The National Diabetes Prevention Program in Rural Communities

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PROJECT SUMMARY Diabetes disproportionately impacts the 60 million individuals living in rural areas where the prevalence of Type 2 diabetes (T2D) is ~17% higher than in urban areas. The Centers for Disease Control and Prevention’s (CDC) National Diabetes Prevention Program (NDPP) which includes a minimum of 16 weekly core sessions over 6 mos. and 6 monthly maintenance sessions provides the framework for the prevention of T2D in the U.S. NDPP recognized programs are available in ~28% of U.S. counties; however, access to at least 1 NDPP recognized program is significantly lower in rural (2.6%) compared with urban areas (11.1%). The Cooperative State Research, Education and Extension Service, a partnership between the U.S Department of Agriculture, land-grant universities and county governments represents a potentially effective but underutilized site for delivery of NDPP to rural residents. However, evidence to support the effectiveness of the NDPP lifestyle intervention in rural adults with prediabetes defined by CDC criteria, with the intervention delivered by Cooperative Extension staff who have completed CDC approved training and using CDC recommendations for both program curriculum and meeting schedule is unavailable. Distance learning, e.g., group video using Zoom®, for delivery of NDPP is currently approved for CDC recognition. Remote delivery platforms provide a potentially cost-effective strategy for improving participation and retention, which are both important predictors of weight loss and reduced diabetes incidence in NDPP. The proposed 12-mo. Type II hybrid effectiveness- implementation trial will compare the effectiveness of the NDPP protocol delivered via distance learning by agents associated with Kansas State Research and Extension (KSRE) serving as a lifestyle coach (GV-NDPP) vs. a self-directed control arm (SD-NDPP) which will receive the NDPP curriculum on the same schedule used for the GV-NDPP arm delivered to individual participants via an iPad® with available lifestyle coach support. Ten KSRE local units/districts serving rural Kansas counties will be allocated to either active (n=5) or passive recruitment (n=5). Active recruitment will form collaborations with rural health clinics to identify potential participants using clinic electronic health records. Passive recruitment will use traditional recruitment techniques, e.g., flyers, email list serves, media advertising etc. Each of the 10 sites will recruit 16 adults with prediabetes defined using current NDPP criteria living in the county served by KSRE (n=160) who will be randomized (1:1) to one of the 2 intervention arms. Aim 1 will compare weight change between the GV-NDPP and SD-NDPP arms across 12 mos. Secondarily, we will compare the proportion of participants meeting CDC weight loss (≥5%) and physical activity goals (≥150 min./wk.), and changes in hemoglobin A1c across 12 mos. between intervention arms. Aim 2 will compare the effectiveness of passive and active recruitment. Aim 3 will compare the cost and cost effectiveness of delivery (GV-NDPP vs. SD-NDPP) and recruitment (passive vs. active) methods.