Patient-Centered Goal-Setting in the National Diabetes Prevention Program

A Pilot Study

Ritchie, Natalie D.
Sauder, Katherine A.
Kaufmann, Peter G.
Perreault, Leigh

¹Office of Research, Denver Health and Hospital Authority, Denver, CO
²Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO
³University of Colorado College of Nursing, Aurora, CO
⁴Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
⁵Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado, Aurora, CO
⁶M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA
⁷Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus and the Colorado School of Public Health, Aurora, CO
⁸Department of Epidemiology and Biostatistics, University of Colorado Anschutz Medical Campus and the Colorado School of Public Health, Aurora, CO

Corresponding author: Natalie D. Ritchie, [email protected]

Received March 27, 2021

Accepted July 08, 2021

Diabetes Care 44(11):p 2464-2469, November 2021. | DOI: 10.2337/dc21-0677

OBJECTIVE

Difficulty achieving preset goals (e.g., ≥5% weight loss, ≥150 min of weekly physical activity) in the yearlong National Diabetes Prevention Program (NDPP) can prompt dropout and diminish benefits. We piloted a more patient-centered NDPP adaptation (NDPP-Flex) that promotes a variety of attainable and individually tailored goals to reduce diabetes risks, along with flexibility to adjust goals each week as needed.

RESEARCH DESIGN AND METHODS

Retention, physical activity, weight, and glycated hemoglobin (HbA_1c) were evaluated among diverse participants with diabetes risks who received our pilot of NDPP-Flex beginning in January and July 2018 (n = 95), with a planned comparison with standard NDPP delivery in preceding cohorts that launched between September 2016 and October 2017 (n = 245). Both the standard NDPP and NDPP-Flex interventions were 1 year in duration and implemented in phases (i.e., nonrandomized).

RESULTS

Average adjusted retention (e.g., 158.90 ± 15.20 vs. 166.71 ± 9.38 days; P = 0.674), physical activity (157.97 ± 11.91 vs. 175.64 ± 7.54 weekly min; P = 0.231), and weight loss (1.46 ± 0.38% vs. 1.90 ± 0.24%; P = 0.396) were similar between NDPP-Flex versus standard NDPP. However, NDPP-Flex participants had greater HbA_1c reduction on average (0.22 ± 0.05% vs. 0.06 ± 0.03%; P = 0.018) and were more likely to have normoglycemia at follow-up (odds ratio 4.62; P = 0.013 [95% CI 1.38–15.50]) than participants in the standard NDPP.

CONCLUSIONS

An adapted, more patient-centered NDPP that focuses on flexible, self-selected goals may be a promising strategy to improve glycemia even in the absence of substantial weight loss.