Presessions to the National Diabetes Prevention Program Are a Promising Strategy to Improve Attendance and Weight Loss Outcomes

Introduction:The National Diabetes Prevention Program (NDPP) is a widely-disseminated lifestyle intervention. Retention in the NDPP is problematic and leads to suboptimal weight loss, especially among racial/ethnic minority participants. We report results of implementing a novel “pre-session” protocol to support engagement among a diverse sample of NDPP participants.

Methods:The NDPP was delivered in a safety net healthcare system. As of September 2016, pre-sessions were offered prior to NDPP attendance and focused on (1) education on diabetes risks, (2) motivational interviewing to participate in the NDPP, and (3) problem-solving barriers to engagement. We compared NDPP attendance and weight loss outcomes between 75 pre-session participants and a historical control group of 42 individuals who were not offered a pre-session prior to their beginning the NDPP in July 2016. This comparator group was selected to reduce potentially confounding effects of other prior modifications to NDPP dissemination over time.

Results: The majority of participants in this analysis were female (78.3%), low-income (51.1%), and Hispanic (57.6%). Mean age was 46.6 (SD=12.7) with a mean baseline BMI of 35.9 (SD=5.7). There were no significant baseline differences in characteristics between NDPP participants who received a pre-session and historical controls. Pre-session participants attended 5.3 (SD=1.4) more NDPP sessions (p<.001) and stayed in the program 96.4 (SD=24.6) days longer (p<.001) than historical controls. Pre-session participants achieved 1.8% (SD=0.8) greater weight loss (p=.039) and were 2.4 times more likely to achieve ≥5% weight loss in the NDPP as historical controls; p=.044, 95% CI [1.0-5.8].

Conclusions:By improving engagement and weight loss, findings suggest pre-sessions may be a promising strategy to improve NDPP effectiveness and mitigate health disparities in program outcomes.