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Diabetes Prevention Program Translation in the Veterans Health Administration.

Moin T, Damschroder LJ, AuYoung M, Maciejewski ML, Datta SK, Weinreb JE, Steinle NI, Billington C, Hughes M, Makki F, Holleman RG, Kim HM, Jeffreys AS, Kinsinger LS, Burns JA, Richardson CR. Diabetes Prevention Program Translation in the Veterans Health Administration. American journal of preventive medicine. 2017 Jul 1; 53(1):70-77.

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Abstract:

INTRODUCTION: This clinical demonstration trial compared the effectiveness of the Veterans Affairs Diabetes Prevention Program (VA-DPP) with an evidence-based usual care weight management program (MOVE!) in the Veterans Health Administration health system. DESIGN: Prospective, pragmatic, non-randomized comparative effectiveness study of two behavioral weight management interventions. SETTING/PARTICIPANTS: Obese/overweight Veterans with prediabetes were recruited from three geographically diverse VA sites between 2012 and 2014. INTERVENTION: VA-DPP included 22 group-based intensive lifestyle change sessions. MAIN OUTCOME MEASURES: Weight change at 6 and 12 months, hemoglobin A1c (HbA1c) at 12 months, and VA health expenditure changes at 15 months were assessed using VA electronic health record and claims data. Between- and within-group comparisons for weight and HbA1c were done using linear mixed-effects models controlling for age, gender, race/ethnicity, baseline outcome values, and site. Analyses were conducted in 2015-2016. RESULTS: A total of 387 participants enrolled (273 VA-DPP, 114 MOVE!). More VA-DPP participants completed at least one (73.3% VA-DPP vs 57.5% MOVE! p = 0.002); four (57.5% VA-DPP vs 42.5% MOVE!, p = 0.007); and eight or more sessions (42.5% VA-DPP vs 31% MOVE!, p = 0.035). Weight loss from baseline was significant at both 6 (p < 0.001) and 12 months (p < 0.001) for VA-DPP participants, but only significant at 6 months for MOVE! participants (p = 0.004). Between groups, there were significant differences in 6-month weight loss (-4.1 kg VA-DPP vs -1.9 kg MOVE!, p < 0.001), but not 12-month weight loss (-3.4 kg VA-DPP vs -2.0 kg MOVE!, p = 0.16). There were no significant differences in HbA1c change or outpatient, inpatient, and total VA expenditures. CONCLUSIONS: VA-DPP participants had higher participation rates and weight loss at 6 months, but similar weight, HbA1c, and health expenditures at 12 months compared to MOVE! PARTICIPANTS: Features of VA-DPP may help enhance the capability of MOVE! to reach a larger proportion of the served population and promote individual-level weight maintenance.





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