The Likely Underestimated Impact of Lifestyle Intervention: Diabetes Prevention Program Translation Examples

Introduction: Lifestyle interventions promoting weight loss and physical activity are important elements of prevention efforts with the evaluation of program impact typically limited to weight loss. Unfortunately, diabetes/cardiovascular disease risk factors and activity are infrequently reported and inconsistent in findings when examined. This inconsistency may partially be due to a lack of consideration for ceiling effects because of broad risk profile inclusion criteria in community translation efforts. To demonstrate this, change in each individual cardiometabolic risk factor limited to those who, at baseline, had a clinically defined abnormal value for that risk factor was examined in 2 cohorts using identical community translations of the Diabetes Prevention Program lifestyle intervention. Methods: For both studies (2010–2014, 2014–2019), adults with prediabetes and/or metabolic syndrome were recruited through community centers. Outcome measures collected at baseline and 6 months included BMI, activity, blood pressure, lipids, and fasting glucose. Data analyses examined pre–post change in each variable after 6 months of intervention and change within randomized groups at 6 months. Results: Change results were examined for the entire cohort and separately for participants with baseline values outside the recommended range for that risk factor. Whether assessing the pre–post intervention change or change within the randomized groups at 6 months, often the risk factor–specific approach demonstrated a greater effect size for that variable and sometimes newly reached statistical significance. Conclusions: When examining the effectiveness of community translation efforts, consideration of the individual's baseline profile with risk factor–specific analysis is suggested to understand the full extent of the impact of the intervention.