title: Diabetes Prevention Program Translation in the Veterans Health Administration.
abstract: BACKGROUND
  This clinical demonstration trial compared the effectiveness of the Veterans Affairs Diabetes Prevention Program (VA-DPP) with an evidence-based usual care weight management program (MOVE!®) in the Veterans Health Administration health system.
  
  
  METHODS
  Prospective, pragmatic, non-randomized comparative effectiveness study of two behavioral weight management interventions.
  
  
  METHODS
  Obese/overweight Veterans with prediabetes were recruited from three geographically diverse VA sites between 2012 and 2014.
  
  
  METHODS
  VA-DPP included 22 group-based intensive lifestyle change sessions.
  
  
  METHODS
  Weight change at 6 and 12 months, hemoglobin A1c (HbA1c) at 12 months, and VA health expenditure changes at 15 months were assessed using VA electronic health record and claims data. Between- and within-group comparisons for weight and HbA1c were done using linear mixed-effects models controlling for age, gender, race/ethnicity, baseline outcome values, and site. Analyses were conducted in 2015-2016.
  
  
  RESULTS
  A total of 387 participants enrolled (273 VA-DPP, 114 MOVE!). More VA-DPP participants completed at least one (73.3% VA-DPP vs 57.5% MOVE! p=0.002); four (57.5% VA-DPP vs 42.5% MOVE!, p=0.007); and eight or more sessions (42.5% VA-DPP vs 31% MOVE!, p=0.035). Weight loss from baseline was significant at both 6 (p<0.001) and 12 months (p<0.001) for VA-DPP participants, but only significant at 6 months for MOVE! participants (p=0.004). Between groups, there were significant differences in 6-month weight loss (-4.1 kg VA-DPP vs -1.9 kg MOVE!, p<0.001), but not 12-month weight loss (-3.4 kg VA-DPP vs -2.0 kg MOVE!, p=0.16). There were no significant differences in HbA1c change or outpatient, inpatient, and total VA expenditures.
  
  
  CONCLUSIONS
  VA-DPP participants had higher participation rates and weight loss at 6 months, but similar weight, HbA1c, and health expenditures at 12 months compared to MOVE!
  
  
  METHODS
  Features of VA-DPP may help enhance the capability of MOVE! to reach a larger proportion of the served population and promote individual-level weight maintenance.
authors.affiliation: Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California; Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California; VA Health Services Research and Development (HSR&D) Center for Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles, California. Electronic address: tannaz.moin@va.gov.
authors.forename: Tannaz
authors.initials: T
authors.lastname: Moin
authors.affiliation: Ann Arbor VA Center for Clinical Management Research, Ann Arbor, Michigan.
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Damschroder
authors.affiliation: Ann Arbor VA Center for Clinical Management Research, Ann Arbor, Michigan.
authors.forename: Mona
authors.initials: M
authors.lastname: AuYoung
authors.affiliation: Department of Medicine, Durham VA Medical Center, Durham, North Carolina; Department of Medicine, Duke University School of Medicine, Durham, North Carolina.
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Maciejewski
authors.affiliation: Department of Medicine, Durham VA Medical Center, Durham, North Carolina; Department of Medicine, Duke University School of Medicine, Durham, North Carolina.
authors.forename: Santanu K
authors.initials: SK
authors.lastname: Datta
authors.affiliation: Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California; Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California.
authors.forename: Jane E
authors.initials: JE
authors.lastname: Weinreb
authors.affiliation: Department of Medicine, Baltimore VA Medical Center, Baltimore, Maryland; Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Nanette I
authors.initials: NI
authors.lastname: Steinle
authors.affiliation: Department of Medicine, Minneapolis VA Healthcare System, Minneapolis, Minnesota; Department of Medicine, University of Minnesota Medical Center, Minneapolis, Minnesota.
authors.forename: Charles
authors.initials: C
authors.lastname: Billington
authors.affiliation: Ann Arbor VA Center for Clinical Management Research, Ann Arbor, Michigan.
authors.forename: Maria
authors.initials: M
authors.lastname: Hughes
authors.affiliation: Ann Arbor VA Center for Clinical Management Research, Ann Arbor, Michigan.
authors.forename: Fatima
authors.initials: F
authors.lastname: Makki
authors.affiliation: Ann Arbor VA Center for Clinical Management Research, Ann Arbor, Michigan.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Holleman
authors.affiliation: Ann Arbor VA Center for Clinical Management Research, Ann Arbor, Michigan; Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, Michigan.
authors.forename: H Myra
authors.initials: HM
authors.lastname: Kim
authors.affiliation: Department of Medicine, Durham VA Medical Center, Durham, North Carolina.
authors.forename: Amy S
authors.initials: AS
authors.lastname: Jeffreys
authors.affiliation: VHA National Center for Health Promotion and Disease Prevention, Durham, North Carolina.
authors.forename: Linda S
authors.initials: LS
authors.lastname: Kinsinger
authors.affiliation: Ann Arbor VA Center for Clinical Management Research, Ann Arbor, Michigan.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Burns
authors.affiliation: Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California; Department of Family Medicine, University of Michigan, Ann Arbor, Michigan; VA Diabetes QUERI, Ann Arbor, Michigan.
authors.forename: Caroline R
authors.initials: CR
authors.lastname: Richardson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001521:Behavior Therapy / Q000379:methods*; D001835:Body Weight; D003924:Diabetes Mellitus, Type 2 / Q000517:prevention & control*; D018450:Disease Progression; D057286:Electronic Health Records / Q000706:statistics & numerical data; D019317:Evidence-Based Medicine / Q000379:methods; D015444:Exercise / Q000502:physiology; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000097:blood / Q000150:complications / Q000628:therapy*; D011236:Prediabetic State / Q000097:blood / Q000473:pathology / Q000628:therapy*; D011446:Prospective Studies; D016896:Treatment Outcome; D014481:United States; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data; D058014:Veterans Health; D015431:Weight Loss; D061217:Weight Reduction Programs / Q000379:methods*
chemical_list: D006442:Glycated Hemoglobin