Patient-Centered Goal-Setting in the National Diabetes Prevention Program: A Pilot Study
Research Design and Methods: Retention, physical activity, weight, and HbA1c were evaluated among diverse participants with diabetes risks who received our pilot of NDPP-Flex beginning in January and July 2018 (n=95), with a planned comparison to standard NDPP delivery in preceding cohorts that launched between September 2016 and October 2017 (n=245). Both the standard NDPP and NDPP-Flex interventions were one year in duration and implemented in phases (i.e., non-randomized).
Results: Average adjusted retention (e.g., 158.90 ± 15.20 vs. 166.71 ± 9.38 days; P=.674), physical activity (157.97 ± 11.91 vs. 175.64 ± 7.54 weekly minutes; P=.231), and weight loss (1.46 ± 0.38% vs. 1.90 ± 0.24%; P=.396) were similar between NDPP-Flex versus standard NDPP. However, NDPP-Flex participants had greater HbA1c reduction on average (0.22 ± 0.05% vs. 0.06 ± 0.03%, P=.018) and were more likely to have normoglycemia at follow-up (OR 4.62; P=.013; 95% CI 1.38-15.50) than participants in the standard NDPP.
Conclusions: An adapted, more patient-centered NDPP that focuses on flexible, self-selected goals may be a promising strategy to improve glycemia even in the absence of substantial weight loss.