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RRP 12-440 – HSR&D Study

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RRP 12-440
VA Diabetes Prevention: Epidemiology of Pre-Diabetes and Implementation Pilot
Caroline R Richardson MD
VA Ann Arbor Healthcare System, Ann Arbor, MI
Ann Arbor, MI
Funding Period: November 2012 - October 2013

BACKGROUND/RATIONALE:
Type 2 diabetes is a preventable disease. Multiple large scale randomized controlled trials have shown that in people with impaired glucose tolerance, Type 2 diabetes can be prevented with lifestyle interventions that emphasize diet, exercise and weight loss. The Diabetes Prevention Program (DPP) showed that lifestyle interventions can reduce the incidence of type 2 diabetes by 58% in this high risk group. Little is known about the incidence of pre-diabetes in the VA because routine screening for pre-diabetes is not an established practice. With a few exceptions, lifestyle modification interventions that target individuals with pre-diabetes and follow the Diabetes Prevention Program curriculum are not available to Veterans in the VA. In order to address this gap in evidence based clinical services, the National Center for Health Promotion and Disease Prevention (NCP) has funded a VA Diabetes Prevention Program Demonstration Project (VA DPP) at 3 VA Medical Centers (Baltimore, Minneapolis, and Greater Los Angeles). NCP has requested assistance to conduct a more extensive implementation focused evaluation of VA DPP.

OBJECTIVE(S):
1. To identify baseline participant demographic characteristics: attitudes and beliefs about diet, exercise and weight loss: psychosocial constructs such as social support; and self-regulation skills that predict 6-month weight loss and program attendance. 2. To collect baseline survey data on hypothesized modifiable mediators of program impact on weight loss including outcome expectations, self-regulation, skill mastery, willingness to self-monitor, self-efficacy for use in subsequent analyses after 12-month survey data and to collect quality of life data to be used in future cost-effectiveness studies.

METHODS:
Baseline survey data was collected from Veterans eligible for the VA DPP from 3 Medical Centers across the country. All participants referred to the VA MOVE! program between August 2012 and December 2013 were evaluated for VA DPP eligibility and scheduled for a VA MOVE! orientation meeting. VA DPP-eligible Veterans were invited to complete the baseline survey after completing an informed consent process and signing a written informed consent document. Consented Veterans were provided with a copy of the surveys and stamped return envelope addressed to the Ann Arbor VA coordinating center. Instructions on the survey included a URL link to an online survey that can be used by Veterans who prefer to answer the survey online as opposed to taking the paper survey. The survey included a unique participant code that will be used to match survey data with clinical and administrative data by participant.

FINDINGS/RESULTS:
A total of 1577 Veterans were referred to MOVE! between August 2012 and December 2013 at three VA Medical Centers across the country and were screened for the VA DPP program. Among these, 378 Veterans were screened and eligible, based on eligibility criteria which included a Hemoglobin A1c value between 5.7 -6.4, consistent with the CDC criteria for pre-diabetes; a travel time to the VA Medical Center within 60 minutes; and not currently taking anti-glycemic medication. 275 Veterans were assigned to the DPP program, and 103 were assigned to the MOVE! program. Baseline surveys were completed by 197 participants (53%). General demographics on the respondents include a mean age of 59.3 years (+8.9) and 86.8% were male. 54.8% of respondents were White and 70.5% had attended some college or more. 54.3% of survey respondents indicated Good or better general health status and the mean number of comorbidities for respondents was 7.2(+1.7). Of the one hundred and ninety seven survey respondents, 89.9% said they were motivated to lose weight, 85.8% were motivated to exercise, and 87.3% were motivated to eat a healthy diet.
To our knowledge this is the first study to examine the prevalence of pre-diabetes among Veterans in multiple VA Medical Centers. The results of this project will contribute to the evidence base used by our partners at the VA National Center for Health Promotion and Disease Prevention (NCP) to develop and implement lifestyle interventions that reflect the need of Veterans. When baseline characteristics are examined with outcome measures at 12 months, the effectiveness of the VA DPP program will be further evaluated and characteristics that influence uptake of the program can be assessed. Our goal is to identify components of VA DPP that are not currently used in VA MOVE! and that enhance effectiveness. If the VA DPP is more effective than VA MOVE! for pre-diabetic Veterans, then NCP will incorporate these results into a national rollout of the program.

IMPACT:
The data obtained from VA Diabetes Prevention Program Demonstration Project (VA DPP) suggests that large-scale implementation of the Diabetes Prevention Program in the VA could yield significant population-level benefits. In collaboration with our Operations partners, this project is helping the VA to identify the prevalence of pre-diabetes among the Veteran population and determine the effect of lifestyle modification programs on Diabetes Prevention. This study collected baseline survey data from three medical centers on VA DPP participants and VA DPP-eligible VA MOVE! participants and identified baseline participant demographic characteristics; attitudes and beliefs about diet, exercise and weight loss, and psychosocial constructs such as social support; and self-regulation skills that predict weight loss and program attendance. The data collected has provided us with an insight into pre-diabetic Veterans' attitudes and beliefs about diet, exercise and weight loss, to our understanding of how different programs may impact weight loss, and to evidence-based targeting in future clinical implementation projects. It will also provide baseline quality of life data for use in a future cost-effectiveness analysis.

PUBLICATIONS:

Journal Articles

  1. Damschroder LJ, Reardon CM, AuYoung M, Moin T, Datta SK, Sparks JB, Maciejewski ML, Steinle NI, Weinreb JE, Hughes M, Pinault LF, Xiang XM, Billington C, Richardson CR. Implementation findings from a hybrid III implementation-effectiveness trial of the Diabetes Prevention Program (DPP) in the Veterans Health Administration (VHA). Implementation science : IS. 2017 Jul 26; 12(1):94.
  2. AuYoung M, Damschroder LJ, Kinsinger L, Moin T, Richardson CR. Practical partnered research to improve weight loss among overweight/obese veterans: lessons from the trenches. BMC medical research methodology. 2017 Mar 29; 17(1):50.
  3. Moin T, Damschroder LJ, AuYoung M, Maciejewski ML, Datta SK, Weinreb JE, Steinle NI, Billington C, Hughes M, Makki F, Holleman RG, Kim HM, Jeffreys AS, Kinsinger LS, Burns JA, Richardson CR. Diabetes Prevention Program Translation in the Veterans Health Administration. American journal of preventive medicine. 2017 Jul 1; 53(1):70-77.
VA Cyberseminars

  1. Damschroder LJ. Diabetes Prevention Program (DPP) Translation in VA. [Cyberseminar]. 2017 Jan 5.
Conference Presentations

  1. AuYoung M, Damschroder LJ, Hughes ME, Youles B, Holleman R, Richardson CR. Who Decides? Self-Selected versus Assigned Goals for Weight Loss in a Veteran Population. Paper presented at: Society of Behavioral Medicine Annual Meeting and Scientific Sessions; 2016 Mar 31; Washington, DC.
  2. Moin T, AuYoung M, Richardson CR, Damschroder LJ. Enhancing Diabetes Prevention Program Translation through Partnership: Key Lessons & Opportunities in Diverse Care Settings. Paper presented at: Society of Behavioral Medicine Annual Meeting and Scientific Sessions; 2016 Mar 31; Washington, DC.
  3. AuYoung M, Reardon C, Sparks J, Richardson CR, Damschroder LJ. What's Your Type? A Qualitative Analysis of Weight Loss Success by Weight Loss Archetype. Poster session presented at: Society of Behavioral Medicine Annual Meeting and Scientific Sessions; 2016 Mar 30; Washington, DC.
  4. Richardson CR, Damschroder LJ, Moin T. Implementing Diabetes Prevention in the VA - Results from a Clinical Demonstration Project. Paper presented at: Society of Behavioral Medicine Annual Meeting and Scientific Sessions; 2015 Apr 24; San Antonio, TX.
  5. Richardson CR. VA Diabetes Prevention Plan. Paper presented at: Case Western Reserve University Grand Rounds; 2015 Jan 21; Cleveland, OH.
  6. Moin T, Makki F, Weinreb JE, Steinle N, Billington CJ, Havens K, Yancy W, Maciejewski ML, Damschroder LJ, Richardson CR. The Burden of Pre-diabetes Among Overweight and Obese Veterans: Understanding Prevalence of Disease and Merits of Routine Screening. Poster session presented at: Michigan Center for Diabetes Translational Research Symposium; 2014 May 22; Ann Arbor, MI.


DRA: Diabetes and Related Disorders
DRE: Prevention
Keywords: QUERI Implementation
MeSH Terms: none