Background: Translational diabetes prevention lifestyle change programs are efficacious in promoting weight loss in clinical and community settings. However, we are unaware of observational studies examining the effectiveness of such programs in routine clinical practice compared to usual care.
Methods: In this retrospective cohort study, we identified program participants and usual-care patients, ≥18 years of age, in the electronic health records of a large, community-based healthcare system (2010-2017). The first program encounter was defined as baseline for program participants and a random encounter date was assigned as baseline for usual-care patients. All subjects were required to have weight recorded prior to baseline (≤12 months) and 12 months after (±3 months). We estimated propensity scores (ps) as the probability of lifestyle change program participation conditional on baseline characteristics. We then matched program participants to usual-care patients 1:5 on the ps. We measured differences in mean change in weight post baseline and percentage of patients with clinically meaningful (≥5%) weight loss, using regression modeling.
Results: We identified 3,156 program participants, of which 1,783 were matched to 8,188 usual-care patients. Matched groups were well balanced on characteristics (mean age=54 years; 76% women; mean weight=95 kg). Mean percent weight change from baseline was -2.8% and -0.2% among program participants and usual-care patients, respectively (mean diff: -2.6%; 95% CI: -2.9%,-2.3%; P<0.001). Clinically meaningful weight loss was observed in 28% and 15% of program participants and usual-care patients, respectively (odds ratio: 2.2; 95% CI: 2.0, 2.5; P<0.001).
Conclusion: In real-world clinical practice, a lifestyle change program was more effective than usual care in promoting weight loss, with more than a two-fold greater odds of clinically meaningful weight loss among program participants.
R. Romanelli: None. H. Huang: None. S. Sudat: None. A. Pressman: None. K.M. Azar: None.
National Institute of Diabetes and Digestive and Kidney Diseases