Veteran's Administration. This planning project is designed to adapt a successful weight-loss program for delivery through an existing outpatient clinic to reach local Veterans at risk for developing diabetes. The information gathered as a part of this project will be used to plan a larger trial designed to improve the health of Veterans by offering them a diabetes prevention program through their usual source of healthcare.
