Translating the DPP Into the Community: The YMCA Model

• Physical activity level [ Time Frame: 6 months ] [ Designated as safety issue: No ]
• Rate of community program participation [ Time Frame: 6 months ] [ Designated as safety issue: No ]
• Change in dietary composition [ Time Frame: 6 months ] [ Designated as safety issue: No ]

The Diabetes Prevention Program (DPP) demonstrated that an intensive lifestyle intervention resulting in modest weight loss and increased physical activity can delay or prevent the development of type 2 diabetes in those at increased risk for the disease. The lifestyle program used, however, was not designed for delivery on a public health scale. Successful community translation of the DPP's findings will require close collaboration with an established community organization committed to improving community health and experienced in implementing sustainable health and wellness programs. With exceptional reach into diverse U.S. communities, the YMCA may be an ideal community partner. We have been collaborating with the YMCA organization for over a year to design a robust recruitment and implementation model that is sensitive to the unique needs and resources of a community organization. We now propose to evaluate if a group-based adaptation of the DPP lifestyle intervention can be successfully implemented by YMCA staff, in YMCA facilities. We have designed this study to develop preliminary data about the reach, effectiveness, and consistent implementation of the DPP lifestyle intervention in this context. This pilot study has two primary aims: 1) to demonstrate the extent to which YMCA staff trained by DPP study personnel can administer a group-based adaptation of the DPP lifestyle intervention in a fashion consistent with DPP intervention protocols, and 2) to evaluate if the intervention program delivered by the YMCA results in changes in body mass, physical activity, and dietary intake that are consistent with a level found to be associated with diabetes risk reduction during the DPP trial. We will also collect valuable data about the feasibility and reach of a selective, community-based marketing and screening approach for recruiting program participants. In combination, these data will enable us to design and conduct a larger, future 3-year trial focusing on the effectiveness and sustainability of community DPP translation in multiple YMCA settings.

• Prediabetic State
• Overweight
• Obesity

• Behavioral: Pre-diabetes assessment and general advice about lifestyle based strategies to prevent type 2 diabetes
  Pre-diabetes risk assessment with brief education and counseling performed by School of Medicine partners at the YMCA and repeated after 6 and 12 months
• Behavioral: Pre-diabetes assessment, brief advice, and access to a group-based diabetes prevention lifestyle intervention at the YMCA
  Pre-diabetes risk assessment, education, and counseling offered at baseline, 6, 12-months. 16-visit lifestyle intervention program occuring for 1 hour every 7-10 days for first 5 months, followed by monthly 90 minute maintenance meetings at YMCA

• Experimental: 1
  Brief counseling for pre-diabetes plus access to a group-based diabetes prevention lifestyle intervention at the YMCA
  Intervention: Behavioral: Pre-diabetes assessment, brief advice, and access to a group-based diabetes prevention lifestyle intervention at the YMCA
• Active Comparator: 2
  Brief Counseling for pre-diabetes alone
  Intervention: Behavioral: Pre-diabetes assessment and general advice about lifestyle based strategies to prevent type 2 diabetes

Inclusion Criteria:

i. 18 years of age or older ii. Body-mass index of >= 24 kg/m2 iii. ADA diabetes risk assessment score >= 10 (see below) iv. Casual capillary blood glucose >= 110 mg/dl

Exclusion Criteria:

i. Exclusions for diseases likely to limit life span and/or increase risk of interventions:

A. Cancer requiring treatment in the past 5 years

B. Cardiovascular disease:

1. A "Yes" response to any item on the modified Physical Activity Readiness Questionnaire (see Appendix 2)
2. Uncontrolled hypertension: SBP >180 mmHg or DBP >105 mmHg
3. Heart attack, stroke, or transient ischemic attack in the past 6 months, C. Lung disease: Chronic obstructive airways disease or asthma requiring home oxygen

ii. Exclusions related to metabolism: A. Diabetes at baseline evaluation B. Casual capillary blood glucose >= 200 mg/dl C. History of anti-diabetic medication use (oral agents or insulin) except during gestational diabetes

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

iii. Exclusion for conditions or behaviors likely to affect the conduct of the study:

A. Unable or unwilling to provide informed consent B. Unable to communicate with the pertinent clinic staff C. Unable to read written English