Skip to main content
SpringerLink
Log in

Factors related to lifestyle goal achievement in a diabetes prevention program dissemination study

  • Original Research
  • Published:
Translational Behavioral Medicine

Abstract

The U.S. Diabetes Prevention Program (DPP) showed that lifestyle participants who achieved ≥7% weight loss and ≥150 min/week physical activity experienced the greatest reduction in type 2 diabetes incidence. Demographic, clinical, and program factors that are related to achieving both these lifestyle goals have seldom been explored in community-delivered DPP programs. The purpose of this investigation is to examine factors associated with concurrent achievement of weight loss and physical activity goals in a 12-month community DPP lifestyle intervention. Adults [n = 223; age = 58.4 (SD = 11.5); BMI = 33.8 (SD = 6.0)] with glucose or HbA1c values in the pre-diabetes range and/or metabolic syndrome risk factors enrolled from one worksite and three community centers in the Pittsburgh, PA metropolitan area between January 2011 and January 2014. Logistic regression analyses determined the demographic, clinical and program adherence factors related to goal achievement at 6, 12, and 18 months. Participants achieving both intervention goals at 6 months (n = 57) were more likely to attend sessions [Adjusted Odds Ratio (AOR) =1.48], self-weigh (AOR = 1.19), and self-monitor behaviors (AOR = 1.18) than those meeting neither goal (n = 35; all p < 0.05). Baseline BMI (AOR = 0.87, p < 0.01), elevated glycemic status (AOR = 0.49, p < 0.05), and female sex (AOR = 0.52, p < 0.05) were inversely related to goal achievement at 6 months. Meeting either lifestyle goal at 6 months had the strongest association with meeting both goals at 12 and 18 months. Our study supports the importance of early engagement, regular attendance, self-monitoring, and self-weighing for goal achievement. Dissemination efforts should consider alternative approaches for those not meeting goals by 6 months to enhance long-term success.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Centers for Disease Control and Prevention. (2014). National Diabetes Statistics Report: Estimates of diabetes and its burden in the Uniter States. U.S. Department of Health and Human Services, Atlanta, GA. Available at https://www.cdc.gov/diabetes/data/statistics/2014statisticsreport.html.

  2. Ervin, R.B., Prevalence of metabolic syndrome among adults 20 years of age and over, by sex, age, race and ethnicity, and body mass index: United States, 2003–2006. Natl Health Stat Report, 2009; (13): p. 1–7.

  3. Knowler, W. C., et al. (2002). Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. New Engl J Med, 346(6), 393–403.

    Article  CAS  PubMed  Google Scholar 

  4. Tuomilehto, J., et al. (2001). Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. The New England Journal of Medicine, 344(18), 1343–1350.

    Article  CAS  PubMed  Google Scholar 

  5. Pan, X. R., et al. (1997). Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The da Qing IGT and diabetes study. Diabetes Care, 20(4), 537–544.

    Article  CAS  PubMed  Google Scholar 

  6. Kosaka, K., Noda, M., & Kuzuya, T. (2005). Prevention of type 2 diabetes by lifestyle intervention: A Japanese trial in IGT males. Diabetes Research and Clinical Practice, 67(2), 152–162.

    Article  PubMed  Google Scholar 

  7. Whittemore, R. (2011). A systematic review of the translational research on the diabetes prevention program. Translational Behavioral Medicine, 1(3), 480–491.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Johnson, M., et al. (2013). Can diabetes prevention programmes be translated effectively into real-world settings and still deliver improved outcomes? A synthesis of evidence. Diabetic Medicine, 30(1), 3–15.

    Article  CAS  PubMed  Google Scholar 

  9. Wing, R. R., et al. (2004). Achieving weight and activity goals among diabetes prevention program lifestyle participants. Obesity Research, 12(9), 1426–1434.

    Article  PubMed  Google Scholar 

  10. Wing, R. R., et al. (2006). A self-regulation program for maintenance of weight loss. The New England Journal of Medicine, 355(15), 1563–1571.

    Article  CAS  PubMed  Google Scholar 

  11. Amundson, H. A., et al. (2009). Translating the diabetes prevention program into practice in the general community: Findings from the Montana cardiovascular disease and diabetes prevention program. The Diabetes Educator, 35(2), 209–210 213-4, 216-20 passim.

    Article  PubMed  Google Scholar 

  12. Pinelli, N. R., et al. (2011). Family support is associated with success in achieving weight loss in a group lifestyle intervention for diabetes prevention in Arab Americans. Ethnicity & Disease, 21(4), 480–484.

    Google Scholar 

  13. Whittemore, R., et al. (2009). Translating the diabetes prevention program to primary care: A pilot study. Nursing Research, 58(1), 2–12.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Brokaw, S. M., et al. (2015). Effectiveness of an adapted diabetes prevention program lifestyle intervention in older and younger adults. Journal of the American Geriatrics Society, 63(6), 1067–1074.

    Article  PubMed  Google Scholar 

  15. Hamman, R. F., et al. (2006). Effect of weight loss with lifestyle intervention on risk of diabetes. Diabetes Care, 29(9), 2102–2107.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Taradash, J., et al. (2015). Recruitment for a diabetes prevention program translation effort in a worksite setting. Contemporary Clinical Trials, 41c, 204–210.

    Article  Google Scholar 

  17. Kramer, M. K., et al. (2015). Improving employee health: Evaluation of a worksite lifestyle change program to decrease risk factors for diabetes and cardiovascular disease. Journal of Occupational and Environmental Medicine, 57(3), 284–291.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Eaglehouse, Y. L., et al. (2016). Impact of a community-based lifestyle intervention program on health-related quality of life. Quality of Life Research, 25(8), 1903–1912.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Eaglehouse, Y. L., et al. (2016). Physical activity levels in a community lifestyle intervention: A randomized trial. Transl J Am Coll Sports Med, 1(5), 45–51.

    PubMed  PubMed Central  Google Scholar 

  20. Kramer, M. K., et al. (2014). Diabetes prevention efforts in the community are effective for older, at-risk adults [abstract]. In: 74th Scientific Sessions of the American Diabetes Association. Diabetes. 63(Suppl 1): A1-A102.

  21. Kerner, W., & Bruckel, J. (2014). Definition, classification and diagnosis of diabetes mellitus. Experimental and Clinical Endocrinology & Diabetes, 122(7), 384–386.

    Article  CAS  Google Scholar 

  22. Grundy, S. M., et al. (2004). Definition of metabolic syndrome: Report of the National Heart, Lung, and Blood Institute/American Heart Association conference on scientific issues related to definition. Circulation, 109(3), 433–438.

    Article  PubMed  Google Scholar 

  23. Kramer, M. K., et al. (2009). Translating the diabetes prevention program: A comprehensive model for prevention training and program delivery. American Journal of Preventive Medicine, 37(6), 505–511.

    Article  PubMed  Google Scholar 

  24. Centers for Disease Control and Prevention. (2011). Centers for Disease Control and Prevention Diabetes Prevention Recognition Program: Standards and Operating Procedures. Available at www.cdc.gov/diabetes/prevention/recognition.

  25. Wadden, T. A., & Butryn, M. L. (2003). Behavioral treatment of obesity. Endocrinology and Metabolism Clinics of North America, 32(4), 981–1003.

    Article  PubMed  Google Scholar 

  26. Kriska, A. M., & Caspersen, C. J. (1997). Introduction to the collection of physical activity questionnaires. Medicine and Science in Sports and Exercise, 29(6S), S5–S9.

    Article  Google Scholar 

  27. Kriska, A. M., et al. (1990). Development of questionnaire to examine relationship of physical activity and diabetes in pima Indians. Diabetes Care, 13(4), 401–411.

    Article  CAS  PubMed  Google Scholar 

  28. Momenan, A. A., et al. (2012). Reliability and validity of the Modifiable activity questionnaire (MAQ) in an Iranian urban adult population. Archives of Iranian Medicine, 15(5), 279–282.

    PubMed  Google Scholar 

  29. Pettee Gabriel, K., et al. (2011). Reliability and convergent validity of the past-week Modifiable activity questionnaire. Public Health Nutrition, 14(3), 435–442.

    Article  PubMed  Google Scholar 

  30. Kriska, A. M., et al. (2006). Physical activity in individuals at risk for diabetes: Diabetes prevention program. Medicine and Science in Sports and Exercise, 38(5), 826–832.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Peterson, B. L., & Harrell, F. E. (1990). Partial proportional odds models for ordinal response variables. Journal of the Royal Statistical Society, Series B(39), 205–217.

    Google Scholar 

  32. Wing, R. R., & Hill, J. O. (2001). Successful weight loss maintenance. Annual Review of Nutrition, 21, 323–341.

    Article  CAS  PubMed  Google Scholar 

  33. Butryn, M. L., et al. (2007). Consistent self-monitoring of weight: A key component of successful weight loss maintenance. Obesity (Silver Spring), 15(12), 3091–3096.

    Article  Google Scholar 

  34. Williamson, D. A., Bray, G. A., & Ryan, D. H. (2015). Is 5% weight loss a satisfactory criterion to define clinically significant weight loss? Obesity (Silver Spring), 23(12), 2319–2320.

    Article  Google Scholar 

  35. Unick, J. L., et al. (2014). Evaluation of early weight loss thresholds for identifying nonresponders to an intensive lifestyle intervention. Obesity (Silver Spring), 22(7), 1608–1616.

    Article  Google Scholar 

  36. Unick, J. L., et al. (2015). Weight change in the first 2 months of a lifestyle intervention predicts weight changes 8 years later. Obesity (Silver Spring), 23(7), 1353–1356.

    Article  Google Scholar 

  37. Miller, C. K., Nagaraja, H. N., & Weinhold, K. R. (2015). Early weight-loss success identifies nonresponders after a lifestyle intervention in a worksite diabetes prevention trial. Journal of the Academy of Nutrition and Dietetics, 115(9), 1464–1471.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, 130 De Soto Street, Pittsburgh, PA, 15261, USA

    Yvonne L. Eaglehouse, Elizabeth M. Venditti, M. Kaye Kramer, Karl K. Vanderwood, Bonny Rockette-Wagner & Andrea M. Kriska

  2. Division of Cancer Prevention and Population Sciences, University of Pittsburgh Cancer Institute, 5150 Centre Avenue, Pittsburgh, PA, 15232, USA

    Yvonne L. Eaglehouse

  3. 11300 Rockville Pike, Suite 1120, Rockville, MD, 20852, USA

    Yvonne L. Eaglehouse

  4. Department of Psychiatry, University of Pittsburgh School of Medicine, 3550 Terrace Street, Pittsburgh, PA, 15261, USA

    Elizabeth M. Venditti

  5. Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, 130 De Soto Street, Pittsburgh, PA, 15261, USA

    Vincent C. Arena

  6. Montana Department of Public Health and Human Services, 111 North Sanders, Helena, MT, 59601, USA

    Karl K. Vanderwood

Authors
  1. Yvonne L. Eaglehouse
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Elizabeth M. Venditti
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Kaye Kramer
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Vincent C. Arena
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Karl K. Vanderwood
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Bonny Rockette-Wagner
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Andrea M. Kriska
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yvonne L. Eaglehouse.

Ethics declarations

The study protocol was approved by the University of Pittsburgh Institutional Review Board (now the Human Research Protection Office). Written, informed consent was obtained from all individual participants included in the study. All procedures and research activities were in accordance with the ethical standards of the Institutional Review Board and in compliance with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Source of funding

Funding support was provided by the National Institutes of Health through grant number R18 DK081323–04 and grant number T32 CA186783 (postdoctoral training award for Dr. Eaglehouse). The funding agency did not have a role in the design and conduct of the study; in the collection, analysis and interpretation of the data; and in the preparation, review, or approval of the manuscript. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Disclosure of potential conflicts of interest

The authors have no conflicts of interest to declare.

Additional information

Implications

Practice: Providers should reinforce early adoption of self-regulation behaviors and offer additional program support to those not achieving desired lifestyle goals within the first 6 months.

Policy: Policymakers should consider provision of coverage for healthy lifestyle programs for patients earlier in the diabetes-development process, i.e. when patients present with metabolic syndrome components even in the absence of prediabetes.

Research: Future efforts should evaluate other participant and program characteristics that impact on individual success at achieving weight and physical activity goals.

Electronic supplementary material

Table 1

(DOCX 13 kb)

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Eaglehouse, Y.L., Venditti, E.M., Kramer, M. et al. Factors related to lifestyle goal achievement in a diabetes prevention program dissemination study. Behav. Med. Pract. Policy Res. 7, 873–880 (2017). https://doi.org/10.1007/s13142-017-0494-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13142-017-0494-0

Keywords

Search

Navigation