Translating the diabetes prevention program to primary care: a pilot study.
BACKGROUND
Research on the translation of efficacious lifestyle change programs to prevent type 2 diabetes into community or clinical settings is needed.


OBJECTIVE
The objective of this study was to examine the reach, implementation, and efficacy of a 6-month lifestyle program implemented in primary care by nurse practitioners (NPs) for adults at risk of type 2 diabetes.


METHODS
The NP sites (n = 4) were randomized to an enhanced standard care program (one NP and one nutrition session) or a lifestyle program (enhanced standard care and six NP sessions). These NPs recruited adults at risk of diabetes from their practice (n = 58), with an acceptance rate of 70%.


RESULTS
The program reached a diverse, obese, and moderately low income sample. The NPs were able to successfully implement the protocols. The average length of the program was 9.3 months. Attendance was high (98%), and attrition was low (12%). The NPs were able to adopt the educational, behavioral, and psychosocial strategies of the intervention easily. Motivational interviewing was more difficult for NPs. Mixed-model repeated-measures analysis indicated significant trends or improvement in both groups for nutrition and exercise behavior. Participants of the lifestyle program demonstrated trends for better high-density lipoprotein (HDL) and exercise behavior compared with the enhanced standard care participants. Twenty-five percent of lifestyle participants met treatment goals of 5% weight loss compared with 11% of standard care participants.


CONCLUSIONS
A lifestyle program can be implemented in primary care by NPs, reach the targeted population, and be modestly successful. Further research is indicated.
Whittemore
Robin
R
Yale School of Nursing, New Haven, Connecticut 06536-0740, USA. robin.whittemore@yale.edu
Melkus
Gail
G
Wagner
Julie
J
Dziura
James
J
Northrup
Veronika
V
Grey
Margaret
M
D000328:Adult; D003924:Diabetes Mellitus, Type 2 / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D006937:Hypercholesterolemia / Q000150:complications / Q000175:diagnosis / Q000517:prevention & control; D006973:Hypertension / Q000150:complications / Q000175:diagnosis / Q000517:prevention & control; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009511:New England; D009722:Nurse Practitioners / Q000458:organization & administration*; D015403:Nursing Evaluation Research; D052756:Nutritional Sciences / Q000193:education; D009765:Obesity / Q000150:complications / Q000175:diagnosis / Q000517:prevention & control; D010353:Patient Education as Topic / Q000458:organization & administration*; D017060:Patient Satisfaction; D010865:Pilot Projects; D011320:Primary Health Care / Q000458:organization & administration*; D015397:Program Evaluation; D011446:Prospective Studies; D016037:Single-Blind Method