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Article Title

What Factors Facilitate Weight Loss Among Medicaid Beneficiaries Participating in the Diabetes Prevention Program?

Publication Date

8-10-2017

Keywords

pragmatic trials, diabetes, health promotion, prevention, screening, Medicaid, SCHIP, incentives in health care

Abstract

Background: The implementation of the Diabetes Prevention Program (DPP) with culturally diverse and low-income participants has had varied success. The We Can Prevent Diabetes study was a pragmatic three-arm cluster-randomized trial with Medicaid beneficiaries to evaluate the effectiveness of financial incentives on group-delivered DPP participation and weight loss. The purpose of this analysis is to identify participant and programmatic factors associated with 5% weight loss.

Methods: Among Medicaid participants attending at least 4 of the 16 DPP core sessions, we examined factors associated with 5% weight loss at any time during the DPP core session period or a sustained 5% weight loss over the 16 sessions. The latter was determined using a latent class trajectory analysis. Univariate associations with P < 0.2 were included in multivariable logistic models.

Results: Among the 658 Medicaid beneficiaries in our analysis, 23% met each of the two outcome measures, 62% were 45–64 years old, 72% were women, 82% were not white, 26% were non-English speakers (Spanish, Somali, Hmong), 76% were obese, 18% received DPP led by a community member as a lifestyle coach, and 68% were in a financial incentive intervention arm. After adjustment, attending 9 or more sessions (odds ratio: 5.7, 95% confidence interval: 2.6–12.7), reporting physical activity 9 or more times (2.9, 1.4–5.9) and being a non-English speaker (2.0, 1.2–3.7) were associated with achieving 5% weight loss at any time. Only the latter was associated with a sustained 5% weight loss (2.1, 1.3–3.6). After adjustment, allocation to a financial incentive arm was not associated with either of the 5% weight-loss metrics.

Conclusion: Session attendance and physical activity reporting may improve successful weight loss during the DPP. Non-English speaking participants had the most success in achieving a sustained 5% weight loss. This may be due to tailoring the DPP curriculum to the specific culture, and using members of the community as lifestyle coaches.

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Submitted

June 23rd, 2017

Accepted

August 10th, 2017