Community Programs Linked to Clinical Services
Resources for Diabetes and Hypertension
Diabetes Prevention Program (DPP) Research Study
Overview
The Diabetes Prevention Program (DPP) was a multicenter clinical research study, involving 27 centers around the United States with 3,234 participants, charged with determining if type 2 diabetes could be prevented or delayed by a modest weight loss accomplished by dietary changes and an increase in physical activity or treatment with the oral diabetes drug metformin (Glucophage). Read the full study
The DPP Research Study design
There were a total of 3,234 participants who were overweight and had prediabetes. 45 percent of the participants were from minority groups; African American, Alaska Native, American Indian, Asian American, Hispanic/Latino or Pacific Islander, all at an increased risk of developing diabetes. They were divided into 3 groups (initially there were 4 with one group being treated with Troglitazone (Rezulin) but was discontinued when researchers discovered that troglitazone can cause serious liver damage). The 3 groups included:
- Lifestyle Intervention Group- received extensive training in diet, physical activity and behavior modification, they ate less fat and fewer calories along with exercising 150 minutes a week with the goal of losing 7 percent of their body weight and maintain the loss.
- The Metformin Group – took 850mg of metformin (Glucophage) twice a day along with receiving information about diet and exercise but no intensive motivational counseling.
- The Placebo Group- received a placebo instead of metformin and received information about diet and exercise but no intensive motivational counseling.
The DPP Research Study Results
- The Lifestyle Modification Group who received intensive education about diet, physical activity and behavior modification along with motivational counseling, showed a 58 percent reduction in developing diabetes.
- The Metformin Group who took 850mg of metformin (Glucophage) twice a day along with some information about diet, and physical activity but no motivational counseling lowered their risk of developing diabetes by 31 percent.
- The Placebo Group who took a placebo instead of metformin and received some information about the diet and physical activity but no motivational counseling showed 11 percent of the participants developing diabetes each year of the study compared to only 5 percent in the lifestyle intervention group and 7.8 percent in the metformin group.
Diabetes Prevention Program Outcomes Study (DPPOS)
Overview
The DPPOS studied the long term effects of the interventions used in the Diabetes Prevention Program (DPP) Research study to prevent type 2 diabetes and its complications. 88 percent of the surviving DPP Research Study participants, enrolled in this ten year follow up outcome study. The goal of DPPOS was to study whether the relatively short-term benefits of delaying diabetes demonstrated in the DPP would translate into long-lasting impact. DPPOS had the following major goals, to determine the effect of DPP interventions on: 1) durability of T2D development; 2) early microvascular disease; and 3) atherosclerosis and CVD risk factors. Read the full description
Findings
After an average of 10 years’ follow up, intensive lifestyle changes aimed at modest weight loss:
- Reduced the rate of developing type 2 diabetes by 34 percent compared with placebo.
- Reduced the rate of developing type 2 diabetes by 49 percent in those age 60 and older compared with placebo.
- Delayed type 2 diabetes by about 4 years compared with placebo.
- Reduced cardiovascular risk factors.
- Reduced hemoglobin A1c (A1C) and fasting glucose compared with placebo. The A1C test gives information about average blood glucose levels for the past 2 to 3 months.
After an average of 10 years’ follow up, treatment with metformin:
- Reduced the rate of developing diabetes by 18 percent compared with placebo.
- Delayed diabetes by 2 years compared with placebo.
- Reduced A1C and fasting glucose compared with placebo.
Community Preventive Services Task Force
The Community Preventive Services Task Force (Task Force) is an independent, nonfederal, unpaid panel of public health and prevention experts that provides evidence-based findings and recommendations about community preventive services, programs, and policies to improve health. Its members represent a broad range of research, practice, and policy expertise in community preventive services, public health, health promotion, and disease prevention. The fifteen Task Force members are appointed by the Director of the Centers for Disease Control and Prevention (CDC). Task Force members serve five year terms, with possible extensions to maintain a full scope of expertise, complete specific work, and ensure consistency of Task Force recommendations. Source
Task Force Recommendations
The recommendations from the task force includes combining diet and physical activity programs for people at risk of developing type 2 diabetes. The recommended programs included trained providers in clinical or community settings who would work with participants for at least 3 months, and include some type of counseling, coaching and extended support. Additionally the program’s sessions need to be provided in person or by other methods and include information about healthy eating and physical activity.
Task Force Systemic Review/Findings
The task force reviewed 47 studies that described 60 programs during the time frames of January 1991 through June 2014. The findings overwhelmingly found that programs promoting the combination of healthy eating and physical activity led to improvements in health outcomes, cardiovascular disease and risk for type 2 diabetes compared with usual care. The findings are as follows:
- The proportion of people who developed type 2 diabetes decreased by a median of 11 percentage points (interquartile interval [IQI]: 5 to 16; 14 studies).
- The proportion of people who achieved normal blood sugar (normoglycemia) increased by a median of 12 percentage points (IQI: 6 to 14; 6 studies).
- Body weight was reduced by an average of 2.4% (95% confidence interval [CI]: 1.2 to 3.6; 21 studies).
- Fasting blood glucose was reduced (improved) by an average of 2.1 mg/dL (95% CI 0.5 to 3.8; 14 studies) and hemoglobin A1c (a measure of long-term glucose levels) was reduced (improved) by an average of 0.07 percentage points (95% CI 0.02 to 0.12; 8 studies).
- Blood pressure (15 studies) and cholesterol levels (10 studies) also were improved.
The effect on mortality was unclear. Mortality was reduced by 2 to 10 percentage points (2 studies) or by 0.6 per 1000 person-years (1 study) over 3 to 23 years of follow-up. However, this benefit was statistically significant in only one study, and in that study only among women.
Regardless of program features, almost all programs led to weight loss, reduced risk of diabetes, or both. However, among 12 studies with direct comparisons, more intensive programs (based on features such as number of sessions, individual sessions, and additional personnel) resulted in greater weight loss and lower rates of diabetes than less intensive programs. Across all studies, more effective programs provided:
- Individual (vs. group) diet sessions, or
- Diet counselors
In studies of programs that used protocols outlined by the U.S. Diabetes Prevention Program (DPP) or Finnish Diabetes Prevention Study (DPS), or modifications of them, participants had a lower risk of developing diabetes (compared with people who did not participate in the programs) than those in programs not based on DPP or DPS (Relative Risk = 0.47 vs. 0.63; P < 0.001).
USPSTF Final Recommendation Statement-Abnormal Blood Glucose and Type 2 Diabetes Mellitus: Screening
This web page contains the USPSTF recommendation on screening for abnormal blood glucose as part of cardiovascular risk assessment in adults aged 40 to 70 years who are overweight or obese.
CDC Diabetes Data and Statistics
This site is the CDC’s Diabetes Home site listing an overview of diabetes including; diabetes basics, who is at risk, living with diabetes, programs and research, training and learning, data and statistics (national, state, county resources, and diabetes statistic resources), newsroom and resource center.