A description of the early phase of this intervention has been published previously, and the initial cohort of participants is included in this report (6
). In brief, the DPHHS funded eight health care facilities with recognized diabetes self-management education (DSME) programs beginning in 2008. Sites used trained health professionals as lifestyle coaches to provide the 16-session core followed by 6 monthly after core sessions (7
). DPHHS staff provided technical assistance, data collection and analyses, and evaluation.
Overweight (BMI ≥25 kg/m2) adults, with medical clearance from their referring provider and one or more of the following cardiovascular disease (CVD) and diabetes risk factors were eligible: a previous diagnosis of pre-diabetes; impaired glucose tolerance or impaired fasting glucose; high blood pressure (≥130/85 mmHg or treatment) or dyslipidemia (triglycerides >150 mg/dl, LDL cholesterol >130 mg/dl or treatment, or HDL cholesterol <40 mg/dl men and <50 mg/dl women); or a history of gestational diabetes mellitus or gave birth to a baby >9 pounds.
Height, weight, blood pressure, fasting blood glucose, and lipid values were collected at enrollment and at completion of the core and after core. Participants were weighed at the beginning of each session and submitted self-monitoring records. Participants were considered core completers if they did not drop out or miss three or more consecutive sessions and after core completers if they had completed follow-up laboratory measurements at 10 months.
Institutional review board approval was not required by the DPHHS because previous research established the safety and efficacy of the lifestyle intervention and only de-identified data were used for analyses.
Participant data were analyzed using SAS 9.1 (SAS Institute, Cary, NC). Baseline characteristics were compared among all enrolled participants and core and after core completers; t tests were used to compare continuous variables, and χ2 tests were used to compare dichotomous variables. We calculated the proportion of completers who met the physical activity goal of >150 min/week in the core and 5 and 7% weight loss in the core and after core. In the core and after core, the last observed weight of completers was used to calculate mean weight loss for those not attending the final session. Paired t tests were used to assess mean weight loss, and the mean systolic and diastolic blood pressure, HDL cholesterol, LDL cholesterol, and fasting blood glucose from baseline to the end of the core (4-month follow-up) and after core (10-month follow-up). Bonferroni correction was applied to the level of significance (α = 0.003) to control for the number of paired t tests calculated.