Primary Care Community Partnerships to Prevent Diabetes

Randomized controlled trials have shown that modest lifestyle changes can prevent or delay
the onset of diabetes in adults with pre-diabetes. Unfortunately, despite the increasing
prevalence of pre-diabetes and diabetes in all facets of the population, intervention
programs needed to achieve these goals are costly and remain unavailable in most clinical
settings. Over the past 3 years, we have demonstrated the feasibility of training community
instructors to deliver a group-based adaptation of the Diabetes Prevention Program (DPP)
lifestyle intervention. In this pilot research, this new delivery model achieves a level of
weight reduction that was associated with diabetes prevention and improved cardiometabolic
risk factor control in the DPP. This new, large-scale randomized effectiveness trial is
designed to evaluate the costs and effectiveness of a partnered approach to identify adults
with pre-diabetes in primary care settings, deliver brief advice for diabetes prevention, and
provide access to a group-based adaptation of the DPP lifestyle intervention offered by the
community. This study will compare costs and outcomes to a standard care, brief clinical
counseling approach delivered by Registered Dietitians.

Inclusion Criteria:

- 18 years of age or older

- Body-mass index of 24 kg/m2 or greater

- Fasting Blood Glucose 100 - 125 mg/dl, OR 2-hour Post-challenge Capillary Glucose 140
- 199 mg/dl

Exclusion Criteria:

- Cancer requiring treatment in the past 5 years

- Uncontrolled hypertension: systolic blood pressure >180 mmHg or diastolic blood
pressure >105 mmHg

- Heart attack, stroke, or transient ischemic attack in the past 6 months,

- Chronic obstructive airways disease or asthma requiring home oxygen

- Other chronic disease or condition, such as advanced arthritis, that could limit
ability to become physically active or limit life span to <5 years

- Pregnancy

- Existing diagnosis of diabetes mellitus

- Fasting capillary blood glucose > 125 mg/dl

- 2-hour post-challenge capillary blood glucose > 199 mg/dl

- History of anti-diabetic medication use (oral agents or insulin) except during
gestational diabetes

- Self-report of a medication known to lead to hyperglycemia (oral steroids,
antipsychotics, anti-epileptics)

- Self-report of disease associated with disordered glucose metabolism: Cushing's
syndrome; acromegaly; pheochromocytoma; chronic pancreatitis