The role of Sociodemographic factors on goal achievement in a community-based diabetes prevention program behavioral lifestyle intervention

Susan M Devaraj, Jenna M Napoleone, Rachel G Miller, Bonny Rockette-Wagner, Vincent C Arena, Chantele Mitchell-Miland, Mohammed Bu Saad, Andrea M Kriska, Susan M Devaraj, Jenna M Napoleone, Rachel G Miller, Bonny Rockette-Wagner, Vincent C Arena, Chantele Mitchell-Miland, Mohammed Bu Saad, Andrea M Kriska

Abstract

Background: The Diabetes Prevention Program (DPP) behavioral lifestyle intervention was effective among a diverse sample of adults with prediabetes. Demonstrated effectiveness in translated versions of the DPP lifestyle intervention (such as Group Lifestyle Balance, DPP-GLB) led to widescale usage with national program oversight and reimbursement. However, little is known about the success of these DPP-translation programs across subgroups of sociodemographic factors. This current effort investigated potential disparities in DPP-translation program primary goal achievement (physical activity and weight) by key sociodemographic factors.

Methods: Data were combined from two 12-month community-based DPP-GLB trials among overweight/obese individuals with prediabetes and/or metabolic syndrome. We evaluated change in weight (kilograms and percent) and activity (MET-hrs/week) and goal achievement (yes/no; ≥5% weight loss and 150 min per week activity) after 6 and 12 months of intervention within and across subgroups of race/ethnicity (non-Hispanic white, non-Hispanic black), employment status, education, income, and gender.

Results: Among 240 participants (85%) with complete data, most sociodemographic subgroups demonstrated significant weight loss. However, non-Hispanic white lost more weight at both 6 and 12 months compared to non-Hispanic black participants [median weight loss (IQR), 6 months: 5.7% (2.7-9.0) vs. 1.5% (1.2-7.5) p = .01 and 12 months: 4.8% (1.1-9.6) vs. 1.1% (- 2.0-3.7) p = .01, respectively]. In addition, a larger percentage of non-Hispanic white demonstrated a 5% weight loss at 6 and 12 months. Employment was significantly related to 12-month weight loss, with retired participants being the most successful. Men, participants with graduate degrees, and those with higher income were most likely to meet the activity goal at baseline and 12 months. Differences in physical activity goal achievement across gender, education, and income groups were significant at baseline, attenuated after 6 months, then re-emerged at 12 months.

Conclusions: The DPP-GLB was effective in promoting weight loss and helped to alleviate disparities in physical activity levels after 6 months. Despite overall program success, differences in weight loss achievement by race/ethnicity were found and disparities in activity re-emerged after 12 months of intervention. These results support the need for intervention modification providing more tailored approaches to marginalized groups to maximize the achievement and maintenance of DPP-GLB behavioral goals.

Trial registration: NCT01050205 , NCT02467881 .

Keywords: Diabetes mellitus; Education; Exercise; Health disparities; Healthcare disparities; Income; Metabolic syndrome; Weight loss and weight gain.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Weight Loss (%) as median with 95% confidence intervals at 6 and 12 months by Gender, Education, Race/Ethnicity, Income, and Employment. Legend: Allegheny County, PA. USA. Study date: 2010–2019. Eligible population: overweight with prediabetes and/or metabolic syndrome. *p < .05, ✢ p < .10 using Wilcoxon Signed-Rank Test of within-group change; Text box p-values determined using Wilcoxon Two Sample or Kruskal-Wallis Test of between-group change. n = 240; Race/Ethnicity n = 230. m: months; Q1: <$51,934, Q2: 1934 – < 65,105, Q3: 65,105 – < 74,935.5, Q4:≥ 74,935.5 median household income in US dollars
Fig. 2
Fig. 2
Physical Activity Success (% meeting ≥7.5 MET-hours/week goal) at Baseline, 6, and 12 months. Legend: Allegheny County, PA. USA. Study date: 2010–2019. Eligible population: overweight with prediabetes and/or metabolic syndrome. P-values determined using Chi Square or Fishers Exact Test for Differences of Proportions meeting goal vs not meeting goal across sociodemographic subgroups; Income measured in quartiles of median annual household income in US dollars. Employment data not shown, no significant differences noted. n = 240; Race/Ethnicity n = 230

References

    1. Centers for Disease Control and Prevention. National Diabetes Statistics Report 2020 [Internet]. Atlanta (GA); 2020. Available from:
    1. Menke A, Casagrande S, Geiss L, Cowie CC. Prevalence of and trends in diabetes among adults in the United States, 1988-2012. JAMA. 2015;314(10):1021–1029. doi: 10.1001/jama.2015.10029.
    1. Bleich SN, Jarlenski MP, Bell CN, LaVeist TA. Health inequalities: trends, progress, and policy. Annu Rev Public Heal. 2012;33:7–40. doi: 10.1146/annurev-publhealth-031811-124658.
    1. Harding JL, Pavkov ME, Magliano DJ, Shaw JE, Gregg EW. Global trends in diabetes complications: a review of current evidence. Diabetologia. 2019;62(1):3–16. Available from:
    1. Saran R, Robinson B, Abbott KC, Bragg-Gresham J, Chen X, Gipson D, et al. US Renal Data System 2019 Annual Data report: epidemiology of kidney disease in the United States. Vol. 75, American journal of kidney diseases : the official journal of the National Kidney Foundation. United States; 2020. p. A6–A7.
    1. Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Shay CM, Spartano NL, Stokes A, Tirschwell DL, VanWagner L, Tsao CW, American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee Heart disease and stroke Statistics-2020 update: a report from the American Heart Association. Circulation. 2020;141(9):e139–e596. doi: 10.1161/CIR.0000000000000757.
    1. Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, Nathan DM, Diabetes Prevention Program Research Group Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393–403. doi: 10.1056/NEJMoa012512.
    1. Ely EK, Gruss SM, Luman ET, Gregg EW, Ali MK, Nhim K, Rolka DB, Albright AL. A National Effort to prevent type 2 diabetes: participant-level evaluation of CDC’s national diabetes prevention program. Diabetes Care. 2017;40(10):1331–1341. doi: 10.2337/dc16-2099.
    1. Centers for Medicare and Medicaid Services. Medicare Diabetes Prevention Program (MDPP) Expanded Model [Internet]. Announced June 15, 2018. Available from: . Accessed 21 Aug 2019.
    1. Kramer MK, Kriska AM, Venditti EM, Semler LN, Miller RG, McDonald T, Siminerio LM, Orchard TJ. A novel approach to diabetes prevention: evaluation of the group lifestyle balance program delivered via DVD. Diabetes Res Clin Pract. 2010;90(3):e60–e63. doi: 10.1016/j.diabres.2010.08.013.
    1. Kramer MK, McWilliams JR, Chen H-Y, Siminerio LM. A community-based diabetes prevention program: evaluation of the group lifestyle balance program delivered by diabetes educators. Diabetes Educ. 2011;37(5):659–668. doi: 10.1177/0145721711411930.
    1. Kramer MK, Vanderwood KK, Arena VC, Miller RG, Meehan R, Eaglehouse YL, Schafer G, Venditti EM, Kriska AM. Evaluation of a diabetes prevention program lifestyle intervention in older adults: a randomized controlled study in three senior/community centers of varying socioeconomic status. Diabetes Educ. 2018;44(2):118–129. doi: 10.1177/0145721718759982.
    1. Ma J, Yank V, Xiao L, Lavori PW, Wilson SR, Rosas LG, Stafford RS. Translating the diabetes prevention program lifestyle intervention for weight loss into primary care: a randomized trial. JAMA Intern Med. 2013;173(2):113–121. doi: 10.1001/2013.jamainternmed.987.
    1. Sattin RW, Williams LB, Dias J, Garvin JT, Marion L, Joshua TV, Kriska A, Kramer MK, Venkat Narayan KM. Community trial of a faith-based lifestyle intervention to prevent diabetes among African-Americans. J Community Health. 2016;41(1):87–96. doi: 10.1007/s10900-015-0071-8.
    1. Kramer MK, Molenaar DM, Arena VC, Venditti EM, Meehan RJ, Miller RG, Vanderwood KK, Eaglehouse Y, Kriska AM. Improving employee health: evaluation of a worksite lifestyle change program to decrease risk factors for diabetes and cardiovascular disease. J Occup Environ Med. 2015;57(3):284–291. doi: 10.1097/JOM.0000000000000350.
    1. Hill J, Nielsen M, Fox MH. Understanding the social factors that contribute to diabetes: a means to informing health care and social policies for the chronically ill. Perm J. 2013;17(2):67–72. doi: 10.7812/TPP/12-099.
    1. Kramer MK, Kriska AM, Venditti EM, Miller RG, Brooks MM, Burke LE, Siminerio LM, Solano FX, Orchard TJ. Translating the diabetes prevention program: a comprehensive model for prevention training and program delivery. Am J Prev Med. 2009;37(6):505–511. doi: 10.1016/j.amepre.2009.07.020.
    1. Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation. 2002;106:3143–421.
    1. United States Census Bureau. 2016: American Community Survey 5-Year Estimates [Internet]. Available from:
    1. Schulz LO, Harper IT, Smith CJ, Kriska AM, Ravussin E. Energy intake and physical activity in Pima Indians: comparison with energy expenditure measured by doubly-labeled water. Obes Res. 1994;2(6):541–548. doi: 10.1002/j.1550-8528.1994.tb00103.x.
    1. Kriska AM, Knowler WC, LaPorte RE, Drash AL, Wing RR, Blair SN, et al. Development of questionnaire to examine relationship of physical activity and diabetes in Pima Indians. Diabetes Care. 1990;13(4):401–411. doi: 10.2337/diacare.13.4.401.
    1. Wing RR, Hamman RF, Bray GA, Delahanty L, Edelstein SL, Hill JO, Horton ES, Hoskin MA, Kriska A, Lachin J, Mayer-Davis EJ, Pi-Sunyer X, Regensteiner JG, Venditti B, Wylie-Rosett J, Diabetes Prevention Program Research Group Achieving weight and activity goals among diabetes prevention program lifestyle participants. Obes Res. 2004;12(9):1426–1434. doi: 10.1038/oby.2004.179.
    1. Gruss SM, Nhim K, Gregg E, Bell M, Luman E, Albright A. Public health approaches to type 2 diabetes prevention: the US National Diabetes Prevention Program and beyond. Curr Diab Rep. 2019;19(9):78. doi: 10.1007/s11892-019-1200-z.
    1. Samuel-Hodge CD, Johnson CM, Braxton DF, Lackey M. Effectiveness of diabetes prevention program translations among African Americans. Obes Rev. 2014;15(Suppl 4):107–24.
    1. Dodani S, Kramer MK, Williams L, Crawford S, Kriska A. Fit body and soul: a church-based behavioral lifestyle program for diabetes prevention in African Americans. Ethn Dis. 2009;19(2):135–141.
    1. West DS, Elaine Prewitt T, Bursac Z, Felix HC. Weight loss of black, white, and Hispanic men and women in the diabetes prevention program. Obesity (Silver Spring) 2008;16(6):1413–1420. doi: 10.1038/oby.2008.224.
    1. Ritchie ND, Sauder KA, Phimphasone-Brady P, Amura CR. Rethinking the national diabetes prevention program for low-income whites. Diabetes care. 2018;41(4):e56–e57. doi: 10.2337/dc17-2230.
    1. Eaglehouse YL, Kramer MK, Rockette-Wagner B, Arena VC, Kriska AM. Evaluation of physical activity reporting in community diabetes prevention program lifestyle intervention efforts: a systematic review. Prev Med (Baltim) 2015;77:191–199. doi: 10.1016/j.ypmed.2015.05.023.
    1. Haire-Joshu D, Hill-Briggs F. The next generation of diabetes translation: a path to health equity. Annu Rev Public Health. 2019;40(1):391–410. doi: 10.1146/annurev-publhealth-040218-044158.
    1. Arnett DK, Blumenthal RS, Albert MA, Buroker AB, Goldberger ZD, Hahn EJ, Himmelfarb CD, Khera A, Lloyd-Jones D, McEvoy J, Michos ED, Miedema MD, Muñoz D, Smith SC Jr, Virani SS, Williams KA Sr, Yeboah J, Ziaeian B. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. Circulation. 2019;140(11):e596–e646. doi: 10.1161/CIR.0000000000000678.
    1. Hill-Briggs F, Adler NE, Berkowitz SA, Chin MH, Gary-Webb TL, Navas-Acien A, et al. Social determinants of health and diabetes: a scientific review. Diabetes Care. 2020;44:258–79.
    1. Whittemore R. A systematic review of the translational research on the diabetes prevention program. Transl Behav Med. 2011;1(3):480–491. doi: 10.1007/s13142-011-0062-y.
    1. AuYoung M, Moin T, Richardson CR, Damschroder LJ. The diabetes prevention program for underserved populations: a brief review of strategies in the real world. Diabetes Spectr. 2019;32(4):312–317. doi: 10.2337/ds19-0007.
    1. Delahanty LM, Trief PM, Cibula DA, Weinstock RS. Barriers to weight loss and physical activity, and coach approaches to addressing barriers, in a real-world adaptation of the DPP lifestyle intervention: a process analysis. Diabetes Educ. 2019;45(6):596–606. doi: 10.1177/0145721719883615.
    1. Hall DL, Lattie EG, McCalla JR, Saab PG. Translation of the diabetes prevention program to ethnic communities in the United States. J Immigr Minor Health. 2016;18(2):479–489. doi: 10.1007/s10903-015-0209-x.
    1. Tabak RG, Sinclair KA, Baumann AA, Racette SB, Sebert Kuhlmann A, Johnson-Jennings MD, Brownson RC. A review of diabetes prevention program translations: use of cultural adaptation and implementation research. Transl Behav Med. 2015;5(4):401–414. doi: 10.1007/s13142-015-0341-0.
    1. Gary-Webb TL, Walker EA, Realmuto L, Kamler A, Lukin J, Tyson W, Carrasquillo O, Weiss L. Translation of the National Diabetes Prevention Program to engage men in disadvantaged neighborhoods in New York City: a description of power up for health. Am J Mens Health. 2018;12(4):998–1006. doi: 10.1177/1557988318758788.

Source: PubMed

Sponsorer og samarbejdspartnere

Medicinske tilstande

Narkotikainterventioner

3
Abonner