Cost-effectiveness analysis of efforts to reduce risk of type 2 diabetes and cardiovascular disease in southwestern Pennsylvania, 2005-2007.

INTRODUCTION: We assessed the cost-effectiveness of a community-based, modified Diabetes Prevention Program (DPP) designed to reduce risk factors for type 2 diabetes and cardiovascular disease. METHODS: We developed a Markov decision model to compare costs and effectiveness of a modified DPP intervention with usual care during a 3-year period. Input parameters included costs and outcomes from 2 projects that implemented a community-based modified DPP for participants with metabolic syndrome, and from other sources. The model discounted future costs and benefits by 3% annually. RESULTS: At 12 months, usual care reduced relative risk of metabolic syndrome by 12.1%. A modified DPP intervention reduced relative risk by 16.2% and yielded life expectancy gains of 0.01 quality-adjusted life-years (3.67 days) at an incremental cost of $34.50 ($3,420 per quality-adjusted life-year gained). In 1-way sensitivity analyses, results were sensitive to probabilities that risk factors would be reduced with or without a modified DPP and that patients would enroll in an intervention, undergo testing, and acquire diabetes with or without an intervention if they were risk-factor-positive. Results were also sensitive to utilities for risk-factor-positive patients. In probabilistic sensitivity analysis, the intervention cost less than $20,000 per quality-adjusted life-year gained in approximately 78% of model iterations. CONCLUSION: We consider the modified DPP delivered in community and primary care settings a sound investment.

Influence of Patient-Centered Decision Making on Sustained Weight Loss and Risk Reduction Following Lifestyle Intervention Efforts in Rural Pennsylvania.

PURPOSE: The purpose of this study was to determine whether weight loss and cardiovascular disease risk factor reduction was maintained following a lifestyle intervention. METHODS: Five hundred fifty-five individuals without diabetes from 8 rural communities were screened for BMI ≥25 kg/m(2) and abdominal obesity (86.1% female, 95.1% white, 55.8% obese). Communities and eligible participants (n = 493; mean age, 51 years, 87.6% female, 94.1% Caucasian) were assigned to 4 study groups: face-to-face, DVD, Internet, and self-selection (SS) (n = 101). Self-selection participants chose the intervention modality (60% face-to-face, 40% Internet, 0% DVD). Outcomes included weight change and risk factor reduction at 18 months. RESULTS: All groups achieved maintenance of 5% weight loss in over half of participants. Self-selection participants had the largest proportion maintain (89.5%). Similarly, nearly 75% of participants sustained risk factor reduction. After multivariate adjustment, participants in SS were 2.3 times more likely to maintain 5% weight loss compared to the other groups, but not risk factor reduction. CONCLUSION: Despite the modality, lifestyle intervention was effective at maintaining weight loss and risk reduction. However, SS participants were twice as likely to sustain improvements compared to other groups. The importance of patient-centered decision making in health care is paramount.

Comparative effectiveness of lifestyle intervention efforts in the community: results of the Rethinking Eating and ACTivity (REACT) study.

OBJECTIVE: To determine the comparative effectiveness of three lifestyle intervention modalities in decreasing risk for diabetes. RESEARCH DESIGN AND METHODS: Five hundred and fifty-five individuals (86.1% female, 95.1% white, and 55.8% obese) from eight rural communities were screened for BMI ≥25 kg/m(2) and waist circumference >40 inches in men and >35 inches in women. Communities with their eligible participants (n = 493; mean age 51 years, 87.6% female, 94.1% Caucasian) were assigned to four Group Lifestyle Balance (GLB) intervention groups: face to face (FF) (n = 119), DVD (n = 113), internet (INT) (n = 101), and self-selection (SS) (n = 101). SS participants chose the GLB modality. GLB is a comprehensive lifestyle behavior-change program. RESULTS: A marked decline was observed in weight after the intervention in all groups (FF -12.5 lbs, P = 0.01; DVD -12.2 lbs, P < 0.0001; INT -13.7 lbs, P < 0.0001; and SS -14 lbs, P < 0.0001). Participants in SS experienced the largest average weight loss. Weight loss was sustained in >90% of participants in each group at 6 months (FF 90.7%, DVD 90.9%, INT 92.1%, and SS 100%). All groups experienced improvements in the proportion of participants with CVD risk factors. The proportion of individuals with CVD risk factors remained steady between 3 and 6 months in all groups and never returned back to baseline. All associations remained after multivariate adjustment. CONCLUSIONS: Despite the modality, the GLB intervention was effective at decreasing weight and improving CVD risk factor control. SS and FF participants experienced greater improvements in outcomes compared with other groups, establishing the importance of patient-centered decision making and a support network for successful behavior change.

Two-year results of translating the diabetes prevention program into an urban, underserved community.

PURPOSE: The purpose of the study was to examine the long-term effect of a Group Lifestyle Balance (GLB) program on weight, impaired fasting glucose, hypertension, and hyperlipidemia in an urban, medically underserved community. METHODS: This study was a single-arm prospective intervention study that was designed to test the effectiveness of a community-based GLB intervention. In sum, 638 residents from 11 targeted neighborhoods were screened for body mass index ≥ 25 kg/m(2) and metabolic syndrome. Eligible individuals took part in a 12-week GLB intervention (n = 105) that addressed weight loss and physical activity. Subjects were followed for 24 months. RESULTS: The probability of being at risk for diabetes and cardiovascular disease was significantly reduced by 25.7% over the long-term follow-up. Of the participants who lost at least 5% of their body weight following the intervention, 52.6% maintained the 5% weight loss at their last follow-up time, weighing about 20 lb less than they did at baseline. CONCLUSION: Risk reduction and weight loss maintenance are possible following a GLB intervention and have substantial potential for future public health impact.

Translating the Diabetes Prevention Program into an urban medically underserved community: a nonrandomized prospective intervention study.

OBJECTIVE: The objective of this study was to determine if a community-based modified Diabetes Prevention Program Group Lifestyle Balance (GLB) intervention, for individuals with metabolic syndrome, was effective in decreasing risk for type 2 diabetes and cardiovascular disease (CVD) in an urban medically underserved community, and subsequently to determine if improvements in clinical outcomes could be sustained in the short term. RESEARCH DESIGN AND METHODS: This nonrandomized prospective intervention study used a one-group design to test the effectiveness of a community-based GLB intervention. Residents from 11 targeted neighborhoods were screened for metabolic syndrome (n = 573) and took part in a 12-week GLB intervention (n = 88) that addressed safe weight loss and physical activity. RESULTS: A marked decline in weight (46.4% lost > or = 5% and 26.1% lost or = 7%) was observed in individuals after completion of the intervention. Of these subjects, 87.5% (n = 28) and 66.7% (n = 12) sustained the 5% and 7% reduction, respectively, at the 6-month reassessment. Over one-third of the population (43.5%, n = 30) experienced improvements in one or more component of metabolic syndrome, and 73.3% (n = 22) sustained this improvement at the 6-month reassessment. Additional improvements occurred in waist circumference (P < 0.009) and blood pressure levels (P = 0.04) after adjustment for age, sex, race, mean number of GLB classes attended, and time. CONCLUSIONS: Adults in an urban medically underserved community can decrease their risk for type 2 diabetes and CVD through participation in a GLB intervention, and short-term sustainability is feasible. Future research will include long-term follow-up of these subjects.