title: A Randomized Comparative Effectiveness Trial for Preventing Type 2 Diabetes.
abstract: OBJECTIVE
  We evaluated the weight loss effectiveness of a YMCA model for the Diabetes Prevention Program (DPP) lifestyle intervention.
  
  
  METHODS
  Between July 2008 and November 2010, we individually randomized 509 overweight or obese, low-income, nondiabetic adults with elevated blood glucose in Indianapolis, Indiana, to receive standard care plus brief lifestyle counseling or be offered a group-based YMCA adaptation of the DPP (YDPP). Primary outcome was mean weight loss difference at 12 months. In our intention-to-treat analyses, we used longitudinal linear or logistic regression, multiply imputing missing observations. We used instrumental variables regression to estimate weight loss effectiveness among participants completing 9 or more intervention lessons.
  
  
  RESULTS
  In the YDPP arm, 161 (62.6%) participants attended ≥ 1 lesson and 103 (40.0%) completed 9 or more lessons. In intention-to-treat analysis, mean 12-month weight loss was 2.3 kilograms (95% confidence interval [CI] = 1.1, 3.4 kg) more for the YDPP arm than for standard care participants. In instrumental variable analyses, persons attending 9 or more lessons had a 5.3-kilogram (95% CI = 2.8, 7.9 kg) greater weight loss than did those with standard care alone.
  
  
  CONCLUSIONS
  The YMCA model for DPP delivery achieves meaningful weight loss at 12 months among low-income adults.
authors.affiliation: Ronald T. Ackermann, David T. Liss, and Emily A. Finch are with the Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL. Karen K. Schmidt and David G. Marrero are with the Department of Medicine, Indiana University School of Medicine, Indianapolis. Laura M. Hays is with the Indiana University School of Nursing, Indianapolis. Chandan Saha is with the Department of Biostatistics, Indiana University School of Medicine, Indianapolis.
authors.forename: Ronald T
authors.initials: RT
authors.lastname: Ackermann
authors.affiliation: Ronald T. Ackermann, David T. Liss, and Emily A. Finch are with the Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL. Karen K. Schmidt and David G. Marrero are with the Department of Medicine, Indiana University School of Medicine, Indianapolis. Laura M. Hays is with the Indiana University School of Nursing, Indianapolis. Chandan Saha is with the Department of Biostatistics, Indiana University School of Medicine, Indianapolis.
authors.forename: David T
authors.initials: DT
authors.lastname: Liss
authors.affiliation: Ronald T. Ackermann, David T. Liss, and Emily A. Finch are with the Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL. Karen K. Schmidt and David G. Marrero are with the Department of Medicine, Indiana University School of Medicine, Indianapolis. Laura M. Hays is with the Indiana University School of Nursing, Indianapolis. Chandan Saha is with the Department of Biostatistics, Indiana University School of Medicine, Indianapolis.
authors.forename: Emily A
authors.initials: EA
authors.lastname: Finch
authors.affiliation: Ronald T. Ackermann, David T. Liss, and Emily A. Finch are with the Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL. Karen K. Schmidt and David G. Marrero are with the Department of Medicine, Indiana University School of Medicine, Indianapolis. Laura M. Hays is with the Indiana University School of Nursing, Indianapolis. Chandan Saha is with the Department of Biostatistics, Indiana University School of Medicine, Indianapolis.
authors.forename: Karen K
authors.initials: KK
authors.lastname: Schmidt
authors.affiliation: Ronald T. Ackermann, David T. Liss, and Emily A. Finch are with the Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL. Karen K. Schmidt and David G. Marrero are with the Department of Medicine, Indiana University School of Medicine, Indianapolis. Laura M. Hays is with the Indiana University School of Nursing, Indianapolis. Chandan Saha is with the Department of Biostatistics, Indiana University School of Medicine, Indianapolis.
authors.forename: Laura M
authors.initials: LM
authors.lastname: Hays
authors.affiliation: Ronald T. Ackermann, David T. Liss, and Emily A. Finch are with the Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL. Karen K. Schmidt and David G. Marrero are with the Department of Medicine, Indiana University School of Medicine, Indianapolis. Laura M. Hays is with the Indiana University School of Nursing, Indianapolis. Chandan Saha is with the Department of Biostatistics, Indiana University School of Medicine, Indianapolis.
authors.forename: David G
authors.initials: DG
authors.lastname: Marrero
authors.affiliation: Ronald T. Ackermann, David T. Liss, and Emily A. Finch are with the Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL. Karen K. Schmidt and David G. Marrero are with the Department of Medicine, Indiana University School of Medicine, Indianapolis. Laura M. Hays is with the Indiana University School of Nursing, Indianapolis. Chandan Saha is with the Department of Biostatistics, Indiana University School of Medicine, Indianapolis.
authors.forename: Chandan
authors.initials: C
authors.lastname: Saha
mesh_terms: D000328:Adult; D001786:Blood Glucose; D015992:Body Mass Index; D003376:Counseling / Q000458:organization & administration*; D003924:Diabetes Mellitus, Type 2 / Q000517:prevention & control*; D005260:Female; D015438:Health Behavior; D006801:Humans; D007196:Indiana; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000628:therapy; D050177:Overweight / Q000628:therapy*; D011203:Poverty; D016037:Single-Blind Method; D015431:Weight Loss; D061217:Weight Reduction Programs / Q000458:organization & administration*
chemical_list: D001786:Blood Glucose