Table 3

Sample translational prevention initiatives and their reported outcomes

Study or initiativeFindings/results
Indian text-messaging intervention study (76)After 2 years, participants receiving twice-weekly motivational text messages had a 36% relative reduction in diabetes risk compared with those receiving standard advice but no text messages.
Finnish National Diabetes Prevention Program (FIN-D2D) (77)After 1 year, average weight loss in this high-risk population was 1.3 kg in men and 1.1 kg in women, with a 1.3-cm reduction in waist circumference. Decreases in blood pressure were 0.8 mmHg systolic and 1.5 diastolic in men, and 1.9 and 1.6 mmHg, respectively, in women. Total cholesterol, LDL cholesterol, and triglyceride levels decreased by 5–8% in men and 2–5% in women. Overall, 17.5% of subjects lost ≥5% of their body weight, 16.8% lost 2.5–4.9% weight, 46.1% maintained their baseline weight, and 19.6% gained ≥2.5% weight. The relative risk of diabetes was 0.31 in the group who lost ≥5% weight, 0.72 in the group who lost 2.5– 4.9% weight, and 1.10 in the group who gained ≥2.5% compared with the group who maintained weight.
Australian Life! Taking Action on Diabetes program (78)Between 2007 and mid-2011, there were >14,800 referrals to the program, and >8,400 individuals started the program. Participants who attended the first 5 sessions (offered every 2 weeks) lost a mean 1.4 kg in weight and 2.5 cm in waist circumference; those who also attended the sixth session (offered 8 months after the first) lost a mean 2.4 kg in weight (2.7% weight) and 3.8 cm in waist circumference, for an imputed potential diabetes risk reduction of 21–39%.
VA MOVE! Weight Management Program (68)Retrospective, observational analysis found a significant, dose-dependent, inverse association between incident diabetes and participation. Compared with nonparticipation, intense and sustained participation (at least eight sessions within 6 months over at least a 4-month span) was associated with a 33% reduction in diabetes incidence, and lower-intensity participation yielded a 20% reduction in diabetes incidence. Those who participated intensively also lost more weight than low-intensity participants (–2.2 vs. –0.64% over 3 years). However, the program has not reached a substantial proportion of the eligible population; only 13% participated in at least one session between 2005 and 2012.
Special Diabetes Program for Indians–Diabetes Prevention (SPDI-DP) (126)More than 2,500 participants started the 16-session program by 31 July 2008, with clinical assessments performed at baseline, soon after completing the program, and annually for up to 3 years. Crude incidence of diabetes was ∼3.5% per year among those who finished all 16 sessions, whereas it more than doubled (7.5% per year) among those who did not finish the program. Participants on average lost 9.6 lb immediately after completing the program, representing a 4.4% weight loss. This attenuated over the three annual visits but still differed significantly from no weight loss. By the end of the program sessions, 22.5% of participants had achieved the 7% weight loss goal; at the 3-year follow-up, 17.5% had achieved this goal. The percentage of participants achieving the 150 min/week exercise goal increased from 22% at baseline to 56% after the program and was ≥38% at each of the annual assessments. Participants also had significant improvements in blood glucose, blood pressure, and lipid parameters throughout the follow-up period.
DEPLOY (Diabetes Education & Prevention with a Lifestyle Intervention Offered at the YMCA) pilot study (127,128) and YMCA Diabetes Prevention Program (129)In the DEPLOY pilot study, body weight at 6 months decreased by a mean 5.7 kg or 6.0% in intervention participants and 1.8 kg or 2.0% in control subjects; this difference persisted through 12 months, with no racial or sex differences. Also, significant between-group differences in total cholesterol levels at both follow-up points were observed. At 4 and 12 months, the intervention group had significant decreases in 10-year coronary heart disease risk of 3.28 and 2.23%, respectively, compared with control subjects, who had a decrease in 10-year risk of 0.78% at 4 months and an increase in risk of 1.88% at 12 months.
As of December 2015, 39,435 individuals had attended at least one program session at one of 202 YMCA centers in 43 states. The average weight loss among participants was 4.7% at the end of the 16 sessions and 5.4% by 1 year. On average, participants undertook 157.5 min/week of physical activity.
NDPP/Medicare/YMCA demonstration program (24)Through this program, funded by CMS under the Affordable Care Act, eligible Medicare beneficiaries at high risk for diabetes attended initial weekly meetings and monthly follow-up sessions with a lifestyle coach to address long-term dietary and lifestyle modification to reduce their risk for diabetes. Mean weight loss was 4.7% for those who attended at least four weekly sessions and 5.2% for those who attended at least nine sessions. More than 80% of recruited participants attended at least four sessions. When compared with similar Medicare beneficiaries not in the program, CMS estimated a savings of $2,650 for each enrollee over a 15-month period, which was more than enough to cover the cost of the program.