The prevention of type 2 diabetes changed dramatically about two decades ago with the release of findings from the U.S. National Diabetes Prevention Program (National DPP). The landmark study found that weight loss through exercise and dietary changes—lifestyle interventions—was substantially more effective than medication for putting prediabetes into remission.
Many studies have been conducted since then looking at how to implement findings from the National DPP within communities, and how lifestyle interventions can be improved. It’s important for clinicians to understand the latest findings to better treat patients with prediabetes, said Hollie Raynor, PhD, RD, LDN, Associate Dean and Professor in the Department of Nutrition at the University of Tennessee.
Dr. Raynor will be joined by three other presenters during a symposium Maximizing Weight Loss Maintenance—Ingredients for the Secret Sauce, which begins at 8:00 a.m. CT Sunday, June 5, in La Nouvelle Orleans Ballroom C at the convention center. The symposium will also be livestreamed for virtual meeting attendees.
The Diabetes Prevention Program clinical research study revealed that a lifestyle intervention, which initially called for a loss of at least 7% of body weight and 150 minutes of exercise a week, was so much more successful at preventing the onset of type 2 diabetes than metformin that the study was ended early.
Subsequent studies found that, for some individuals, as little as 5% weight loss helped improve insulin resistance and could put prediabetes into remission. Dr. Raynor will review those findings and discuss optimal dietary strategies, physical activity goals, and the latest in counseling and behavior change approaches for patients with prediabetes and type 2 diabetes.
“Researchers have looked at what type of diet, beyond just calories and fat, is best,” she said. “Are there some diets that might be better for some people as compared to other types of people? Is there a different type of physical activity prescription that should be provided than what was in the original program? And what kind of counseling strategies are best to assist people in making changes in their diet and activity?”
Angela Forfia, Associate Director of Diabetes Education and Prevention at the Association of Diabetes Care & Education Specialists (ADCES), will present the public health perspective in her lecture Real-World Lessons and Application to Practice from the U.S. National Diabetes Prevention Program Experience.
About 10 years ago, ADCES partnered with the Centers for Disease Control and Prevention (CDC) to deliver lifestyle interventions to communities across the country by building upon an existing infrastructure of accredited diabetes self-management education and support programs. Alongside other organizations like the YMCA and the Black Women’s Health Imperative, ADCES helped transition diabetes prevention programs from costly one-on-one counseling sessions at research hospitals to small group interventions in more accessible health care and community settings.
Although diabetes prevention programs were expanding nationally, the CDC realized that many of the people most at risk for developing type 2 diabetes were not enrolling in them. In response, a greater emphasis was placed on getting Latinos, African Americans, men, and other priority populations to enroll while also expandeding programs into rural communities and urban neighborhoods. The CDC also set more realistic goals for patients. Forfia noted that the original DPP study revealed that each kilogram of weight loss (2.2 pounds) resulted in a 16% reduction in the incidence of type 2 diabetes.
“So you don’t actually have to get to some ideal mythical BMI to really reduce your risk of developing type 2 diabetes and other chronic conditions,” she said. “That’s one of the messages of the National DPP—that a small amount of weight loss can have some really big benefits, as can preventing further weight gain.
“These small and sustainable changes that are taught and conveyed within the DPP, by the lifestyle coach or by a community group, are more sustainable over time than large amounts of weight loss,” Forfia added.
ADCES’ goal now is to equip those in their network to train primary care providers to discuss diabetes prevention with patients, who can then be referred back to community-based organizations for follow-up.
“It starts with this really basic question: ‘Can I talk to you about your weight today?’” Forfia said.
Linda M. Delahanty, MS, RDN, Associate Professor of Medicine at Harvard Medical School, will discuss her own experiences with patients with prediabetes and type 2 diabetes, and the communication techniques and sample language that clinicians can use when implementing lifestyle interventions with patients.
“It’s one thing to know the factors associated with better weight loss and weight loss maintenance, and it’s another thing to implement them in a real-world practice setting,” said Delahanty, who is also Director of Nutrition and Behavioral Research and Director of the Path to Lifestyle Change Program at Massachusetts General Hospital Diabetes Center. She will provide sample phrases and messaging that clinicians can use to help patients build self-efficacy and maximize their results.
“I have done research on modifiable psychological and behavioral factors that are associated with weight loss and weight loss maintenance,” she said. “Some of the techniques, like motivational interviewing, have a structure and a framework for you. But then it’s what kind of language do you insert into that framework that makes a participant feel motivated to change the behavior?”
The session’s final speaker, Scott Kahan, MD, MPH, Director of the National Center for Weight & Wellness and faculty at Johns Hopkins Bloomberg School of Public Health, will review the evidence and best practices for pairing behavioral counseling and obesity pharmacotherapy.