Presessions to the National Diabetes Prevention Program May be a Promising Strategy to Improve Attendance and Weight Loss Outcomes

Abstract

Purpose:

The National Diabetes Prevention Program (NDPP) is a widely disseminated lifestyle intervention. Attendance is problematic, leading to suboptimal weight loss, especially among racial/ethnic minority participants. We conducted a novel “presession” protocol to improve engagement of diverse NDPP candidates, comparing NDPP participants who attended a presession to those who did not on attendance and weight loss outcomes.

Design:

Longitudinal cohort study.

Setting:

A safety net health-care system.

Participants:

A total of 1140 patients with diabetes risks (58.9% Hispanic, 19.8% non-Hispanic black, 61.8% low income).

Intervention:

The NDPP has been delivered in a Denver, Colorado health-care system since 2013. The program included 22 to 25 sessions over 1 year. Beginning September 2016, individuals were required to attend a presession before enrollment that focused on (1) increasing risk awareness, (2) motivational interviewing to participate in the NDPP, and (3) problem-solving around engagement barriers.

Measures:

Duration and intensity of NDPP attendance and weight loss.

Analysis:

Outcomes of 75 presession participants who enrolled in the NDPP were compared to 1065 prior participants using analysis of covariance and multivariable logistic regression.

Results:

Presession participants stayed in the NDPP 99.8 days longer (P < .001) and attended 14.3% more sessions (P < .001) on average than those without a presession. Presession participants lost 2.0% more weight (P < .001) and were 3.5 times more likely to achieve the 5% weight loss target (P < .001).

Conclusion:

Presessions may improve NDPP outcomes for individuals from diverse backgrounds. A full-scale trial is needed to determine whether presessions reliably improve NDPP effectiveness.

Keywords

type 2 diabetes prevention retention weight loss disparities

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