688-P: Factors Associated with Diabetes Prevention Program (DPP) Compliance and Weight Loss among Low Income Participants

Achieving 5% weight loss in the DPP is challenging. We examine factors associated with compliance and weight change in low income participants.

The We Can Prevent Diabetes study enrolled 854 Medicaid beneficiaries (93 DPP groups) for 16 weekly core sessions with. Financial incentives for attendance and weight loss were offered to 568 participants (63 DPP groups). Participants were aged 18-74 years, BMI ≥ 25 kg/m², had prediabetes, and enrolled in Medicaid. Compliance measures were attendance, self-reported physical activity, and food logs. Patient factors were sex, age, race/ethnicity, primary language, BMI, education, marital status, chronic and mental health conditions. Program factors were incentives, lifestyle coach (YMCA or clinic staff), and DPP group size. Analyses examined bivariate associations with three weight trajectories (gain, stable, loss). Factors significant at p<0.25 were included in regression models examining compliance and weight trajectories.

Participants (N=647) who attended 4+ sessions were analyzed, with 450 eligible for incentives. Patient factors significantly associated (p<0.05) with attendance were aged 45-64 years (OR=1.5), aged 65-84 years (OR=3.6) and presence of a chronic condition (OR=2.0). Those associated with weight change were aged 45-64 years (OR=1.4), English speaking (OR=0.4), and being Hispanic (OR=0.5). At the program level, incentives were associated with attendance (OR=2.9) but not weight change. Clinic lifestyle coach was associated with weight change (OR=1.6). Participants with 8+ sessions (OR 1.8), having an average of more than 150 minutes/week (OR 2.1), and food log documentation (OR 1.6) were more likely (p<0.05) to lose weight.

In culturally diverse low income DPP participants, incentives improve attendance but not weight loss. Use of clinic-based coaches and attention to cultural factors, such language, may enhance program effectiveness.