More than 60 million Americans have pre-diabetes, and most of them are unaware. Adults with pre-diabetes are at more than 10 times the normal risk for developing diabetes and at twice the risk for heart attack or stroke. Reaching this growing population is a concern for diabetes educators and physicians.
“Previous studies, such as the highly regarded national Diabetes Prevention Program, have shown that structured diet and physical exercise can significantly reduce the progression of pre-diabetes to diabetes. But these trials involved major lifestyle changes that are difficult to translate into large-scale, community-level programs. In our study we were able to train lay people in the community to deliver the program at the YMCA, an environment accessible to many people with pre-diabetes, to help them sustain lifestyle changes,” said the study’s principal author, Ronald Ackermann, M.D., M.P.H., IU School of Medicine assistant professor of medicine and an affiliated scientist of the Regenstrief Institute.
With more than 2,500 facilities serving more than 10,000 inner-city, suburban and rural communities nationwide and a long history of implementing successful health promotion programs, the YMCA is in a unique position to reach persons with pre-diabetes, according to Dr. Ackermann. In this study, 92 individuals were enrolled in two groups. The intervention group received a core curriculum involving 16 classroom-style meetings focused on building knowledge and skills for goal setting, self-monitoring and problem-solving. The control group was offered standard diabetes-prevention advice.
At the 4–6-month follow-up visit, body weight had decreased by 6 percent in the intervention participants and by 2 percent in the control participants. This was equal to a mean weight loss of 12.5 pounds for intervention participants and 4 pounds for the group that received the standard information. The difference in the amount of weight lost is a clinically meaningful and significant difference, as was the change in total cholesterol concentration, according to Dr. Ackermann. These differences persisted at the 12-14 month follow-up visits.
“This is the first study to demonstrate that the YMCA is a promising vehicle for the dissemination of the DPP lifestyle intervention into the community. In the DPP, a 5 percent weight loss was associated with a 58 percent reduction in risk of developing diabetes. In our pilot study, people at high risk for developing diabetes achieved and maintained a mean 6 percent reduction in baseline body weight and significant reductions in total cholesterol,” he noted.
The study concludes, “By lowering the cost of and expanding the accessibility to diabetes-prevention services, the YMCA may serve not only to increase the number of individuals with pre-diabetes who have access to and can pay for evidence-based diabetes prevention; it may also provide a compelling model for health-plan reimbursement. This provides yet another compelling reason to develop and test novel strategies that link community-based program delivery with existing clinical services that could help to identify and activate more adults with pre-diabetes.”
Support for this study was provided by the National Institute of Diabetes and Digestive and Kidney Diseases, the IU School of Medicine and the YMCA of Greater Indianapolis.
Dr. Ackermann is the deputy director of the Center for Health Policy and Professionalism Research (CHPPR), an innovative think tank at the IU School of Medicine and Riley Hospital for Children.
In addition to Dr. Ackermann, authors of “Translating the Diabetes Prevention Program into the Community: The DEPLOY Pilot Study” are Emily A. Finch, M.A.; Edward Brizendine, M.S.; Honghong Zhou, Ph.D and David G. Marrero, Ph.D., of the IU School of Medicine.