The Science of Diabetes Self-Management and Care
2023, Vol. 49(4) 322 –323© The Author(s) 2023Article reuse guidelines:sagepub.com/journals-permissionsDOI: 10.1177/26350106231169690journals.sagepub.com/home/tde
Have you ever thought about diabetes prevention through the lens of both a research and clinical practice continuum? Our collective research and clinical care journey with diabetes prevention provides a powerful demonstration of what is possible when research is translated into evidence-based clinical practice.
The research translation continuum starts with efficacy trials and progresses to effectiveness trials that in turn inform evidence-based clinical practice. Efficacy trials like the Diabetes Prevention Program (DPP) ask the question, “How well does lifestyle intervention work in ideal settings with highly screened participants, highly trained coaches, and a maximum intensity intervention?” The answer: The DPP ended 1 year early in 2001 due to the powerful effects of lifestyle intervention in preventing diabetes. Compared to placebo, lifestyle intervention reduced the risk of developing diabetes by 58%.1 We learned that the lifestyle intervention aimed at a modest 7% weight loss was more powerful than the medication metformin and that the benefits of the lifestyle intervention were sustained 10 and 15 years later.2,3
DPP’s landmark research set the stage for a multitude of effectiveness trials that asked the question, “How well does lifestyle intervention work in real-world practice settings?” This translation research demonstrated that DPP-based lifestyle interventions can be adapted, implemented, and effective in a variety of practice settings (primary care, YMCAs, public health departments) and using various delivery formats, including in-person groups, digital platforms with human coaching, and fully automated digital programs achieving weight losses ranging from 3.6% to 7.5%, with in-person groups achieving the greatest weight losses.4
Effectiveness trials are important because they can help providers, payors, and policymakers make informed decisions about health care and reimbursement for these types of programs. In this case, the compelling cumulative results of DPP effectiveness research led to the establishment of the Centers for Disease Control’s (CDC’s) National Diabetes Prevention program in 2010 to implement this model of evidence-based practice. In 2012, the American Association of Diabetes Educators (AADE) worked with CDC to select 30 certified Diabetes Self-Management Education programs for National Diabetes Prevention Program delivery and 3 years later represented about 25% of all the fully recognized programs on CDC’s website. At that time, these sites achieved mean weight losses of 5.59% at 6 months and 5.63% at 12 months in those who attended minimum of 4 sessions5 as indicated in the accompanying article. [Click this link to access article: https://journals.sagepub.com/doi/10.1177/0145721716668415] Since then, the Association of Diabetes Care & Education Specialists (ADCES) secured additional CDC funding and has expanded its reach and scaled the National Diabetes Prevention Program working with 27 new organizations across 13 states and 1 online provider to target underserved populations (email communication, Patrick McMahon, MPH, ADCES, January 10, 2023).
The clinical practice continuum of diabetes prevention is bidirectional. The original DPP demonstrated that about one-third of people with prediabetes reverted to normal glucose tolerance, which underscores the power of early and timely lifestyle change, that this lifestyle intervention can delay progression to type 2 diabetes for up to 15 years, and that the risk of developing diabetes is 56% lower in those who revert to normoglycemia no matter how transiently.3,6,7 Providing this messaging to our patients can instill hope and motivation to invest in lifestyle change.
Although some people who participate in the lifestyle intervention do progress along the continuum to develop diabetes, they will have learned foundational skills for managing their weight and activity so that they are better prepared to manage the condition. We also know that with early diagnosis of diabetes (within 5 years), that there is still a good chance to achieve diabetes remission, particularly if they achieve weight losses of 10% or more.8
The DPP was a game changer for AADE/ADCES because this landmark clinical trial proved that lifestyle interventions could prevent or delay the development of type 2 diabetes, better manage many diabetes related comorbidities with less medication, and be delivered cost-effectively. The strategic vision of ADCES leadership to expand the mission to include diabetes prevention as an integral aspect of their continuum of care model and then proceed to provide training to certify coaches, obtain funding to implement programs nationwide, and report high-quality outcome data shows just how far we have come!
Linda M. Delahanty, MS, RDN, is chief dietitian and director of nutrition and behavioral research at Massachusetts General Hospital’s Diabetes Center and associate professor of medicine at Harvard Medical School. She served as a co-investigator, lifestyle interventionist, and co-chair of the Lifestyle Advisory Group on the Diabetes Prevention Program (DPP) and the DPP Outcomes Study. Ms Delahanty currently directs the Path to Lifestyle Change diabetes prevention program at Massachusetts General Hospital’s Diabetes Center and has authored the book Beating Diabetes.
The author serves on Advisory Boards for Omada Health, Inc and WW, International, Inc and has stock/stock options in Omada Health, Inc, and JanaCare, Inc.
Linda M. Delahanty https://orcid.org/0000-0002-1525-3559
From Diabetes Center, Massachusetts General Hospital, Boston, Massachusetts (Ms Delahanty); and Department of Medicine, Harvard Medical School, Boston, Massachusetts (Ms Delahanty).
Corresponding Author:Linda M Delahanty, Diabetes Center, Massachusetts General Hospital, 50 Staniford St Suite 340, Boston, MA 02115, USA.Email: Delahanty.Linda@mgh.harvard.edu
