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Patient-Centered Goal-Setting in the National Diabetes Prevention Program: A Pilot Study

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posted on 17.08.2021, 14:50 by Natalie D. Ritchie, Katherine A. Sauder, Peter G. Kaufmann, Leigh Perreault
Introduction: Difficulty achieving preset goals (e.g., ≥5% weight loss, ≥150 minutes of weekly physical activity) in the yearlong National Diabetes Prevention Program (NDPP) can prompt dropout and diminish benefits. We piloted a more patient-centered NDPP adaptation (NDPP-Flex) that promotes a variety of attainable and individually-tailored goals to reduce diabetes risks, along with flexibility to adjust goals each week as needed.

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.

Funding

The National Diabetes Prevention Program at Denver Health was funded by the Amendment 35 Cancer, Cardiovascular Disease and Pulmonary Disease Grant Program administered by the Colorado Department of Public Health and Environment, and an award from America’s Health Insurance Plans in partnership with the Centers for Disease Control and Prevention. Additional support was provided by Denver Health, including the Denver Health Office of Research Pilot Award Program. Manuscript preparation was supported in part by a grant from the National Institute of Diabetes and Digestive and Kidney Diseases at the National Institutes of Health (R01DK119478).

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