A Randomized Comparative Effectiveness Trial for Preventing Type 2 Diabetes

• Published in: American journal of public health (1971) 2015-11, Vol.105 (11), p.2328-2334
• Main Authors: Ackermann, Ronald T, Liss, David T, Finch, Emily A, Schmidt, Karen K, Hays, Laura M, Marrero, David G, Saha, Chandan
• Format: Article
• Language: English
• Subjects: Adult; Blood Glucose; Blood pressure; Blood tests; Body Mass Index; Cholesterol; Community; Comparative studies; Counseling; Counseling - organization & administration; Diabetes; Diabetes Mellitus, Type 2 - prevention & control; Exercise; Female; Glucose; Health Behavior; Health Promotion; Hemoglobin; Humans; Indiana; Intervention; Life Style; Lifestyles; Low income groups; Male; Middle Aged; Obesity - therapy; Obesity/Overweight/Underweight; Overweight; Overweight - therapy; Patients; Poverty; Prevention; Prevention programs; Primary care; Public health; Race/Ethnicity; Regression analysis; Research and Practice; Single-Blind Method; Weight Loss; Weight Reduction Programs - organization & administration
• ISSN: 0090-0036; 1541-0048
• DOI: 10.2105/AJPH.2015.302641

We evaluated the weight loss effectiveness of a YMCA model for the Diabetes Prevention Program (DPP) lifestyle intervention. Between July 2008 and November 2010, we individually randomized 509 overweight or obese, low-income, nondiabetic adults with elevated blood glucose in Indianapolis, Indiana, to receive standard care plus brief lifestyle counseling or be offered a group-based YMCA adaptation of the DPP (YDPP). Primary outcome was mean weight loss difference at 12 months. In our intention-to-treat analyses, we used longitudinal linear or logistic regression, multiply imputing missing observations. We used instrumental variables regression to estimate weight loss effectiveness among participants completing 9 or more intervention lessons. In the YDPP arm, 161 (62.6%) participants attended ≥ 1 lesson and 103 (40.0%) completed 9 or more lessons. In intention-to-treat analysis, mean 12-month weight loss was 2.3 kilograms (95% confidence interval [CI] = 1.1, 3.4 kg) more for the YDPP arm than for standard care participants. In instrumental variable analyses, persons attending 9 or more lessons had a 5.3-kilogram (95% CI = 2.8, 7.9 kg) greater weight loss than did those with standard care alone. The YMCA model for DPP delivery achieves meaningful weight loss at 12 months among low-income adults.