• Research Review
• Journal Review

Authors: L Vadheim, K Brewer, D Kassner, K Vanderwood, et al.

Reference: The Journal of Rural Health, 2010; 26(3):266-272
http://onlinelibrary.wiley.com/doi/10.1111/j.1748-0361.2010.00288.x/abstract

Reviewer: Carlos Mendoza Montano, PhD, ProCor contributing editor; President, Guatemalan Association for the Prevention of Heart Diseases (APRECOR), Guatemala City, Guatemala

Reviewer comments: Clinical trials in the US and other countries have demonstrated that weight loss achieved through increased physical activity and decreased fat and caloric intake can reduce the incidence of diabetes. In the US high-risk participants in the Diabetes Prevention Program (DPP) study receiving the lifestyle intervention had a 58% reduction in the incidence of diabetes. To date, few studies have been conducted to translate the DPP in rural communities. The current study implemented an adapted DPP lifestyle intervention in a rural community. This report describes the development and implementation of this program within a rural health care facility and the weight loss outcomes among participants at high risk for both diabetes and cardiovascular disease (CVD). The findings of the study suggest that despite a variety of barriers in a rural community, novel intervention strategies can be used to provide lifestyle recommendations and physical activity opportunities in rural communities.

Purpose of study: To evaluate the feasibility of translating the DPP lifestyle intervention into practice in a rural community.

Location of study: Montana, US

Study design: Adults at high risk for diabetes and CVD were recruited and enrolled. Participants set targets to reduce fat intake and increase physical activity (greater than or equal to 150 min/week) in order to achieve a 7% weight loss goal. The intervention site had two paid lifestyle coaches. In addition to teaching the curriculum, the lifestyle coaches provided demonstrations of fat content in common foods, tips about where to find nutrient rich foods and practical ways to determine correct portion sizes. The lifestyle coach with training in the exercise sciences taught the sessions specifically related to physical activity.

Results: Eighty-three percent (n = 84) of participants completed the 16-session core program and 65 (64%) participated in one or more after-core sessions. Approximately two-thirds of these participants had dyslipidemia, 44% had hypertension, and 13% had elevated blood glucose levels. Of those completing the core program, the mean participation was 14.4 and 3.9 sessions during the core and after core, respectively. 65% percent of participants met the 150-min-per-week physical activity goal during the core program. 62% percent achieved the 7% weight loss goal and 78% achieved at least a 5% weight loss during the core program. The average weight loss per participant was 7.5 kg, which was 7.5% of initial body weight. At the last recorded weight in the after core, 52% of participants had met the 7% weight loss goal and 66% had achieved at least a 5% weight loss.

Additional references:
W Knowler, E Barrett-Connor, S Fowler, R Hamman, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002; 346: 393-403 (open access). http://www.nejm.org/doi/pdf/10.1056/NEJMoa012512

R Ratner, R Goldberg, S Haffner, S Marcovina, et al. Diabetes Prevention Program Research Group. Impact of intensive lifestyle and metformin therapy on cardiovascular disease risk factors in the diabetes prevention program. Diabetes Care 2005; 28(4):888-894 (open access). http://care.diabetesjournals.org/content/28/4/888.full