Current Diabetes Reports

, Volume 12, Issue 2, pp 138–146 | Cite as

Necessary Components for Lifestyle Modification Interventions to Reduce Diabetes Risk

  • Elizabeth M. Venditti
  • M. Kaye Kramer
Translational Strategies for Diabetes Prevention (D Marrero, Section Editor)


Several efficacy trials and subsequent dissemination studies indicate that behavioral lifestyle interventions for diabetes risk reduction require, at a minimum, provision of 4 to 6 months of frequent intervention contact to induce clinically meaningful weight losses of at least 5% of initial body weight. Weekly contact during the first several months of intervention, followed by less frequent but regular therapeutic contact for a longer time period, appears necessary for participants to adopt and enact behavioral self-regulatory skills such as the self-monitoring of diet, weight, and physical activity and the problem solving of common physical, social, and cognitive barriers that impede sustained weight loss. In-person contact is associated with the largest effect sizes but may not be a necessary component for clinically meaningful weight loss. Regardless of intervention mode, setting, or provider, the interactive process of feedback and social support is crucial for skill development and sustained weight loss.


Diabetes risk Lifestyle intervention Behavior modification Weight management Weight loss Diet Physical activity Maintenance Prevention 



Conflicts of interest: E.M. Venditti: has been a consultant for UPMC Health Plan; is employed by the University of Pittsburgh; has received grant support from NIH-NIDDK, DOD; and has received payment for lectures including service on speakers bureaus from the American Diabetes Association; M.K. Kramer: is employed by the University of Pittsburgh; has received grant support from NIH-NIDDK, DOD; and has received payment for lectures including service on speakers bureaus from the American Diabetes Association.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Knowler WC, Barrett-Connor E, Fowler SE. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393–403. PMCID: 1370926.PubMedCrossRefGoogle Scholar
  2. 2.
    Pan XR, Li GW, Hu YH, et al. Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT and Diabetes Study. Diabetes Care. 1997;20(4):537–44.PubMedCrossRefGoogle Scholar
  3. 3.
    Tuomilehto J, Lindstrom J, Eriksson JG, et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med. 2001;344(18):1343–50.PubMedCrossRefGoogle Scholar
  4. 4.
    Knowler WC, Fowler SE, Hamman RF. 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study. Lancet. 2009;374(9702):1677–86. PMCID: 3135022.PubMedCrossRefGoogle Scholar
  5. 5.
    Li G, Zhang P, Wang J, et al. The long-term effect of lifestyle interventions to prevent diabetes in the China Da Qing Diabetes Prevention Study: a 20-year follow-up study. Lancet. 2008;371(9626):1783–9.PubMedCrossRefGoogle Scholar
  6. 6.
    Lindstrom J, Ilanne-Parikka P, Peltonen M, et al. Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: follow-up of the Finnish Diabetes Prevention Study. Lancet. 2006;368(9548):1673–9.PubMedCrossRefGoogle Scholar
  7. 7.
    Tuomilehto J, Schwarz P, Lindstrom J. Long-term benefits from lifestyle interventions for type 2 diabetes prevention: time to expand the efforts. Diabetes Care. 2011;34 Suppl 2:S210–4.PubMedCrossRefGoogle Scholar
  8. 8.
    Uusitupa M, Peltonen M, Lindstrom J. Ten-year mortality and cardiovascular morbidity in the Finnish Diabetes Prevention Study--secondary analysis of the randomized trial. PLoS One. 2009;4(5):e5656. PMCID: 2682577.PubMedCrossRefGoogle Scholar
  9. 9.
    Eckel RH, Kahn SE, Ferrannini E. Obesity and type 2 diabetes: what can be unified and what needs to be individualized? Diabetes Care. 2011;34(6):1424–30. PMCID: 3114323.PubMedCrossRefGoogle Scholar
  10. 10.
    Hunter CM. News from NIH: obesity and diabetes. Translational Behavioral Medicine. 2011;1(3):367–8.CrossRefGoogle Scholar
  11. 11.
    Venditti EM. Efficacy of lifestyle behavior change programs in diabetes. Curr Diab Rep. 2007;7(2):123–7.PubMedCrossRefGoogle Scholar
  12. 12.
    Jackson L. Translating the Diabetes Prevention Program into practice: a review of community interventions. Diabetes Educ. 2009;35(2):309–20.PubMedCrossRefGoogle Scholar
  13. 13.
    Whittemore R. A systematic review of the translational research on the Diabetes Prevention Program. Translational Behavioral Medicine. 2011;1(3):480–91.CrossRefGoogle Scholar
  14. 14.
    Pagoto S. The current state of lifestyle intervention implementation research: where do we go next? Translational Behavioral Medicine. 2011;1(3):401–5.CrossRefGoogle Scholar
  15. 15.
    Bandura A. Health promotion by social cognitive means. Health Educ Behav. 2004;31(2):143–64.PubMedCrossRefGoogle Scholar
  16. 16.
    The Diabetes Prevention Program (DPP) Research Group: description of lifestyle intervention. Diabetes Care. 2002;25(12):2165-71. PMCID: 1282458.Google Scholar
  17. 17.
    Wing RR, Hamman RF, Bray GA. Achieving weight and activity goals among diabetes prevention program lifestyle participants. Obes Res. 2004;12(9):1426–34. PMCID: 2505058.PubMedCrossRefGoogle Scholar
  18. 18.
    Pi-Sunyer X, Kris-Etherton PM. Improving health outcomes: future directions in the field. J Am Diet Assoc. 2005;105(5 Suppl 1):S14–6.PubMedCrossRefGoogle Scholar
  19. 19.
    Butryn ML, Webb V, Wadden TA. Behavioral treatment of obesity. Psychiatr Clin North Am. 2011;34(4):841–59. PMCID: 3233993.PubMedCrossRefGoogle Scholar
  20. 20.
    Ali MK, Echoufo-Tcheugui, Williamson DF. How effective were lifestyle interventions in real-world settings that were modeled on the diabetes prevention program? Health Aff. 2012;31(1):67–75. PMCID: 22232096.CrossRefGoogle Scholar
  21. 21.
    Hamman RF, Wing RR, Edelstein SL. Effect of weight loss with lifestyle intervention on risk of diabetes. Diabetes Care. 2006;29(9):2102–7. PMCID: 1762038.PubMedCrossRefGoogle Scholar
  22. 22.
    Venditti EM, Bray GA, Carrion-Petersen ML. First versus repeat treatment with a lifestyle intervention program: attendance and weight loss outcomes. Int J Obes (Lond). 2008;32(10):1537–44. PMCID: 2574826.CrossRefGoogle Scholar
  23. 23.
    Eddy DM, Schlessinger L, Kahn R. Clinical outcomes and cost-effectiveness of strategies for managing people at high risk for diabetes. Ann Intern Med. 2005;143(4):251–64.PubMedGoogle Scholar
  24. 24.
    Kramer MK, Kriska AM, Venditti EM, et al. Translating the Diabetes Prevention Program: a comprehensive model for prevention training and program delivery. Am J Prev Med. 2009;37(6):505–11.PubMedCrossRefGoogle Scholar
  25. 25.
    Kramer MK, McWilliams JR, Chen HY, et al. A community-based diabetes prevention program: evaluation of the group lifestyle balance program delivered by diabetes educators. Diabetes Educ. 2011;37(5):659–68.PubMedCrossRefGoogle Scholar
  26. 26.
    McTigue KM, Conroy MB, Bigi L. Weight loss through living well: translating an effective lifestyle intervention into clinical practice. Diabetes Educ. 2009;35(2):199–204. 8.PubMedCrossRefGoogle Scholar
  27. 27.
    Pagoto SL, Kantor L, Bodenlos JS, et al. Translating the diabetes prevention program into a hospital-based weight loss program. Health Psychol. 2008;27(1 Suppl):S91–8.PubMedCrossRefGoogle Scholar
  28. 28.
    •• Wadden TA, Volger S, Sarwer DB. A two-year randomized trial of obesity treatment in primary care practice. N Engl J Med. 2011;365(21):1969–79. In a large network of primary care practices, high-risk overweight and obese patients were provided DPP-adapted brief (10- to 15-minute) adjunctive counseling by MAs (with 8 hours of direct training) in addition to quarterly PCP guidance visits. This was compared to an enhanced version of the same condition. Brief enhanced counseling by MAs included the option of receiving sibutramine, orlistat, or meal replacements as determined by the patient and physician. Brief counseling alone was associated with a mean weight loss of 3.5% at 1 year and the brief enhanced counseling condition was associated with an average 7% weight loss. PubMedCrossRefGoogle Scholar
  29. 29.
    Whittemore R, Melkus G, Wagner J. Translating the diabetes prevention program to primary care: a pilot study. Nurs Res. 2009;58(1):2–12. PMCID: 2689783.PubMedCrossRefGoogle Scholar
  30. 30.
    •• Katula JA, Vitolins MZ, Rosenberger EL. One-year results of a community-based translation of the Diabetes Prevention Program: Healthy-Living Partnerships to Prevent Diabetes (HELP PD) Project. Diabetes Care. 2011;34(7):1451–7. PMCID: 3120203. This paper demonstrated that well-trained (36 hours), monitored, and supervised CHWs delivering a DPP-adapted group intervention of greater than 30 face-to-face contacts in the first year (including personalized dietician visits and supplemental phone contact) was associated with excellent adherence, 7.5% mean weight change, and significant reductions in glucose, insulin, HOMA-IR, and waist circumference at 1 year from baseline. PubMedCrossRefGoogle Scholar
  31. 31.
    Vanderwood KK, Hall TO, Harwell TS. Implementing a state-based cardiovascular disease and diabetes prevention program. Diabetes Care. 2010;33(12):2543–5. PMCID: 2992185.PubMedCrossRefGoogle Scholar
  32. 32.
    West DS, Bursac Z, Cornell CE, et al. Lay health educators translate a weight-loss intervention in senior centers: a randomized controlled trial. Am J Prev Med. 2011;41(4):385–91.PubMedCrossRefGoogle Scholar
  33. 33.
    Vadheim LM, Brewer KA, Kassner DR, et al. Effectiveness of a lifestyle intervention program among persons at high risk for cardiovascular disease and diabetes in a rural community. J Rural Health. 2010;26(3):266–72.PubMedCrossRefGoogle Scholar
  34. 34.
    Jaber LA, Pinelli NR, Brown MB. Feasibility of group lifestyle intervention for diabetes prevention in Arab Americans. Diabetes Res Clin Pract. 2011;91(3):307–15. PMCID: 3055934.PubMedCrossRefGoogle Scholar
  35. 35.
    Ackermann RT, Finch EA, Brizendine E. Translating the Diabetes Prevention Program into the community. The DEPLOY Pilot Study. Am J Prev Med. 2008;35(4):357–63. PMCID: 2610485.PubMedCrossRefGoogle Scholar
  36. 36.
    Parikh P, Simon EP, Fei K. Results of a pilot diabetes prevention intervention in East Harlem, New York City: Project HEED. Am J Public Health. 2010;1(100):S232–9. PMCID: 2837455.CrossRefGoogle Scholar
  37. 37.
    Ruggiero L, Oros S, Choi YK. Community-based translation of the diabetes prevention program’s lifestyle intervention in an underserved Latino population. Diabetes Educ. 2011;37(4):564–72.PubMedCrossRefGoogle Scholar
  38. 38.
    Mau MK, Kaholokula JK, West MR, et al. Translating diabetes prevention into native Hawaiian and Pacific Islander communities: the PILI 'Ohana Pilot project. Progr Comm Health Partnersh. 2010;4(1):7–16. PMID: 20364073.Google Scholar
  39. 39.
    Boltri JM, Davis-Smith M, Okosun IS, et al. Translation of the National Institutes of Health Diabetes Prevention Program in African American churches. J Natl Med Assoc. 2011;103(3):194–202.PubMedGoogle Scholar
  40. 40.
    de Groot M, Fisher L. Building a pipeline of training for behavioral diabetes researchers and clinicians: a call for national dialogue. Curr Diab Rep. 2011;11(6):503–10.PubMedCrossRefGoogle Scholar
  41. 41.
    • Kramer MK, Kriska AM, Venditti EM. A novel approach to diabetes prevention: evaluation of the Group Lifestyle Balance program delivered via DVD. Diabetes Res Clin Pract. 2010;90(3):e60–3. This pilot study of a DPP-adapted treatment is important because clinically significant weight loss was achieved using both a CDE group-delivered intervention (6.6% on average), and a DVD plus weekly phone counseling version of the same treatment protocol (5.6%). The results are encouraging and should be replicated with a larger sample in other settings. PubMedCrossRefGoogle Scholar
  42. 42.
    Perri MG, Nezu AM, McKelvey WF, et al. Relapse prevention training and problem-solving therapy in the long-term management of obesity. J Consult Clin Psychol. 2001;69(4):722–6.PubMedCrossRefGoogle Scholar
  43. 43.
    Svetkey LP, Ard JD, Stevens VJ, et al. Predictors of Long-Term Weight Loss in Adults With Modest Initial Weight Loss, by Sex and Race. Obesity (Silver Spring). 2011.Google Scholar
  44. 44.
    Wing RR, Tate DF, Gorin AA, et al. A self-regulation program for maintenance of weight loss. N Engl J Med. 2006;355(15):1563–71.PubMedCrossRefGoogle Scholar
  45. 45.
    Harvey-Berino J, West D, Krukowski R. Internet delivered behavioral obesity treatment. Prev Med. 2010;51(2):123–8. PMCID: 3101104.PubMedCrossRefGoogle Scholar
  46. 46.
    Sherwood NE, Jeffery RW, Pronk NP, et al. Mail and phone interventions for weight loss in a managed-care setting: weigh-to-be 2-year outcomes. Int J Obes (Lond). 2006;30(10):1565–73.CrossRefGoogle Scholar
  47. 47.
    Krukowski RA, Tilford JM, Harvey-Berino J. Comparing behavioral weight loss modalities: incremental cost-effectiveness of an internet-based versus an in-person condition. Obesity (Silver Spring). 2011;19(8):1629–35. PMCID: 3137759.CrossRefGoogle Scholar
  48. 48.
    Gold BC, Burke S, Pintauro S, et al. Weight loss on the web: A pilot study comparing a structured behavioral intervention to a commercial program. Obesity (Silver Spring). 2007;15(1):155–64.CrossRefGoogle Scholar
  49. 49.
    McTigue KM, Conroy MB, Hess R, et al. Using the internet to translate an evidence-based lifestyle intervention into practice. Telemed E Health. 2009;15(9):851–8.CrossRefGoogle Scholar
  50. 50.
    Wing RR, Crane MM, Thomas JG, et al. Improving weight loss outcomes of community interventions by incorporating behavioral strategies. Am J Public Health. 2010;100(12):2513–9.PubMedCrossRefGoogle Scholar
  51. 51.
    Vadheim LM, McPherson C, Kassner DR, et al. Adapted diabetes prevention program lifestyle intervention can be effectively delivered through telehealth. Diabetes Educ. 2010;36(4):651–6. PMID: 20534873.Google Scholar
  52. 52.
    McBride PE, Einerson JA, Grant H, et al. Putting the Diabetes Prevention Program into practice: a program for weight loss and cardiovascular risk reduction for patients with metabolic syndrome or type 2 diabetes mellitus. J Nutr Health Aging. 2008;12(10):745S–9S. PMID:19043651.Google Scholar
  53. 53.
    Seidel MC, Powell RO, Zgibor JC, et al. Translating the Diabetes Prevention Program into an urban medically underserved community: a nonrandomized prospective intervention study. Diabetes Care. 2008;31(4):684–9. PMID:18252904.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Diabetes Prevention Program Outcomes StudyWestern Psychiatric Institute and Clinics, University of Pittsburgh Medical CenterPittsburghUSA
  2. 2.Diabetes Prevention Support CenterGraduate School of Public Health, University of PittsburghPittsburghUSA

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