Health Services Research & Development

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2017 HSR&D/QUERI National Conference Abstract

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1038 — Weight and Participation Outcomes in an Online Diabetes Prevention Program (DPP) for Veterans with Prediabetes

Lead/Presenter: Tannaz Moin, COIN - Los Angeles
All Authors: Moin T (VA HSR&D Center for Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles, California) Damschroder LJ (Ann Arbor VA Center for Clinical Management Research, Ann Arbor, Michigan) AuYoung M (Ann Arbor VA Center for Clinical Management Research, Ann Arbor, Michigan) Holleman R (Ann Arbor VA Center for Clinical Management Research, Ann Arbor, Michigan) Kim M (Ann Arbor VA Center for Clinical Management Research, Ann Arbor, Michigan) Richardson CR (Department of Family Medicine, University of Michigan and Ann Arbor VA Center for Clinical Management Research, Ann Arbor, Michigan)

Objectives:
One in four Veterans has Type 2 diabetes, thus diabetes prevention is a high priority. Between 2011-2016, the Diabetes Quality Enhancement Research Initiative (QUERI) and the VA National Center for Health Promotion and Disease Prevention (VA NCP) partnered to conduct two pragmatic evaluations to test the implementation of both an online and in-person DPP intervention for Veterans with prediabetes. The primary aim of the Online DPP Trial was to examine 6- and 12-month weight and participation outcomes among an intent-to-treat (ITT) cohort of online DPP enrollees. The secondary aim was to compare effectiveness of online DPP to in-person DPP and MOVE!, using an as-treated (AT) cohort of similarly motivated enrollees who had completed at least one module/session.

Methods:
Obese/overweight Veterans were recruited from 4 VHA Medical Centers with geographically and racially diverse populations. Demographic and weight data were extracted from the VA Corporate Data Warehouse; wireless scales provided objective weights for online DPP participants. Between-group and within-group weight change comparisons were estimated using linear mixed-effects models.

Results:
268 Veterans enrolled in the online DPP; 149 (56%) completed > 8 modules. ITT analyses included 242 participants; mean weight change (kg) was -4.7 (-6.5, -2.8) at 6 months and -4.0 (-4.9, -3.0) at 12 months. The secondary AT analyses of participants completing > 1 modules/sessions included 180 online DPP, 198 in-person DPP, and 64 MOVE! participants. Significantly more online DPP participants completed > 8 modules/sessions (87% vs. 57% in-person vs. 55% MOVE!, p < 0.001 for comparisons). Weight loss for online DPP participants was comparable to in-person DPP, but significantly higher than MOVE! (-5.9 vs. -2.0 at 6 months, -5.2 vs. -1.0, p < 0.001 for comparisons).

Implications:
A multifaceted online DPP intervention resulted in significant weight loss at 6 and 12 months. Furthermore, among online participants who completed > 1 modules/sessions, weight loss was comparable to in-person DPP but participation was significantly higher.

Impacts:
Multifaceted online DPP interventions may be effective in both expanding reach and participation of Veterans with prediabetes in an intensive lifestyle intervention. Online DPP is a promising strategy for effective translation of DPP with potential to significantly impact the health of many Veterans.