An outpatient-based clinical program for diabetes prevention: an update.

OBJECTIVE: To update outcomes of the Diet-Exercise-Activity-Lifestyle (DEAL) program, a clinic-based diabetes prevention intervention. METHODS: Changes in weight, fasting blood glucose, and 2-hour glucose after a 75-g oral glucose tolerance test were evaluated in patients who enrolled in the DEAL program between January 2007 and August 2009. RESULTS: The 221 qualified participants had a mean age of 62 years, weight of 87.4 kg, body mass index of 31.2 kg/m², fasting glucose level of 109 mg/dL, and 2-hour glucose value of 138 mg/dL. Among the program participants, 67% were women and 88% were white; 56% had isolated impaired fasting glucose, 5% had impaired glucose tolerance only, and 39% had both. The 6-month follow-up medical appointment was kept by 72% of program participants, but only 56% attended the 12-month visit. By 6 months after baseline, 59% had significantly lower fasting glucose concentrations, 59% had improvement in 2-hour glucose levels, and 61% had weight loss. Nearly 40%, however, were nonresponders and had increased fasting glucose, 2-hour glucose, and weight by 6 months. By the 12-month visit, significant declines in fasting glucose (P<.001), 2-hour glucose (P<.001), and weight (P = .008) occurred in comparison with baseline values; however, no significant changes occurred in these measures between the 6- and 12-month visits (P>.30 for all). CONCLUSION: Most DEAL participants showed improvement in glucose levels and weight, but some patients exhibited worsening glucose intolerance. Factors underlying nonresponse need to be identified. Ongoing experience and analysis should help revise the DEAL program so that outcomes for all participating patients will improve.

Hemoglobin A1c testing alone does not sufficiently identify patients with prediabetes.

Whether hemoglobin A(1c) (HbA(1c)) values are suitable for diagnosing diabetes has been debated. We sought to assess the prevalence of elevated HbA(1c) levels in a prediabetes patient population. Oral glucose tolerance tests and HbA(1c) levels were analyzed for patients entering a diabetes prevention program between January 1, 2007, and September 13, 2009. We calculated the percentage of patients with impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT) who had HbA(1c) values in the 6.0% to 6.4% range or in the 5.7% to 6.4% range. The mean age of the 242 patients was 62 years; 64.0% were women, and 88.0% were white. Isolated IFG was detected in about 56.2% of patients and combined IFG and IGT in about 37.2%. Only 28.5% of patients had HbA(1c) values in the 6.0% to 6.4% range, whereas 65.3% had values in the 5.7% to 6.4% range. Our data suggest that reliance on HbA(1c) testing alone to identify candidates for a diabetes prevention program would miss a substantial number of eligible patients.

An outpatient-based clinical program for type 2 diabetes prevention.

OBJECTIVE: To review first-year results of a clinic-based type 2 diabetes prevention program. METHODS: From January through December 2007, patients with a diagnosis of prediabetes participated in the Diet-Exercise-Activity-Lifestyle program for instruction in lifestyle changes. Physical therapy assessments were retrospectively reviewed to search for symptoms or findings of physical impairments. Changes in weight and 2-hour glucose tolerance test results were assessed at 6 months. Patient satisfaction with the program was evaluated. RESULTS: Ninety-two patients qualified for the program. Mean baseline fasting glucose concentration was 108 mg/dL, and 2-hour glucose concentration was 134 mg/dL. Mean age was 62 years, and 66% were women. Review of physical therapy assessments demonstrated gait/balance disturbances in 47% of patients, peripheral neuropathy in 43%, and musculoskeletal problems in 63%. Among 47 patients who had 6-month follow-up visits, 72% lost weight. Fasting glucose levels improved in 58% in persons with impaired fasting glucose, and 2-hour glucose values decreased in patients who had impaired glucose tolerance. Seventy-eight percent graded the program as either "very good" or "excellent." CONCLUSIONS: Programs geared toward type 2 diabetes prevention can be feasibly implemented on an outpatient basis. Preliminary data suggest that improvements in weight and glucose values can be achieved. As the prevalence of prediabetes increases, health care systems must gain further experience with effective outpatient diabetes prevention strategies.