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Implementing a State-Based Cardiovascular Disease and Diabetes Prevention Program

Implementing a State-Based Cardiovascular Disease and Diabetes Prevention Program Clinical Care/Education/Nutrition/Psychosocial Research BRIEF REPORT Implementing a State-Based Cardiovascular Disease and Diabetes Prevention Program KARL K. VANDERWOOD, MPH STEVEN D. HELGERSON, MD, MPH ring provider and one or more of the fol- TARYN O. HALL, MPH ON BEHALF OF THE MONTANA lowing cardiovascular disease (CVD) and TODD S. HARWELL, MPH CARDIOVASCULAR DISEASE AND DIABETES diabetes risk factors were eligible: a pre- MARCENE K. BUTCHER, RD, CDE PREVENTION PROGRAM WORKGROUP* vious diagnosis of pre-diabetes; impaired glucose tolerance or impaired fasting glu- cose; high blood pressure (130/85 OBJECTIVE — To evaluate weight loss and cardiometabolic risk reduction achieved through mmHg or treatment) or dyslipidemia an adapted Diabetes Prevention Program intervention among adults at high risk for cardiovas- (triglycerides 150 mg/dl, LDL choles- cular disease (CVD) and diabetes. terol 130 mg/dl or treatment, or HDL cholesterol 40 mg/dl men and 50 RESEARCH DESIGN AND METHODS — Eight health care facilities implemented a mg/dl women); or a history of gestational group-based lifestyle intervention beginning in 2008. Participants attended 16 weekly core diabetes mellitus or gave birth to a baby sessions followed by 6 monthly after core sessions. 9 pounds. Height, weight, blood pressure, fast- RESULTS — A total of 1,003 participants were enrolled, 816 (81%) completed the core and ing blood glucose, and lipid values were 578 (58%) completed the after core. Of participants completing the core and after core, 45 and 49% achieved the 7% weight loss goal, respectively. There were significant improvements in collected at enrollment and at completion blood pressure, fasting glucose, and LDL cholesterol among participants completing the of the core and after core. Participants intervention. were weighed at the beginning of each session and submitted self-monitoring CONCLUSIONS — Our findings indicate it is feasible for state-coordinated CVD and dia- records. Participants were considered betes prevention programs to achieve significant weight loss and improve cardiometabolic risk. core completers if they did not drop out or miss three or more consecutive ses- Diabetes Care 33:2543–2545, 2010 sions and after core completers if they had completed follow-up laboratory measure- he Diabetes Prevention Program RESEARCH DESIGN AND ments at 10 months. (DPP) and other studies demon- METHODS — A description of the Institutional review board approval strated that lifestyle intervention early phase of this intervention has been was not required by the DPHHS because can prevent the development of type 2 published previously, and the initial co- previous research established the safety diabetes and reduce cardiometabolic hort of participants is included in this re- and efficacy of the lifestyle intervention risk among participants, prompting port (6). In brief, the DPHHS funded and only de-identified data were used for many countries to begin implementing eight health care facilities with recognized analyses. efforts to translate these studies into diabetes self-management education Participant data were analyzed using practice (1–5). In 2008, the Montana (DSME) programs beginning in 2008. SAS 9.1 (SAS Institute, Cary, NC). Base- Department of Public Health and Hu- Sites used trained health professionals as line characteristics were compared man Services (DPHHS) implemented an lifestyle coaches to provide the 16-session among all enrolled participants and core adapted DPP, and preliminary results core followed by 6 monthly after core ses- and after core completers; t tests were demonstrated feasibility and effective- sions (7). DPHHS staff provided technical used to compare continuous variables, ness (6). This report describes weight assistance, data collection and analyses, 2 and tests were used to compare dichot- loss and cardiometabolic risk improve- and evaluation. omous variables. We calculated the pro- ment among participants completing Overweight (BMI25 kg/m ) adults, portion of completers who met the the intervention. with medical clearance from their refer- physical activity goal of 150 min/week in the core and 5 and 7% weight loss in ●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●● the core and after core. In the core and From the Montana Department of Public Health and Human Services, Helena, Montana. after core, the last observed weight of Corresponding author: Karl K. Vanderwood, [email protected]. completers was used to calculate mean Received 11 May 2010 and accepted 21 August 2010. Published ahead of print at http://care. diabetesjournals.org on 30 August 2010. DOI: 10.2337/dc10-0862. weight loss for those not attending the fi- *A complete list of the members of the Montana Cardiovascular Disease and Diabetes Prevention Pro- nal session. Paired t tests were used to gram Workgroup can be found in an online appendix at http://care.diabetesjournals.org/cgi/content/ assess mean weight loss, and the mean full/dc10-0862/DC1. systolic and diastolic blood pressure, The contents of this report are solely the responsibility of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention. HDL cholesterol, LDL cholesterol, and © 2010 by the American Diabetes Association. Readers may use this article as long as the work is properly fasting blood glucose from baseline to the cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons. end of the core (4-month follow-up) and org/licenses/by-nc-nd/3.0/ for details. after core (10-month follow-up). Bonfer- The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact. roni correction was applied to the level of care.diabetesjournals.org DIABETES CARE, VOLUME 33, NUMBER 12, DECEMBER 2010 2543 State-based approach to diabetes prevention Table 1—Weight loss and cardiometabolic risk factor outcomes among all participants completing the core and after core lifestyle intervention at 4 and 10 months, Montana, 2008–2010 Baseline Completed core P value* Completed after core P value† Weight (kg) Completed core, n816 99.2  20.7 92.4  20.0 0.001 — — Completed after core, n578 97.4  20.4 90.3  19.5 0.001 89.7  19.3 0.001 Systolic blood pressure (mmHg) Completed core, n684 133.6  15.7 126.5  14.9 0.001 — — Completed after core, n453 132.7  15.4 125.9  14.3 0.001 127.1  14.6 0.001 Diastolic blood pressure (mmHg) Completed core, n683 82.0  11.0 78.6  9.6 0.001 — — Completed after core, n452 81.2  10.9 77.7  9.1 0.001 77.7  9.2 0.001 HDL cholesterol (mg/dl) Completed core, n692 48.8  12.0 46.3  10.8 0.001 — — Completed after core, n488 49.1  11.6 46.1  10.7 0.001 51.0  11.8 0.001 LDL cholesterol (mg/dl) Completed core, n663 125.2  34.6 114.9  32.6 0.001 — — Completed after core, n473 123.2  33.2 112.0  32.0 0.001 118.7  31.2 0.001 Fasting blood glucose (mg/dl) Completed core, n613 101.5  14.7 97.4  12.7 0.001 — — Completed after core, n418 101.6  14.9 96.9  11.7 0.001 96.9  15.2 0.001 Data are means  SD. *Results of the paired-samples t test, comparisons of 4-month and baseline values. †Results of the paired-samples t test, comparisons of 10-month and baseline values. significance ( 0.003) to control for the sure, LDL cholesterol, and fasting blood and diabetes (10). We also relied on number of paired t tests calculated. glucose and a significant reduction in physician referrals rather than time- HDL cholesterol at the end of core (Table consuming screening events. Finally, of- RESULTS — Between February 2008 1). Significant improvements in HDL fering the DPP in groups allowed for and January 2010, 1,003 participants cholesterol were seen for those complet- greater participant enrollment than a one- were enrolled in the intervention; 816 ing the after core. Participants with and on-one intervention. There are several (81%) completed the core and 578 (58%) without impaired glucose values at limitations to our study. First, there was a completed the after core. Mean  SD at- baseline achieved significant improve- dropout rate of 19 and 42% at the end of tendance was 14.9  1.6 sessions during ments in weight, blood pressure, LDL the core and after core, respectively. the core and 3.7  2.1 sessions during cholesterol, and blood glucose values at Second, we used a pre- and post- after the core. The age of enrolled partic- completion of the core and after core evaluation with no comparison group. ipants was 52.3  11.6, and 80% (n  (data not shown). Third, we relied on self-reported phys- 805) were female. Core completers were ical activity and diet measures. Fourth, significantly older than those who did not CONCLUSIONS — Core and after we were unable to obtain laboratory complete the core and after core com- core completers achieved significant re- measures for all participants. Last, our pleters were significantly older, had a ductions in weight and improvements in analyses only included participants lower BMI at baseline, and were more cardiometabolic risk. However, HDL de- completing the intervention, which dif- likely to have diagnosed dyslipidemia at creased significantly at the end of the core fered from the DPP, in which an inten- baseline than those completing only the but was followed by a significant increase tion-to-treat analysis was used. core (supplementary Table, available in an for those completing the after core. Other Coordinated state and national ap- online appendix at http://care.diabetes studies have found similar results, indi- proaches to implement diabetes preven- journals.org/cgi/content/full/dc10-0862/ cating reductions in HDL during initial tion programs are needed. A recent DC1). weight loss, followed by increased HDL assessment of Montana DSME programs At the conclusion of the core, 45% of levels during weight maintenance (8,9). indicated that these programs have the ca- completers achieved the 7% weight loss Our lifestyle intervention has a num- pacity to provide diabetes prevention ser- goal, 66% achieved 5% weight loss, and ber of strengths, which support translat- vices, the primary barrier being lack of 66% met the physical activity goal. ing this research into practice. We reimbursement (11). Other promising Among the after core completers, 49% included overweight adults with risk fac- models in the U.S. include regional train- met the 7% weight loss goal, 64% tor(s) for CVD or diabetes, rather than ing and implementation centers in Pitts- achieved 5% weight loss, and 70% only adults with pre-diabetes, an ap- burgh, Pennsylvania, and Indianapolis, achieved the physical activity goal at the proach supported by recommendations Indiana (12,13). Because of the large end of core. from the American Diabetes Association number of individuals at high risk for di- Core and after core completers and American Heart Association, ac- abetes in the U.S., many prevention sites achieved significant improvements in knowledging the importance of address- will be needed, including DSME pro- weight, systolic and diastolic blood pres- ing an individual’s global risk for CVD grams and other settings. 2544 DIABETES CARE, VOLUME 33, NUMBER 12, DECEMBER 2010 care.diabetesjournals.org Vanderwood and Associates Impact of intensive lifestyle and met- www.hncp.org/wst/hpdp/NLB. Accessed Acknowledgments — This project was funded formin therapy on cardiovascular disease 8 March 2008 through the Montana State Legislature and risk factors in the diabetes prevention 8. Rossner S, Bjorvell H. Early and late ef- supported through a cooperative agreement program. Diabetes Care 2005;28: fects of weight loss on lipoprotein metab- with the Centers for Disease Control and Pre- 888 – 894 olism in severe obesity. Atherosclerosis vention, Division of Diabetes Translation 3. Saaristo T, Peltonen M, Keina ¨ nen-Kiu- 1987;64:125–130 (U32/CCU822743-05) in Atlanta, Georgia. kaanniemi S, Vanhala M, Saltevo J, Nis- 9. Fox AA, Thompson JL, Butterfield GE, No potential conflicts of interest relevant to kanen L, Oksa H, Korpi-Hyo ¨va ¨ lti E, Gylfadottir U, Moynihan S, Spiller G. Ef- this article were reported. Tuomilehto J. National type 2 diabetes fects of diet and exercise on common car- K.K.V. and T.O.H. researched data, contrib- prevention programme in Finland: FIN- diovascular disease risk factors in uted to discussion, wrote the manuscript, and D2D. Int J Circumpolar Health 2007;66: moderately obese older women. Am J Clin reviewed/edited the manuscript. T.S.H. re- 101–112 Nutr 1996;63:225–233 searched data, contributed to discussion, and 4. Schwarz PEH, Reddy P, Greaves CJ, J 10. Eckel RH, Kahn R, Robertson RM, Rizza reviewed/edited the manuscript. M.K.B. and Dunbar JA, Schwarz J. Diabetes Prevention RA. Preventing cardiovascular disease S.D.H. researched data and reviewed/edited in Practice. Dresden, Germany, TUMAINI and diabetes: a call to action from the the manuscript. Institute for Prevention Management, American Diabetes Association and the Parts of this study were presented in ab- 2010, p. 45–56 American Heart Association. Circulation stract form at the 70th Scientific Sessions of 5. Schwarz PE, Lindstro ¨ m J, Kissimova- 2006;113:2943–2946 the American Diabetes Association, Orlando, Scarbeck K, Szybinski Z, Barengo NC, 11. Butcher MK, Vanderwood KK, Hall TO, Florida, 25–29 June 2010. Peltonen M, Tuomilehto J. The European Gohdes D, Helgerson SD, Harwell TS. Ca- We thank and acknowledge Susan Day perspective of type 2 diabetes prevention: from the Montana DPHHS for her work and pacity of diabetes education programs to diabetes in Europe—prevention using support on this project. We also thank Carol provide both diabetes self-management lifestyle, physical activity and nutritional Percy and Cathy Manus from ACKCO Ameri- education and to implement diabetes pre- intervention (DE-PLAN) project. Exp can Indian Professional Services for providing vention services. J Public Health Manag Clin Endocrinol Diabetes 2008;116:167– the initial training and technical assistance for Pract. In press this project. 12. Ackermann RT, Marrero DG. Adapting 6. Amundson HA, Butcher MK, Gohdes D, the Diabetes Prevention Program lifestyle Hall TO, Harwell TS, Helgerson SD, intervention for delivery in the commu- Vanderwood KK. Translating the Diabe- nity: the YMCA model. Diabetes Educ References tes Prevention Program into practice in 2007;33:69, 74 –75, 77–78 1. Knowler WC, Barrett-Connor E, Fowler the general community: findings from the 13. Kramer MK, Kriska AM, Venditti EM, SE, Hamman RF, Lachin JM, Walker EA, Montana Cardiovascular Disease and Di- Miller RG, Brooks MM, Burke LE, Simin- Nathan DM. Reduction in the incidence of abetes Prevention Program. Diabetes erio LM, Solano FX, Orchard TJ. Translat- type 2 diabetes with lifestyle intervention Educ 2009;35:209 –210, 213–214, 216 – ing the Diabetes Prevention Program: a or metformin. N Engl J Med 2002;346: 220 393– 403 7. Healthy Native Community Partnership. comprehensive model for prevention 2. Ratner R, Goldberg R, Haffner S, Marco- Native lifestyle balance curriculum [arti- training and program delivery. Am J Prev vina S, Orchard T, Fowler S, Temprosa M. cle online], 2008. Available from http:// Med 2009;37:505–511 care.diabetesjournals.org DIABETES CARE, VOLUME 33, NUMBER 12, DECEMBER 2010 2545 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Diabetes Care Pubmed Central

Implementing a State-Based Cardiovascular Disease and Diabetes Prevention Program

Vanderwood, Karl K.; Hall, Taryn O.; Harwell, Todd S.; Butcher, Marcene K.; Helgerson, Steven D.; ,
Diabetes Care , Volume 33 (12) – Aug 30, 2010
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Pubmed Central
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© 2010 by the American Diabetes Association.
ISSN
0149-5992
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1935-5548
DOI
10.2337/dc10-0862
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Abstract

Clinical Care/Education/Nutrition/Psychosocial Research BRIEF REPORT Implementing a State-Based Cardiovascular Disease and Diabetes Prevention Program KARL K. VANDERWOOD, MPH STEVEN D. HELGERSON, MD, MPH ring provider and one or more of the fol- TARYN O. HALL, MPH ON BEHALF OF THE MONTANA lowing cardiovascular disease (CVD) and TODD S. HARWELL, MPH CARDIOVASCULAR DISEASE AND DIABETES diabetes risk factors were eligible: a pre- MARCENE K. BUTCHER, RD, CDE PREVENTION PROGRAM WORKGROUP* vious diagnosis of pre-diabetes; impaired glucose tolerance or impaired fasting glu- cose; high blood pressure (130/85 OBJECTIVE — To evaluate weight loss and cardiometabolic risk reduction achieved through mmHg or treatment) or dyslipidemia an adapted Diabetes Prevention Program intervention among adults at high risk for cardiovas- (triglycerides 150 mg/dl, LDL choles- cular disease (CVD) and diabetes. terol 130 mg/dl or treatment, or HDL cholesterol 40 mg/dl men and 50 RESEARCH DESIGN AND METHODS — Eight health care facilities implemented a mg/dl women); or a history of gestational group-based lifestyle intervention beginning in 2008. Participants attended 16 weekly core diabetes mellitus or gave birth to a baby sessions followed by 6 monthly after core sessions. 9 pounds. Height, weight, blood pressure, fast- RESULTS — A total of 1,003 participants were enrolled, 816 (81%) completed the core and ing blood glucose, and lipid values were 578 (58%) completed the after core. Of participants completing the core and after core, 45 and 49% achieved the 7% weight loss goal, respectively. There were significant improvements in collected at enrollment and at completion blood pressure, fasting glucose, and LDL cholesterol among participants completing the of the core and after core. Participants intervention. were weighed at the beginning of each session and submitted self-monitoring CONCLUSIONS — Our findings indicate it is feasible for state-coordinated CVD and dia- records. Participants were considered betes prevention programs to achieve significant weight loss and improve cardiometabolic risk. core completers if they did not drop out or miss three or more consecutive ses- Diabetes Care 33:2543–2545, 2010 sions and after core completers if they had completed follow-up laboratory measure- he Diabetes Prevention Program RESEARCH DESIGN AND ments at 10 months. (DPP) and other studies demon- METHODS — A description of the Institutional review board approval strated that lifestyle intervention early phase of this intervention has been was not required by the DPHHS because can prevent the development of type 2 published previously, and the initial co- previous research established the safety diabetes and reduce cardiometabolic hort of participants is included in this re- and efficacy of the lifestyle intervention risk among participants, prompting port (6). In brief, the DPHHS funded and only de-identified data were used for many countries to begin implementing eight health care facilities with recognized analyses. efforts to translate these studies into diabetes self-management education Participant data were analyzed using practice (1–5). In 2008, the Montana (DSME) programs beginning in 2008. SAS 9.1 (SAS Institute, Cary, NC). Base- Department of Public Health and Hu- Sites used trained health professionals as line characteristics were compared man Services (DPHHS) implemented an lifestyle coaches to provide the 16-session among all enrolled participants and core adapted DPP, and preliminary results core followed by 6 monthly after core ses- and after core completers; t tests were demonstrated feasibility and effective- sions (7). DPHHS staff provided technical used to compare continuous variables, ness (6). This report describes weight assistance, data collection and analyses, 2 and tests were used to compare dichot- loss and cardiometabolic risk improve- and evaluation. omous variables. We calculated the pro- ment among participants completing Overweight (BMI25 kg/m ) adults, portion of completers who met the the intervention. with medical clearance from their refer- physical activity goal of 150 min/week in the core and 5 and 7% weight loss in ●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●● the core and after core. In the core and From the Montana Department of Public Health and Human Services, Helena, Montana. after core, the last observed weight of Corresponding author: Karl K. Vanderwood, [email protected]. completers was used to calculate mean Received 11 May 2010 and accepted 21 August 2010. Published ahead of print at http://care. diabetesjournals.org on 30 August 2010. DOI: 10.2337/dc10-0862. weight loss for those not attending the fi- *A complete list of the members of the Montana Cardiovascular Disease and Diabetes Prevention Pro- nal session. Paired t tests were used to gram Workgroup can be found in an online appendix at http://care.diabetesjournals.org/cgi/content/ assess mean weight loss, and the mean full/dc10-0862/DC1. systolic and diastolic blood pressure, The contents of this report are solely the responsibility of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention. HDL cholesterol, LDL cholesterol, and © 2010 by the American Diabetes Association. Readers may use this article as long as the work is properly fasting blood glucose from baseline to the cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons. end of the core (4-month follow-up) and org/licenses/by-nc-nd/3.0/ for details. after core (10-month follow-up). Bonfer- The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact. roni correction was applied to the level of care.diabetesjournals.org DIABETES CARE, VOLUME 33, NUMBER 12, DECEMBER 2010 2543 State-based approach to diabetes prevention Table 1—Weight loss and cardiometabolic risk factor outcomes among all participants completing the core and after core lifestyle intervention at 4 and 10 months, Montana, 2008–2010 Baseline Completed core P value* Completed after core P value† Weight (kg) Completed core, n816 99.2  20.7 92.4  20.0 0.001 — — Completed after core, n578 97.4  20.4 90.3  19.5 0.001 89.7  19.3 0.001 Systolic blood pressure (mmHg) Completed core, n684 133.6  15.7 126.5  14.9 0.001 — — Completed after core, n453 132.7  15.4 125.9  14.3 0.001 127.1  14.6 0.001 Diastolic blood pressure (mmHg) Completed core, n683 82.0  11.0 78.6  9.6 0.001 — — Completed after core, n452 81.2  10.9 77.7  9.1 0.001 77.7  9.2 0.001 HDL cholesterol (mg/dl) Completed core, n692 48.8  12.0 46.3  10.8 0.001 — — Completed after core, n488 49.1  11.6 46.1  10.7 0.001 51.0  11.8 0.001 LDL cholesterol (mg/dl) Completed core, n663 125.2  34.6 114.9  32.6 0.001 — — Completed after core, n473 123.2  33.2 112.0  32.0 0.001 118.7  31.2 0.001 Fasting blood glucose (mg/dl) Completed core, n613 101.5  14.7 97.4  12.7 0.001 — — Completed after core, n418 101.6  14.9 96.9  11.7 0.001 96.9  15.2 0.001 Data are means  SD. *Results of the paired-samples t test, comparisons of 4-month and baseline values. †Results of the paired-samples t test, comparisons of 10-month and baseline values. significance ( 0.003) to control for the sure, LDL cholesterol, and fasting blood and diabetes (10). We also relied on number of paired t tests calculated. glucose and a significant reduction in physician referrals rather than time- HDL cholesterol at the end of core (Table consuming screening events. Finally, of- RESULTS — Between February 2008 1). Significant improvements in HDL fering the DPP in groups allowed for and January 2010, 1,003 participants cholesterol were seen for those complet- greater participant enrollment than a one- were enrolled in the intervention; 816 ing the after core. Participants with and on-one intervention. There are several (81%) completed the core and 578 (58%) without impaired glucose values at limitations to our study. First, there was a completed the after core. Mean  SD at- baseline achieved significant improve- dropout rate of 19 and 42% at the end of tendance was 14.9  1.6 sessions during ments in weight, blood pressure, LDL the core and after core, respectively. the core and 3.7  2.1 sessions during cholesterol, and blood glucose values at Second, we used a pre- and post- after the core. The age of enrolled partic- completion of the core and after core evaluation with no comparison group. ipants was 52.3  11.6, and 80% (n  (data not shown). Third, we relied on self-reported phys- 805) were female. Core completers were ical activity and diet measures. Fourth, significantly older than those who did not CONCLUSIONS — Core and after we were unable to obtain laboratory complete the core and after core com- core completers achieved significant re- measures for all participants. Last, our pleters were significantly older, had a ductions in weight and improvements in analyses only included participants lower BMI at baseline, and were more cardiometabolic risk. However, HDL de- completing the intervention, which dif- likely to have diagnosed dyslipidemia at creased significantly at the end of the core fered from the DPP, in which an inten- baseline than those completing only the but was followed by a significant increase tion-to-treat analysis was used. core (supplementary Table, available in an for those completing the after core. Other Coordinated state and national ap- online appendix at http://care.diabetes studies have found similar results, indi- proaches to implement diabetes preven- journals.org/cgi/content/full/dc10-0862/ cating reductions in HDL during initial tion programs are needed. A recent DC1). weight loss, followed by increased HDL assessment of Montana DSME programs At the conclusion of the core, 45% of levels during weight maintenance (8,9). indicated that these programs have the ca- completers achieved the 7% weight loss Our lifestyle intervention has a num- pacity to provide diabetes prevention ser- goal, 66% achieved 5% weight loss, and ber of strengths, which support translat- vices, the primary barrier being lack of 66% met the physical activity goal. ing this research into practice. We reimbursement (11). Other promising Among the after core completers, 49% included overweight adults with risk fac- models in the U.S. include regional train- met the 7% weight loss goal, 64% tor(s) for CVD or diabetes, rather than ing and implementation centers in Pitts- achieved 5% weight loss, and 70% only adults with pre-diabetes, an ap- burgh, Pennsylvania, and Indianapolis, achieved the physical activity goal at the proach supported by recommendations Indiana (12,13). Because of the large end of core. from the American Diabetes Association number of individuals at high risk for di- Core and after core completers and American Heart Association, ac- abetes in the U.S., many prevention sites achieved significant improvements in knowledging the importance of address- will be needed, including DSME pro- weight, systolic and diastolic blood pres- ing an individual’s global risk for CVD grams and other settings. 2544 DIABETES CARE, VOLUME 33, NUMBER 12, DECEMBER 2010 care.diabetesjournals.org Vanderwood and Associates Impact of intensive lifestyle and met- www.hncp.org/wst/hpdp/NLB. Accessed Acknowledgments — This project was funded formin therapy on cardiovascular disease 8 March 2008 through the Montana State Legislature and risk factors in the diabetes prevention 8. Rossner S, Bjorvell H. Early and late ef- supported through a cooperative agreement program. Diabetes Care 2005;28: fects of weight loss on lipoprotein metab- with the Centers for Disease Control and Pre- 888 – 894 olism in severe obesity. Atherosclerosis vention, Division of Diabetes Translation 3. Saaristo T, Peltonen M, Keina ¨ nen-Kiu- 1987;64:125–130 (U32/CCU822743-05) in Atlanta, Georgia. kaanniemi S, Vanhala M, Saltevo J, Nis- 9. Fox AA, Thompson JL, Butterfield GE, No potential conflicts of interest relevant to kanen L, Oksa H, Korpi-Hyo ¨va ¨ lti E, Gylfadottir U, Moynihan S, Spiller G. Ef- this article were reported. Tuomilehto J. National type 2 diabetes fects of diet and exercise on common car- K.K.V. and T.O.H. researched data, contrib- prevention programme in Finland: FIN- diovascular disease risk factors in uted to discussion, wrote the manuscript, and D2D. Int J Circumpolar Health 2007;66: moderately obese older women. Am J Clin reviewed/edited the manuscript. T.S.H. re- 101–112 Nutr 1996;63:225–233 searched data, contributed to discussion, and 4. Schwarz PEH, Reddy P, Greaves CJ, J 10. Eckel RH, Kahn R, Robertson RM, Rizza reviewed/edited the manuscript. M.K.B. and Dunbar JA, Schwarz J. Diabetes Prevention RA. Preventing cardiovascular disease S.D.H. researched data and reviewed/edited in Practice. Dresden, Germany, TUMAINI and diabetes: a call to action from the the manuscript. Institute for Prevention Management, American Diabetes Association and the Parts of this study were presented in ab- 2010, p. 45–56 American Heart Association. Circulation stract form at the 70th Scientific Sessions of 5. Schwarz PE, Lindstro ¨ m J, Kissimova- 2006;113:2943–2946 the American Diabetes Association, Orlando, Scarbeck K, Szybinski Z, Barengo NC, 11. Butcher MK, Vanderwood KK, Hall TO, Florida, 25–29 June 2010. Peltonen M, Tuomilehto J. The European Gohdes D, Helgerson SD, Harwell TS. Ca- We thank and acknowledge Susan Day perspective of type 2 diabetes prevention: from the Montana DPHHS for her work and pacity of diabetes education programs to diabetes in Europe—prevention using support on this project. We also thank Carol provide both diabetes self-management lifestyle, physical activity and nutritional Percy and Cathy Manus from ACKCO Ameri- education and to implement diabetes pre- intervention (DE-PLAN) project. Exp can Indian Professional Services for providing vention services. J Public Health Manag Clin Endocrinol Diabetes 2008;116:167– the initial training and technical assistance for Pract. In press this project. 12. Ackermann RT, Marrero DG. Adapting 6. Amundson HA, Butcher MK, Gohdes D, the Diabetes Prevention Program lifestyle Hall TO, Harwell TS, Helgerson SD, intervention for delivery in the commu- Vanderwood KK. Translating the Diabe- nity: the YMCA model. Diabetes Educ References tes Prevention Program into practice in 2007;33:69, 74 –75, 77–78 1. Knowler WC, Barrett-Connor E, Fowler the general community: findings from the 13. Kramer MK, Kriska AM, Venditti EM, SE, Hamman RF, Lachin JM, Walker EA, Montana Cardiovascular Disease and Di- Miller RG, Brooks MM, Burke LE, Simin- Nathan DM. Reduction in the incidence of abetes Prevention Program. Diabetes erio LM, Solano FX, Orchard TJ. Translat- type 2 diabetes with lifestyle intervention Educ 2009;35:209 –210, 213–214, 216 – ing the Diabetes Prevention Program: a or metformin. N Engl J Med 2002;346: 220 393– 403 7. Healthy Native Community Partnership. comprehensive model for prevention 2. Ratner R, Goldberg R, Haffner S, Marco- Native lifestyle balance curriculum [arti- training and program delivery. Am J Prev vina S, Orchard T, Fowler S, Temprosa M. cle online], 2008. Available from http:// Med 2009;37:505–511 care.diabetesjournals.org DIABETES CARE, VOLUME 33, NUMBER 12, DECEMBER 2010 2545

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Diabetes Care – Pubmed Central

Published: Aug 30, 2010

There are no references for this article.