title: Translating the Diabetes Prevention Program lifestyle intervention for weight loss into primary care: a randomized trial.
abstract: BACKGROUND
  The Diabetes Prevention Program (DPP) lifestyle intervention reduced the incidence of type 2 diabetes mellitus (DM) among high-risk adults by 58%, with weight loss as the dominant predictor. However, it has not been adequately translated into primary care.
  
  
  METHODS
  We evaluated 2 adapted DPP lifestyle interventions among overweight or obese adults who were recruited from 1 primary care clinic and had pre-DM and/or metabolic syndrome. Participants were randomized to (1) a coach-led group intervention (n = 79), (2) a self-directed DVD intervention (n = 81), or (3) usual care (n = 81). During a 3-month intensive intervention phase, the DPP-based behavioral weight-loss curriculum was delivered by lifestyle coach-led small groups or home-based DVD. During the maintenance phase, participants in both interventions received lifestyle change coaching and support remotely-through secure email within an electronic health record system and the American Heart Association Heart360 website for weight and physical activity goal setting and self-monitoring. The primary outcome was change in body mass index (BMI) (calculated as weight in kilograms divided by height in meters squared) from baseline to 15 months.
  
  
  RESULTS
  At baseline, participants had a mean (SD) age of 52.9 (10.6) years and a mean BMI of 32.0 (5.4); 47% were female; 78%, non-Hispanic white; and 17%, Asian/Pacific Islander. At month 15, the mean ± SE change in BMI from baseline was -2.2 ± 0.3 in the coach-led group vs -0.9 ± 0.3 in the usual care group (P < .001) and -1.6 ± 0.3 in the self-directed group vs usual care (P = .02). The percentages of participants who achieved the 7% DPP-based weight-loss goal were 37.0% (P = .003) and 35.9% (P = .004) in the coach-led and self-directed groups, respectively, vs 14.4% in the usual care group. Both interventions also achieved greater net improvements in waist circumference and fasting plasma glucose level.
  
  
  CONCLUSIONS
  Proven effective in a primary care setting, the 2 DPP-based lifestyle interventions are readily scalable and exportable with potential for substantial clinical and public health impact.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT00842426.
authors.affiliation: Department of Health Services Research, Palo Alto Medical Foundation Research Institute, Palo Alto, CA 94301, USA. maj@pamfri.org
authors.forename: Jun
authors.initials: J
authors.lastname: Ma
authors.forename: Veronica
authors.initials: V
authors.lastname: Yank
authors.forename: Lan
authors.initials: L
authors.lastname: Xiao
authors.forename: Philip W
authors.initials: PW
authors.lastname: Lavori
authors.forename: Sandra R
authors.initials: SR
authors.lastname: Wilson
authors.forename: Lisa G
authors.initials: LG
authors.lastname: Rosas
authors.forename: Randall S
authors.initials: RS
authors.lastname: Stafford
mesh_terms: D000328:Adult; D000368:Aged; D003920:Diabetes Mellitus / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008297:Male; D024821:Metabolic Syndrome / Q000628:therapy; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D011320:Primary Health Care; D012307:Risk Factors; D040242:Risk Reduction Behavior; D012648:Self Care; D014742:Videodisc Recording; D061217:Weight Reduction Programs