1097 — Implementing the Diabetes Prevention Program in the VA: Weight Outcomes from a Clinical Demonstration Project

Moin T, VA Greater Los Angeles Healthcare System and Health Services Research and Development (HSR&D) Center for Healthcare Innovation, Los Angeles, CA; Damschroder LJ, Ann Arbor VA Center for Clinical Management Research and VA Diabetes QUERI, Ann Arbor, MI; Makki F, Ann Arbor VA Center for Clinical Management Research, Ann Arbor, MI; Weinreb JE, VA Greater Los Angeles Healthcare System; Steinle N, Baltimore VA; Billington C, Minneapolis VA; Yancy W, Durham VA; Maciejewski ML, Durham VA; Kinsinger LS, A National Center for Health Promotion and Disease Prevention; Richardson C, Ann Arbor VA Center for Clinical Management Research and VA Diabetes QUERI, Ann Arbor, MI

Objectives:
In an effort to decrease incident diabetes amongst Veterans, the VA National Centers for Health Promotion and Disease Prevention (VA NCP) and the Diabetes Quality Enhancement Research Initiative (QUERI) partnered to conduct a pragmatic evaluation of the VA Diabetes Prevention Clinical Demonstration Project (VA DPP), to test implementation of a DPP intervention for Veterans with pre-diabetes. The objective was to compare weight loss among participants systematically assigned to either VA DPP or an established VHA weight loss known as MOVE!.

Methods:
Obese and overweight Veterans were recruited from three VHA Medical Centers (VAMCs) with geographically and racially diverse populations using an established referral system for MOVE!. Veterans with pre-diabetes (defined by HbA1c 5.7-6.4% or FPG 100-125 mg/dL) who attended a MOVE! orientation and lived within one hour driving distance to the VAMC were eligible. Weight loss data was collected from the VA Corporate Data Warehouse.

Results:
Between August 2012 and January 2014, 1345 Veterans were screened and 252 met all eligibility criteria. Eligible Veterans were systematically assigned to VA DPP (n = 211) or MOVE! (n = 41). VA DPP participants were more likely to attend at least 9 sessions (39% vs. 29%, p = 0.055). VA DPP participants lost significantly more weight than MOVE! participants at 6 months (VA DPP lost 9.6 lbs and MOVE! lost 3.1lbs, p = .03).

Implications:
Compared to usual care, an evidence based DPP intervention was associated with higher mean percent weight loss and uptake among obese/overweight Veterans with pre-diabetes.

Impacts:
Aligning MOVE! more closely to DPP or alternatively providing diabetes prevention specific interventions may help increase weight loss and reduce incident diabetes amongst Veterans.