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.
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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.
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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.
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The authors have no conflicts of interest to declare.
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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.
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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
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DOI: https://doi.org/10.1007/s13142-017-0494-0