title: Prevention of type 2 diabetes in adults with impaired glucose tolerance: the European Diabetes Prevention RCT in Newcastle upon Tyne, UK The Healthy Living Partnerships to Prevent Diabetes study: 2-year outcomes of a randomized controlled trial. Prevention of Type 2 Diabetes by lifestyle intervention in an Australian primary health care setting: Greater Green Triangle (GGT) Diabetes Prevention Project Effects of lifestyle intervention and meal replacement on glycaemic and body-weight control in Chinese subjects with impaired glucose regulation: a 1-year randomised controlled trial. Translating the Diabetes Prevention Program into the community. The DEPLOY Pilot Study. The effect of medical nutrition therapy by a registered dietitian nutritionist in patients with prediabetes participating in a randomized controlled clinical research trial. Community-Based Translation of the Diabetes Prevention Program’s Lifestyle Intervention in an Underserved Latino Population A Randomized-Controlled, Pilot Intervention on Diabetes Prevention and Healthy Lifestyles in the New York City Korean Community Prevention of type 2 diabetes by lifestyle intervention: a Japanese trial in IGT males. Prevention of Type II diabetes in subjects with impaired glucose tolerance: the Diabetes Prevention Study (DPS) in Finland
  Study design and 1-year interim report on the feasibility of the lifestyle intervention programme Effects of lifestyle intervention in persons at risk for type 2 diabetes mellitus - results from a randomised, controlled trial One-Year Results of a Community-Based Translation of the Diabetes Prevention Program Randomized controlled trial of a new dietary education program to prevent type 2 diabetes in a high-risk group of Japanese male workers. Translating the Diabetes Prevention Program lifestyle intervention for weight loss into primary care: a randomized trial. Reach and Effectiveness of a Weight Loss Intervention in Patients With Prediabetes in Colorado The Finnish Diabetes Prevention Study (DPS): Lifestyle intervention and 3-year results on diet and physical activity. A randomized comparative effectiveness trial of using cable television to deliver diabetes prevention programming Prevention of type 2 diabetes in a primary healthcare setting: Three-year results of lifestyle intervention in Japanese subjects with impaired glucose tolerance Effects of Internet behavioral counseling on weight loss in adults at risk for type 2 diabetes: a randomized trial. Results of a pilot diabetes prevention intervention in East Harlem, New York City: Project HEED. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. Translating the Diabetes Prevention Program into an Online Social Network The InnvaDiab-DE-PLAN study: a randomised controlled trial with a culturally adapted education programme improved the risk profile for type 2 diabetes in Pakistani immigrant women. Preventing diabetes in primary care: a feasibility cluster randomized trial. Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: follow-up of the Finnish Diabetes Prevention Study Can the onset of type 2 diabetes be delayed by a group-based lifestyle intervention? A randomised control trial Long-term nutrition education reduces several risk factors for type 2 diabetes mellitus in Brazilians with impaired glucose tolerance. A lifestyle intervention to reduce Type 2 diabetes risk in Dutch primary care: 2.5-year results of a randomized controlled trial. Two-year weight-loss maintenance in primary care-based Diabetes Prevention Program lifestyle interventions Piloting a behavioral intervention delivered through interactive voice response telephone messages to promote weight loss in a pre-diabetic population. Translation of the Diabetes Prevention Program for diabetes risk reduction in Chinese immigrants in New York City. Change of body weight and lifestyle of persons at risk for diabetes after screening and counselling in pharmacies Implementing a diabetes prevention program in a rural African-American church. Effect of a lifestyle intervention on weight change in south Asian individuals in the UK at high risk of type 2 diabetes: a family-cluster randomised controlled trial. Lowering dietary glycaemic index through nutrition education among Malaysian women with a history of gestational diabetes mellitus. Predictors of lifestyle intervention outcome and dropout: the SLIM study The Live Well, Be Well study: a community-based, translational lifestyle program to lower diabetes risk factors in ethnic minority and lower-socioeconomic status adults. A Feasibility Study to Develop a Diabetes Prevention Program for Young Adults With Prediabetes by Using Digital Platforms and a Handheld Device A Trial of Simple versus Intensified Dietary Modification for Prevention of Progression to Diabetes Mellitus in Women with Impaired Glucose Tolerance Randomised controlled trial evaluating lifestyle interventions in people with impaired glucose tolerance. Consumer Preferences in Format and Type of Community-Based Weight Control Programs Erratum. Reduction in the Incidence of Type 2 Diabetes With the Mediterranean Diet: Results of the PREDIMED-Reus nutrition intervention randomized trial. Diabetes Care 2011;34:14–19 A Community-Based Diabetes Prevention Program Effectiveness of Prediabetes Nutrition Shared Medical Appointments Effect of a continuous diabetes lifestyle intervention program on male workers in Korea.
abstract: Abstract Background Diabetes prevalence is increasing . The Finnish Diabetes Prevention Study ( DPS ) showed a 58 % reduction in Type 2 Diabetes ( T2D ) incidence in adults with impaired glucose tolerance ( IGT ) . The European Diabetes Prevention Study ( EDIPS ) extends the DPS to different European population s , using the same study design . In the Newcastle arm of this study ( EDIPS-Newcastle ) , we tested the hypothesis that T2D can be prevented by lifestyle intervention and explored secondary outcomes in relation to diabetes incidence . Methods We recruited 102 participants ( 42 men and 60 women , mean age 57 years , mean BMI 34 kgm-2 ) with IGT to EDIPS-Newcastle and r and omised to Intervention and usual care Control groups .  The intervention included individual motivational interviewing aim ed at : weight reduction , increase in physical activity , fibre and carbohydrate intake and reduction of fat intake ( secondary outcomes ) . The primary outcome was diagnosis of T2D . Results Mean duration of follow-up was 3.1 years . T2D was diagnosed in 16 participants ( I = 5 , C = 11 ) . Absolute incidence of T2D was 32.7 per 1000 person-years in the Intervention-group and 67.1 per 1000 person-years in the Control-group . The overall incidence of diabetes was reduced by 55 % in the Intervention-group , compared with the Control-group : RR 0.45 ( 95%CI 0.2 to 1.2).Explanatory survival analysis of secondary outcomes showed that those who sustained beneficial changes for two or more years reduced their risk of developing T2D . Conclusion Our results are consistent with other diabetes prevention trials . This study was design ed as part of a larger study and although the sample size limits statistical significance , the results contribute to the evidence that T2D can be prevented by lifestyle changes in adults with IGT . In explanatory analysis small sustained beneficial changes in weight , physical activity or dietary factors were associated with reduction in T2D incidence . Trial Registration International St and ard R and omised Controlled Trial Number registry ( IS RCT N)Registry number : IS RCT N 15670600 http://www.controlled-trials.com/is rct n/ search .html?srch=15670600%26sort=3%26dir = BACKGROUND Since the Diabetes Prevention Project ( DPP ) demonstrated that lifestyle weight-loss interventions can reduce the incidence of diabetes by 58 % , several studies have translated the DPP methods to public health-friendly context s. Although these studies have demonstrated short-term effects , no study to date has examined the impact of a translated DPP intervention on blood glucose and adiposity beyond 12 months of follow-up . PURPOSE To examine the impact of a 24-month , community-based diabetes prevention program on fasting blood glucose , insulin , insulin resistance as well as body weight , waist circumference , and BMI in the second year of follow-up . DESIGN An RCT comparing a 24-month lifestyle weight-loss program ( LWL ) to an enhanced usual care condition ( UCC ) in participants with prediabetes ( fasting blood glucose=95 - 125 mg/dL ) . Data were collected in 2007 - 2011 ; analyses were conducted in 2011 - 2012 . SETTING / PARTICIPANTS 301 participants with prediabetes were r and omized ; 261 completed the study . The intervention was held in community-based sites . INTERVENTION The LWL program was led by community health workers and sought to induce 7 % weight loss at 6 months that would be maintained over time through decreased caloric intake and increased physical activity . The UCC received two visits with a registered dietitian and a monthly newsletter . MAIN OUTCOME MEASURES The main measures were fasting blood glucose , insulin , insulin resistance , body weight , waist circumference , and BMI . RESULTS Intent-to-treat analyses of between-group differences in the average of 18- and 24-month measures of outcomes ( controlling for baseline values ) revealed that the LWL participants experienced greater decreases in fasting glucose ( -4.35 mg/dL ) ; insulin ( -3.01 μU/ml ) ; insulin resistance ( -0.97 ) ; body weight ( -4.19 kg ) ; waist circumference ( -3.23 cm ) ; and BMI ( -1.40 ) , all p-values < 0.01 . CONCLUSIONS A diabetes prevention program administered through an existing community-based system and delivered by community health workers is effective at inducing significant long-term reductions in metabolic indicators and adiposity Background R and omised controlled trials demonstrate a 60 % reduction in  type 2 diabetes incidence through lifestyle modification programmes . The aim of this study is to determine whether such programmes are feasible in primary health care . Methods An intervention study including 237 individuals 40–75 years of age with moderate or high risk of developing type 2 diabetes . A structured group programme with six 90 minute sessions delivered during an eight month period by trained nurses in Australian primary health care in 2004–2006 . Main outcome measures taken at baseline , three , and 12 months included weight , height , waist circumference , fasting plasma glucose and lipids , plasma glucose two hours after oral glucose challenge , blood pressure , measures of psychological distress and general health outcomes . To test differences between baseline and follow-up , paired t-tests and Wilcoxon rank sum tests were performed . Results At twelve months participants ' mean weight reduced by 2.52 kg ( 95 % confidence interval 1.85 to 3.19 ) and waist circumference by 4.17 cm ( 3.48 to 4.87 ) . Mean fasting glucose reduced by 0.14 mmol/l ( 0.07 to 0.20 ) , plasma glucose two hours after oral glucose challenge by 0.58 mmol/l ( 0.36 to 0.79 ) , total cholesterol by 0.29 mmol/l ( 0.18 to 0.40 ) , low density lipoprotein cholesterol by 0.25 mmol/l ( 0.16 to 0.34 ) , triglycerides by 0.15 mmol/l ( 0.05 to 0.24 ) and diastolic blood pressure by 2.14 mmHg ( 0.94 to 3.33 ) . Significant improvements were also found in most psychological measures . Conclusion This study provides evidence that a type 2 diabetes prevention programme using lifestyle intervention is feasible in primary health care setting s , with reductions in risk factors approaching those observed in clinical trials . Trial NumberCurrent Controlled Trials IS RCT The purpose of the present study was to evaluate the impact of a lifestyle intervention programme , combined with a daily low-glycaemic index meal replacement , on body-weight and glycaemic control in subjects with impaired glucose regulation ( IGR ) . Subjects with IGR were r and omly assigned to an intervention group ( n 46 ) and a control group ( n 42 ) . Both groups received health counselling at baseline . The intervention group also received a daily meal replacement and intensive lifestyle intervention to promote healthy eating habits during the first 3 months of the study , and follow-up visits performed monthly until the end of the 1-year study . Outcome measurements included changes in plasma glucose , glycated Hb ( HbA1c ) , plasma lipids , body weight , blood pressure and body composition ( such as body fat mass and visceral fat area ) . The results showed that body-weight loss after 1 year was significant in the intervention group compared with the control group ( -1·8 ( SEM 0·35 ) v. -0·6 ( SEM 0·40 ) 2·5 kg , P<0·05 ) . The 2 h plasma glucose concentration decreased 1·24 mmol/l in the intervention group and increased 0·85 mmol/l in the control group ( P<0·05 ) compared with their baseline , respectively . A 5 kg body-weight loss at 1 year was associated with a decrease of 1·49 mmol/l in 2 h plasma glucose ( P<0·01 ) . The incidence of normal glucose regulation ( NGR ) in the two groups was significantly different ( P=0·001 ) . In conclusion , the combination of regular contact , lifestyle advice and meal replacement is beneficial in promoting IGR to NGR BACKGROUND The Diabetes Prevention Program ( DPP ) found that an intensive lifestyle intervention can reduce the development of diabetes by more than half in adults with prediabetes , but there is little information about the feasibility of offering such an intervention in community setting s. This study evaluated the delivery of a group-based DPP lifestyle intervention in partnership with the YMCA . METHODS This pilot cluster-r and omized trial was design ed to compare group-based DPP lifestyle intervention delivery by the YMCA to brief counseling alone ( control ) in adults who attended a diabetes risk-screening event at one of two semi-urban YMCA facilities and who had a BMI > or=24 kg/m2 , > or=2 diabetes risk factors , and a r and om capillary blood glucose of 110 - 199 mg/dL. Multivariate regression was used to compare between-group differences in changes in body weight , blood pressures , HbA1c , total cholesterol , and HDL-cholesterol after 6 and 12 months . RESULTS Among 92 participants , controls were more often women ( 61 % vs 50 % ) and of nonwhite race ( 29 % vs 7 % ) . After 6 months , body weight decreased by 6.0 % ( 95 % CI=4.7 , 7.3 ) in intervention participants and 2.0 % ( 95 % CI=0.6 , 3.3 ) in controls ( p<0.001 ; difference between groups ) . Intervention participants also had greater changes in total cholesterol ( -22 mg/dL vs + 6 mg/dL controls ; p<0.001 ) . These differences were sustained after 12 months , and adjustment for differences in race and gender did not alter these findings . With only two matched YMCA sites , it was not possible to adjust for potential clustering by site . CONCLUSIONS The YMCA may be a promising channel for wide-scale dissemination of a low-cost approach to lifestyle diabetes prevention BACKGROUND Prior studies have provided evidence that lifestyle change prevents or delays the occurrence of  type 2 diabetes mellitus . The challenge is to translate research evidence for type 2 diabetes mellitus prevention into health care setting s. OBJECTIVE We investigated the effect of medical nutrition therapy ( MNT ) compared with usual care on fasting plasma glucose values , glycated hemoglobin ( HbA1c ) , serum lipid levels , and Diabetes Risk Score , from baseline to the end of a 12-week intervention in overweight or obese adults with prediabetes . DESIGN Prospect i ve , r and omized , parallel group study of 76 adults with impaired fasting plasma glucose or an HbA1c of 5.7 % to 6.4 % , recruited between April 2010 and May 2011 who completed a 12-week intervention period . MAIN OUTCOME MEASURES The primary outcome measure was fasting plasma glucose . Secondary outcome measures were HbA1c , serum lipid levels , and Diabetes Risk Score . STATISTICAL ANALYSES A factorial repeated measures analysis of variance was used to make comparisons between the two groups ( the MNT and usual care groups ) and two measures of time ( baseline and 12 weeks postintervention ) . Data analysis was performed using the Statistical Package for the Social Sciences ( release 19.0 , 2010 , SPSS Inc ) . RESULTS There was a significant interaction for group assignment and HbA1c ( P=0.01 ) , with the MNT group experiencing significantly lower HbA1c levels than the usual care group ( 5.79 % vs 6.01 % ) after the 12-week intervention . There was a significant interaction for group assignment and Diabetes Risk Score ( P=0.001 ) . Diabetes Risk Score for the MNT group decreased from 17.54±3.69 to 15.31±3.79 compared with the usual care group score , which went from 17.23±4.69 to 16.83±4.73 . Regardless of group assignment , both groups experienced a reduction in total cholesterol ( P=0.01 ) and low-density lipoprotein cholesterol ( P=0.04 ) level . CONCLUSIONS The results demonstrate that individualized MNT is effective in decreasing HbA1c level in patients diagnosed with prediabetes Purpose The objective was to take prevention from the clinic to the community by including a high-risk group and working with the community to tailor , enhance , deliver , and evaluate a community-based version of the Diabetes Prevention Program ’s ( DPP ) clinic-based lifestyle intervention . Methods This was a nonr and omized prospect i ve study using a single-group design . Study eligibility included a screening glucose value in the normal to prediabetes range with no current diagnosis of diabetes , overweight , not pregnant nor planning to become pregnant during study period , aged 18 to 65 , Latino , living in the study target communities , and no reported medical restrictions related to the program goals . A total of 69 individuals participated . The Healthy Living Program ( HLP ) was based on the DPP ’s 1-year intensive lifestyle program , was tailored and enhanced for a Latino community , and was delivered by community health workers . Anthropometric and paper and pencil measures were administered to examine program outcome at 6 months and 12 months . Results In general , results indicate statistically significant improvements in anthropometrics and many behavioral outcomes , particularly at 6 months . Participants demonstrated forward movement through the stages of change during the program . Conclusions Results support the effectiveness of the intervention and show that delivery of the translated version of the DPP ’s lifestyle intervention in the community by community residents holds promise as one strategy to reach people at increased risk of developing diabetes . Use of this translation model , including collaboration with community health workers , offers diabetes educators an opportunity to extend their reach into underserved communities Asian Americans experience diabetes at a higher rate than non-Hispanic whites . Diabetes prevention programs using lifestyle interventions have been shown to produce beneficial results , yet there have been no culturally-tailored programs for diabetes prevention in the Korean community . We explore the impact and feasibility of a pilot Community Health Worker ( CHW ) intervention to improve health behaviors and promote diabetes prevention  among Korean Americans using a r and omized controlled trial . Between 2011 and 2012 , a total of 48 Korean Americans at risk for diabetes living in New York City ( NYC ) participated in the intervention . Participants were allocated to treatment or control groups . A community-based participatory research approach guided development of the intervention , which consisted of 6 workshops held by CHWs on diabetes prevention , nutrition , physical activity , diabetes complications , stress and family support , and access to health care . Changes over 6 months were examined for clinical measurements ( weight , BMI , waist circumference , blood pressure , glucose , and cholesterol ) ; health behaviors ( physical activity , nutrition , food behaviors , diabetes knowledge , self-efficacy , and mental health ) ; and health access ( insurance and self-reported health ) . In this small pilot study , changes were seen in weight , waist circumference , diastolic blood pressure , physical activity nutrition , diabetes knowledge , and mental health . Qualitative findings provide additional context ual information that inform ways in which CHWs may influence health outcomes . These findings demonstrate that a diabetes prevention program can be successful among a Korean American population in NYC , and important insight is provided for ways that programs can be tailored to meet the needs of vulnerable population Prevention of type 2 diabetes by intensive lifestyle intervention design ed to achieve and maintain ideal body weight was assessed in subjects with impaired glucose tolerance ( IGT ) . Male subjects with IGT recruited from health-screening examinees were r and omly assigned in a 4:1 ratio to a st and ard intervention group ( control group ) and intensive intervention group ( intervention group ) . The final numbers of subjects were 356 and 102 , respectively . The subjects in the control group and in the intervention group were advised to maintain body mass index ( BMI ) of < 24.0 kg/m2 and of < 22.0 kg/m2 , respectively , by diet and exercise . In the intervention group , detailed instructions on lifestyle were repeated every 3 - 4 months during hospital visits . Diabetes was judged to have developed when two or more consecutive fasting plasma glucose ( FPG ) values exceeded 140 mg/dl . A 100 g oral glucose tolerance test was performed every 6 months to detect improvement of glucose tolerance . The subjects were seen in an ordinary outpatient clinic . The cumulative 4-year incidence of diabetes was 9.3 % in the control group , versus 3.0 % in the intervention group , and the reduction in risk of diabetes was 67.4 % ( P < 0.001 ) . Body weight decreased by 0.39 kg in the control group and by 2.18 kg in the intervention group ( P < 0.001 ) . The control group was subclassified according to increase and decrease in body weight . The incidence of diabetes was positively correlated with the changes in body weight , and the improvement in glucose tolerance was negatively correlated . Subjects with higher FPG at baseline developed diabetes at a higher rate than those with lower FPG . Higher 2h plasma glucose values and higher BMI values at baseline were also associated with a higher incidence of diabetes , but the differences were not significant . Subjects with a low insulinogenic index ( DeltaIRI/DeltaPG 30 min after an oral glucose load ) developed diabetes at a significantly higher rate than those with a normal insulinogenic index . Comparison of the BMI data and incidence of diabetes in five diabetes prevention studies by lifestyle intervention revealed a linear correlation between the incidence of diabetes and the BMI values , with the exception of the DaQing Study . However , the slope of the reduction in incidence of diabetes in the intensive intervention groups was steeper than expected simply on the basis of the reduction of BMI , suggesting that the effect of lifestyle intervention can not be solely ascribed to the body weight reduction . We conclude that lifestyle intervention aim ed at achieving ideal body weight in men with IGT  is effective and can be conducted in an outpatient clinic setting Aims /hypothesis . The aim of the Diabetes Prevention Study is to assess the efficacy of an intensive diet-exercise programme in preventing or delaying  Type II ( non-insulin-dependent ) diabetes mellitus in subjects with impaired glucose tolerance , to evaluate the effects of the intervention programme on cardiovascular risk factors and to assess the determinants for the progression to diabetes in persons with impaired glucose tolerance . Methods . A total of 523 overweight subjects with impaired glucose tolerance ascertained by two oral glucose tolerance tests were r and omised to either a control or intervention group . The control subjects received general information at the start of the trial about the lifestyle changes necessary to prevent diabetes and about annual follow-up visits . The intervention subjects had seven sessions with a nutritionist during the first year and a visit every 3 months thereafter aim ed at reducing weight , the intake of saturated fat and increasing the intake of dietary fibre . Intervention subjects were also guided individually to increase their physical activity .  Results . During the first year , weight loss in the first 212 study subjects was 4.7 ± 5.5 vs 0.9 ± 4.1 kg in the intervention and control group , respectively ( p < 0.001 ) . The plasma glucose concentrations ( fasting : 5.9 ± 0.7 vs 6.4 ± 0.8 mmol/l , p < 0.001 ; and 2-h 7.8 ± 1.8 vs 8.5 ± 2.3 mmol/l , p < 0.05 ) were significantly lower in the intervention group after the first year of intervention . Favourable changes were also found in blood pressure , serum lipids and anthropometric indices in the intervention group . Conclusion /interpretation . The interim results show the efficacy and feasibility of the lifestyle intervention programme . [ Diabetologia ( 1999 ) 42 : 793–801 Background Lifestyle change is probably the most important single action to prevent type 2 diabetes mellitus . The purpose of this study was to assess the effects of a low-intensity individual lifestyle intervention by a physician and compare this to the same physician intervention combined with an interdisciplinary , group-based approach in a real-life setting . Methods The " Finnish Diabetes Risk score " ( FINDRISC ) was used by GPs to identify individuals at high risk . A r and omised , controlled design and an 18 month follow-up was used to assess the effect of individual lifestyle counselling by a physician ( individual physician group , ( IG ) ) every six months , with emphasis on diet and exercise , and compare this to the same individual lifestyle counselling combined with a group-based interdisciplinary program ( individual and interdisciplinary group , ( IIG ) ) provided over 16 weeks . Primary outcomes were changes in lifestyle indicated by weight reduction ≥ 5 % , improvement in exercise capacity as assessed by VO2 max and diet improvements according to the Smart Diet Score ( SDS ) . Results 213 participants ( 104 in the IG and 109 in the IIG group , 50 % women ) , with a mean age of 46 and mean body mass index 37 , were included ( inclusion rate > 91 % ) of whom 182 returned at follow-up ( drop-out rate 15 % ) . There were no significant differences in changes in lifestyle behaviours between the two groups . At baseline 57 % ( IG ) and 53 % ( IIG ) of participants had poor aerobic capacity and after intervention 35 % and 33 % , respectively , improved their aerobic capacity at least one metabolic equivalent . Unhealthy diets according to SDS were common in both groups at baseline , 61 % ( IG ) and 60 % ( IIG ) , but uncommon at follow-up , 17 % and 10 % , respectively . At least 5 % weight loss was achieved by 35 % ( IG ) and 28 % ( IIG ) . In the combined IG and IIG group , at least one primary outcome was achieved by 93 % while all primary outcomes were achieved by 6 % . Most successful was the 78 % reduction in the proportion of participants with unhealthy diet ( almost 50 % absolute reduction ) . Conclusion It is possible to achieve important lifestyle changes in persons at risk for type 2 diabetes with modest clinical efforts . Group intervention yields no additional effects . The design of the study , with high inclusion and low dropout rates , should make the results applicable to ordinary clinical setting s . Trial registration Clinical Trials.gov : OBJECTIVE Although the Diabetes Prevention Program ( DPP ) and the Finnish Diabetes Prevention Study ( FDPS ) demonstrated that weight loss from lifestyle change reduces type 2 diabetes incidence in patients with prediabetes , the translation into community setting s has been difficult . The objective of this study is to report the first-year results of a community-based translation of the DPP lifestyle weight loss ( LWL ) intervention on fasting glucose , insulin resistance , and adiposity . RESEARCH DESIGN AND METHODS We r and omly assigned 301 overweight and obese volunteers ( BMI 25–40 kg/m2 ) with fasting blood glucose values between 95 and 125 mg/dL to a group-based translation of the DPP LWL intervention administered through a diabetes education program ( DEP ) and delivered by community health workers ( CHWs ) or to an enhanced usual-care condition . CHWs were volunteers with well-controlled type 2 diabetes . A total of 42.5 % of participants were male , mean age was 57.9 years , 26 % were of a race/ethnicity other than white , and 80 % reported having an education beyond high school . The primary outcome is mean fasting glucose over 12 months of follow-up , adjusting for baseline glucose . RESULTS Compared with usual-care participants , LWL intervention participants experienced significantly greater decreases in blood glucose ( −4.3 vs. −0.4 mg/dL ; P < 0.001 ) , insulin ( −6.5 vs. −2.7 μU/mL ; P < 0.001 ) , homeostasis model assessment of insulin resistance ( −1.9 vs. −0.8 ; P < 0.001 ) , weight ( −7.1 vs. −1.4 kg ; P < 0.001 ) , BMI ( −2.1 vs. −0.3 kg/m2 ; P < 0.001 ) , and waist circumference ( −5.9 vs. −0.8 cm ; P < 0.001 ) . CONCLUSIONS This translation of the DPP intervention conducted in community setting s , administered through a DEP , and delivered by CHWs holds great promise for the prevention of diabetes by significantly decreasing glucose , insulin , and adiposity OBJECTIVE The aim of this study was to assess the effectiveness of a new dietary education ( NDE ) program in reducing plasma glucose ( PG ) levels in Japanese male workers at high risk for type 2 diabetes through a r and omized controlled trial . RESEARCH DESIGN AND METHODS We r and omly assigned 173 high-risk men ( mean age , 55 years ) to either the NDE or the  control ( conventional dietary education )  group . Each subject in the NDE group received two individualized interventions especially aim ed at reducing total energy intake at dinner by modifying dietary intake . The control group received conventional group counseling . An " overintake/underintake fraction " for total energy intake was used to measure the status of dietary intake . Our hypothesis was that the NDE group would have a 10 % decrease in 2-h PG 1 year after the start of the education . Outcome measures were compared with ANCOVA by adjusting for baseline values . RESULTS The NDE group had a significantly lower total energy intake at dinner and daily than the control group . The adjusted differences in changes from baseline in the absolute value of the ' overintake/underintake fraction ' were -15.3 % ( 95 % CI -24.6 to -6.0 % , P = 0.002 ) for dinner and -6.0 % ( -9.8 to -2.2 % , P = 0.002 ) for daily [ corrected ] . The NDE group had a decreased 2-h PG after 1 year , whereas that value was increased in the control group . The adjusted difference in the percent change of 2-h PG was significant ( -15.2 % , -22.0 to -8.4 % , P < 0.001 ) . CONCLUSIONS The NDE was shown to reduce glucose levels in high-risk subjects for type 2 diabetes BACKGROUND The Diabetes Prevention Program ( DPP ) lifestyle intervention reduced the incidence of type 2 diabetes mellitus ( DM ) among high-risk adults by 58 % , with weight loss as the dominant predictor . However , it has not been adequately translated into primary care . METHODS We evaluated 2 adapted DPP lifestyle interventions  among overweight or obese adults who were recruited from 1 primary care clinic and had pre-DM and /or metabolic syndrome . Participants were r and omized to ( 1 ) a coach-led group intervention ( n = 79 ) , ( 2 ) a self-directed DVD intervention ( n = 81 ) , or ( 3 ) usual care ( n = 81 ) . During a 3-month intensive intervention phase , the DPP-based behavioral weight-loss curriculum was delivered by lifestyle coach-led small groups or home-based DVD . During the maintenance phase , participants in both interventions received lifestyle change coaching and support remotely-through secure email within an electronic health record system and the American Heart Association Heart360 website for weight and physical activity goal setting and self-monitoring . The primary outcome was change in body mass index ( BMI ) ( calculated as weight in kilograms divided by height in meters squared ) from baseline to 15 months . RESULTS At baseline , participants had a mean ( SD ) age of 52.9 ( 10.6 ) years and a mean BMI of 32.0 ( 5.4 ) ; 47 % were female ; 78 % , non-Hispanic white ; and 17 % , Asian/Pacific Isl and er . At month 15 , the mean ± SE change in BMI from baseline was -2.2 ± 0.3 in the coach-led group vs -0.9 ± 0.3 in the usual care group ( P < .001 ) and -1.6 ± 0.3 in the self-directed group vs usual care ( P = .02 ) . The percentages of participants who achieved the 7 % DPP-based weight-loss goal were 37.0 % ( P = .003 ) and 35.9 % ( P = .004 ) in the coach-led and self-directed groups , respectively , vs 14.4 % in the usual care group . Both interventions also achieved greater net improvements in waist circumference and fasting plasma glucose level . CONCLUSION Proven effective in a primary care setting , the 2 DPP-based lifestyle interventions are readily scalable and exportable with potential for substantial clinical and public health impact . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00842426 Introduction Although lifestyle interventions are effective in delaying the onset of diabetes , translating these lessons to routine health care setting s remains a challenge . We investigated the effectiveness of a theory-based , brief , small-group weight loss intervention for diabetes prevention . A secondary purpose was to determine the potential reach of the intervention . Methods A total of 14,379 members of an integrated health care organization newly diagnosed with prediabetes were potentially eligible to participate in this matched cohort longitudinal study . Of this group , 1,030 attended a 90-minute , small-group session that targeted personal action planning for healthful eating , physical activity , and weight management . We accessed electronic medical records to select 1 to 2 controls ( matched on impaired fasting glucose measurement , sex , age , and body mass index ) for each member who attended the small-group session ( n = 760 ) . Weight change , as recorded in the medical record , was the primary outcome . Mixed models analyses were used to adjust for matching variables and covariates and to account for individual r and om effects over time . Results Small-group participants  lost significantly more weight than did their matched controls . A significantly higher proportion of small-group participants  lost at least 5 % of their body weight compared with controls . Conclusion A brief , small-group weight loss intervention was effective . However , it did not reach broadly into the population that was at risk for diabetes OBJECTIVE To describe the 1 ) lifestyle intervention used in the Finnish Diabetes Prevention Study , 2 ) short- and long-term changes in diet and exercise behavior , and 3 ) effect of the intervention on glucose and lipid metabolism . RESEARCH DESIGN AND METHODS There were 522 middle-aged , overweight subjects with impaired glucose tolerance who were r and omized to either a usual care control group or an intensive lifestyle intervention group .  The control group received general dietary and exercise advice at baseline and had an annual physician 's examination . The subjects in the intervention group received additional individualized dietary counseling from a nutritionist . They were also offered circuit-type resistance training sessions and advised to increase overall physical activity .  The intervention was the most intensive during the first year , followed by a maintenance period . The intervention goals were to reduce body weight , reduce dietary and saturated fat , and increase physical activity and dietary fiber . RESULTS The intervention group showed significantly greater improvement in each intervention goal . After 1 and 3 years , weight reductions were 4.5 and 3.5 kg in the intervention group and 1.0 and 0.9 kg in the control group , respectively . Measures of glycemia and lipemia improved more in the intervention group . CONCLUSIONS The intensive lifestyle intervention produced long-term beneficial changes in diet , physical activity , and clinical and biochemical parameters and reduced diabetes risk . This type of intervention is a feasible option to prevent type 2 diabetes and should be implemented in the primary health care system Objective To evaluate the use and effectiveness of two “ in-home ” strategies for delivering diabetes prevention programming using cable television . Methods An individually r and omized , two-arm intervention trial including adults with diabetes risk factors living in two US cities . Interventions involved a 16-session lifestyle intervention delivered via “ video-on-dem and ” cable television , offered alone versus in combination with web-based lifestyle support tools . Repeated measures longitudinal linear regression with imputation of missing observations was used to compare changes in body weight . Results A total of 306 individuals were r and omized and offered the interventions . After 5 months , 265 ( 87 % ) participants viewed at least 1 , and 110 ( 36 % ) viewed ≥9 of the video episodes . A total of 262 ( 86 % ) participants completed a 5-month weight measurement . In intention-to-treat analysis with imputation of missing observations , mean weight loss at 5 months for both treatment groups combined was 3.3 % ( 95 % CI 0.7 - 5.0 % ) , regardless of intervention participation ( with no differences between r and omized groups ( P = 0.19 ) ) , and was 4.9 % ( 95 % CI 2.1 - 6.5 % ) for participants who viewed ≥9 episodes . Conclusions In-home delivery of evidence -based diabetes prevention programming in a reality television format , offered with or without online behavioral support tools , can achieve modest weight losses consistent with past implementation studies of face-to-face programs using similar content Background A r and omized control trial was performed to test whether a lifestyle intervention program , carried out in a primary healthcare setting using existing re sources , can reduce the incidence of type 2 diabetes in Japanese with impaired glucose tolerance ( IGT ) . The results of 3 years ' intervention are summarized . Methods Through health checkups in communities and workplaces , 304 middle-aged IGT subjects with a mean body mass index ( BMI ) of 24.5 kg/m2 were recruited and r and omized to the intervention group or control group . The lifestyle intervention was carried out for 3 years by public health nurses using the curriculum and educational material s provided by the study group . Results After 1 year , the intervention had significantly improved body weight ( -1.5 ± 0.7 vs. -0.7 ± 2.5 kg in the control ; p = 0.023 ) and daily non-exercise leisure time energy expenditure ( 25 ± 113 vs. -3 ± 98 kcal ; p = 0.045 ) . Insulin sensitivity assessed by the Matsuda index was improved by the intervention during the 3 years . The 3-year cumulative incidence tended to be lower in the intervention group ( 14.8 % vs.8.2 % , log-rank test : p = 0.097 ) . In a sub- analysis for the subjects with a BMI > 22.5 kg/m2 , a significant reduction in the cumulative incidence was found ( p = 0.027 ) . Conclusions The present lifestyle intervention program using existing healthcare re sources is beneficial in preventing diabetes in Japanese with IGT . This has important implication s for primary healthcare-based diabetes prevention . Trial registration CONTEXT Weight loss programs on the Internet appear promising for short-term weight loss but have not been studied for weight loss in individuals at risk of type 2 diabetes ; thus , the longer-term efficacy is unknown . OBJECTIVE To compare the effects of an Internet weight loss program alone vs with the addition of behavioral counseling via e-mail provided for 1 year to individuals at risk of type 2 diabetes . DESIGN , SETTING , AND PARTICIPANTS A single-center r and omized controlled trial conducted from September 2001 to September 2002 in Providence , RI , of 92 overweight adults whose mean ( SD ) age was 48.5 ( 9.4 ) years and body mass index , 33.1 ( 3.8 ) . INTERVENTIONS Participants were r and omized to a basic Internet ( n = 46 ) or to an Internet plus behavioral e-counseling program ( n = 46 ) . Both groups received 1 face-to-face counseling session and the same core Internet programs and were instructed to su bmi t weekly weights . Participants in e-counseling su bmi tted calorie and exercise information and received weekly e-mail behavioral counseling and feedback from a counselor . MAIN OUTCOME MEASURES Measured weight and waist circumference at 0 and 12 months . RESULTS Intent-to-treat analyses showed the behavioral e-counseling group lost more mean ( SD ) weight at 12 months than the basic Internet group ( -4.4 [ 6.2 ] vs -2.0 [ 5.7 ] kg ; P = .04 ) , and had greater decreases in percentage of initial body weight ( 4.8 % vs 2.2 % ; P = .03 ) , body mass index ( -1.6 [ 2.2 ] vs -0.8 [ 2.1 ] ; P = .03 ) , and waist circumference ( -7.2 [ 7.5 ] vs -4.4 [ 5.7 ] cm ; P = .05 ) . CONCLUSION Adding e-mail counseling to a basic Internet weight loss intervention program significantly improved weight loss in adults at risk of diabetes OBJECTIVES Our community-academic partnership employed community-based participatory research to develop and pilot a simple , peer-led intervention to promote weight loss  , which can prevent diabetes and eliminate racial/ethnic disparities in incident diabetes among overweight adults with prediabetes . METHODS We recruited overweight adults at community sites , performed oral glucose tolerance testing to identify persons with blood glucose levels in the prediabetes range , and r and omized eligible people to a  peer-led lifestyle intervention group or delayed intervention  in 1 year . Outcomes , including weight , blood pressure , and health behaviors , were measured at baseline and 3 , 6 , and 12 months . RESULTS More than half of those tested ( 56 % , or 99 of 178 ) had prediabetes and enrolled in the study . Participants were predominantly Spanish-speaking , low-income , undereducated women . The intervention group lost significantly more weight than the control group and maintained weight loss at 12 months ( 7.2 versus 2.4 pounds ; P < .01 ) . One fourth ( 24 of 99 ) of participants progressed to diabetes . CONCLUSIONS In underserved minority communities , prediabetes prevalence may be higher than previously reported . Low-cost , community-based interventions can succeed in encouraging weight loss to prevent diabetes BACKGROUND Type 2 diabetes mellitus is increasingly common , primarily because of increases in the prevalence of a sedentary lifestyle and obesity . Whether type 2 diabetes can be prevented by interventions that affect the lifestyles of subjects at high risk for the disease is not known . METHODS We r and omly assigned 522 middle-aged , overweight subjects ( 172 men and 350 women ; mean age , 55 years ; mean body-mass index [ weight in kilograms divided by the square of the height in meters ] , 31 ) with impaired glucose tolerance to either the intervention group or the control group . Each subject in the intervention group received individualized counseling aim ed at reducing weight , total intake of fat , and intake of saturated fat and increasing intake of fiber and physical activity . An oral glucose-tolerance test was performed annually ; the diagnosis of diabetes was confirmed by a second test . The mean duration of follow-up was 3.2 years . RESULTS The mean ( + /-SD ) amount of weight lost between base line and the end of year 1 was 4.2+/-5.1 kg in the intervention group and 0.8+/-3.7 kg in the control group ; the net loss by the end of year 2 was 3.5+/-5.5 kg in the intervention group and 0.8+/-4.4 kg in the control group ( P<0.001 for both comparisons between the groups ) . The cumulative incidence of diabetes after four years was 11 percent ( 95 percent confidence interval , 6 to 15 percent ) in the intervention group and 23 percent ( 95 percent confidence interval , 17 to 29 percent ) in the control group . During the trial , the risk of diabetes was reduced by 58 percent ( P<0.001 ) in the intervention group . The reduction in the incidence of diabetes was directly associated with changes in lifestyle . CONCLUSIONS Type 2 diabetes can be prevented by changes in the lifestyles of high-risk subjects Purpose The purpose of this study was to evaluate the efficacy of Prevent , an online social network-based translation of the Diabetes Prevention Program ( DPP ) lifestyle intervention , against the Centers for Disease Control and Prevention ( CDC ) Diabetes Prevention and Recognition Program ( DPRP ) outcome st and ards and weight loss outcomes of other DPP translations . Methods Two hundred twenty participants previously diagnosed with prediabetes were recruited online and enrolled in Prevent , a DPP-based group lifestyle intervention that integrates a private online social network , weekly lessons , health coaching , and a wireless scale and pedometer . Participants underwent a core 16-week intensive lifestyle change intervention and were then offered to continue with a post-core lifestyle change maintenance intervention , with the entire intervention ( core plus post-core ) totaling 12 months . Results One hundred eighty-seven participants met inclusion criteria for the core program and achieved an average of 5.0 % and 4.8 % weight loss at 16 weeks and 12 months , respectively . They also had a 0.37 % reduction in their A1C level at final measurement . One hundred forty-four of these same participants also met inclusion criteria for the post-core program and achieved an average of 5.4 % and 5.2 % weight loss at 16 weeks and 12 months , respectively , and a 0.40 % reduction in A1C at final measurement . Conclusion Results indicate that Prevent meets CDC DPRP outcome st and ards for diabetes prevention programs and performs favorably to other DPP translations . Considering national initiatives to address the obesity and diabetes epidemics , online delivery platforms like Prevent offer an effective and scalable solution The objective of the present study was to explore whether a culturally adapted lifestyle education programme would improve the risk factor profile for type 2 diabetes ( T2D ) and the metabolic syndrome ( MetS ) among Pakistani immigrant women in Oslo , Norway . The r and omised controlled trial ( the InnvaDiab study ) , lasting 7 ± 1 months , comprised six educational sessions about blood glucose , physical activity and diet .  Participants ( age 25 - 62 years ) were r and omised into either a  control ( n 97 ) or an  intervention ( n 101 ) group . Primary outcome variables were fasting and 2 h blood glucose , and secondary outcome variables were fasting levels of insulin , C-peptide , lipids , glycated Hb , BMI , waist circumference and blood pressure , measured 1 - 3 weeks before and after the intervention . During the intervention period , the mean fasting blood glucose decreased by 0·16 ( 95 % CI -0·27 , -0·05 ) mmol/l in the intervention group , and remained unchanged in the control group ( difference between the groups , P=0·022 ) . Glucose concentration 2 h after the oral glucose tolerance test decreased by 0·53 ( 95 % CI -0·84 , -0·21 ) mmol/l in the intervention group , but not significantly more than in the control group . A larger reduction in fasting insulin was observed in the intervention group than in the control group ( between-group difference , P= 0·036 ) . Among the individuals who attended four or more of the educational sessions ( n 59 ) , we found a more pronounced decrease in serum TAG ( -0·1 ( 95 % CI -0·24 , 0·07 ) mmol/l ) and BMI ( -0·48 ( 95 % CI -0·78 , -0·18 ) kg/m² ) compared with the control group . During the intervention period , there was a significant increase in participants having the MetS in the control group ( from 41 to 57 % ) , which was not seen in the intervention group ( from 44 to 42 % ) . Participation in a culturally adapted education programme may improve risk factors for T2D and prevent the development of the MetS in Pakistani immigrant women OBJECTIVE To determine the feasibility of implementing a large-scale primary care-based diabetes prevention trial . METHODS A feasibility cluster r and omized controlled trial was conducted in British Columbia , Canada , amongst adults with prediabetes using the Facilitated Lifestyle Intervention Prescription ( FLIP ) vs. usual care . FLIP included lifestyle advice , a pedometer , and telephone support from a lifestyle facilitator for 6 months . Indicators of feasibility included recruitment rates of family practice s , participants and facilitators , as well as feasibility and retention rates in the FLIP program and study protocol s. RESULTS Six family practice s participated ; 59 patients were enrolled between October 2012 and March 2013 . The trial protocol was acceptable to practice s and participants and had a 95 % participant retention rate over the 6 months ( 56/59 ) . Adherence to the intervention was high ( 97 % ) , with 34 of 35 patients continuing to receive telephone calls from the facilitator for 6 months . The mean cost of the intervention was C$ 144 per person . Compared with control , intervention participants significantly reduced weight by 3.2 kg ( 95 % CI , 1.7 to 4.6 ) ; body mass index by 1.2 ( 95 % CI , 0.7 to 1.7 ) and waist circumference by 3 cm ( 95 % CI , 0.3 to 5.7 ) . CONCLUSIONS It is feasible to implement FLIP and to conduct a trial to assess effectiveness . A larger trial with longer follow up to assess progression to diabetes is warranted BACKGROUND Lifestyle interventions can prevent the deterioration of impaired glucose tolerance to manifest type 2 diabetes , at least as long as the intervention continues . In the extended follow-up of the Finnish Diabetes Prevention Study , we assessed the extent to which the originally-achieved lifestyle changes and risk reduction remain after discontinuation of active counselling . METHODS Overweight , middle-aged men ( n=172 ) and women ( n=350 ) with impaired glucose tolerance were r and omly assigned to intensive lifestyle intervention or control group . After a median of 4 years of active intervention period , participants who were still free of diabetes were further followed up for a median of 3 years , with median total follow-up of 7 years . Diabetes incidence , bodyweight , physical activity , and dietary intakes of fat , saturated fat , and fibre were measured . FINDINGS During the total follow-up , the incidence of type 2 diabetes was 4.3 and 7.4 per 100 person-years in the intervention and control group , respectively ( log-rank test p=0.0001 ) , indicating 43 % reduction in relative risk . The risk reduction was related to the success in achieving the intervention goals of weight loss , reduced intake of total and saturated fat and increased intake of dietary fibre , and increased physical activity . Beneficial lifestyle changes achieved by participants in the intervention group were maintained after the discontinuation of the intervention , and the corresponding incidence rates during the post-intervention follow-up were 4.6 and 7.2 ( p=0.0401 ) , indicating 36 % reduction in relative risk . INTERPRETATION Lifestyle intervention in people at high risk for type 2 diabetes result ed in sustained lifestyle changes and a reduction in diabetes incidence , which remained after the individual lifestyle counselling was stopped This study was a r and omised control trial with a waiting control group . It was design ed to evaluate the effectiveness of a 6-month , group-based diabetes prevention programme , The Healthy Living Course and assess whether participation in the programme led to changes in modifiable risk factors for type 2 diabetes among an already at-risk pre-diabetic population . Individuals design ated at risk for diabetes by their general practitioners ( GPs ) were screened using an Oral Glucose Tolerance Test . Volunteers ( N = 307 ) with pre-diabetes were assigned to an intervention or wait-control group in the ratio of approximately 2 : 1 . The sample was pre-tested on biochemical , anthropometric and self-report behavioural , cognitive and mood variables and post-tested either at the end of the educational/support-based lifestyle programme or the end of the wait period . The intervention group significantly improved their diabetes knowledge , motivation to change , positive affect , healthy eating and activity levels and showed significantly greater reductions in weight , body mass index , waist circumference , diastolic blood pressure and fasting plasma glucose in comparison with controls . The intervention group also changed their diagnostic status from pre-diabetes to non-diabetes at a greater rate than the wait group ( 43 % vs. 26 % ) who received st and ard care from their GPs The aim of this study was to evaluate the effects of a nutrition education program ( NEP ) on anthropometric , dietetic , and metabolic parameters in high-risk subjects for type 2 diabetes mellitus . Fifty-one participants , both sexes , were r and omly assigned to either the control ( 58.8 % ) or the intervention ( NEP ) group . The intervention group received frequent individual and group nutritional counseling from a team of nutritionists . Participants were assessed at baseline ( M0 ) and after 12 months ( M1 ) for anthropometric , dietetic , and metabolic parameters . The hypothesis was that high-risk subjects for type 2 diabetes mellitus participating in NEP would show an improvement in these parameters . At M1 , the intervention group showed a significant decline in body weight ( -3.4 % ) , body mass index ( -5.7 % ) , cholesterol intake ( -49.5 % ) , fasting glycemia ( -14.0 % ) , fasting insulin ( -9.0 % ) , postpr and ial glycemia ( -21.0 % ) , postpr and ial insulin ( -71.0 % ) , total serum cholesterol ( -23.0 % ) , and glycated hemoglobin ( -24.0 % ) . A decrease in energy intake ( 5 % , P = .06 ) and low-density lipoprotein cholesterol ( 25 % , P = .07 ) was observed in the interventional group , although it did not reach statistical significance . In contrast , the control group presented a significantly higher energy intake ( 19 % , P = .04 ) and a nonsignificant increase in consumption of all macronutrients . The long-term NEP was found to improve anthropometric , dietary , and metabolic parameters in high-risk subjects for type 2 diabetes mellitus AIMS To determine the effectiveness of a 2.5-year lifestyle intervention for Type 2 diabetes prevention in Dutch general practice compared with usual care . METHODS A r and omized controlled trial of 925 individuals at high risk for Type 2 diabetes ( FINDRISC-score ≥ 13 ) in 14 general practice s in the Netherl and s. Intervention consisted of lifestyle counselling from the nurse practitioner and the general practitioner . Usual care consisted of oral and written information at the start of the study . Study groups were compared over 2.5 years regarding changes in clinical and lifestyle measures . RESULTS Both groups showed modest changes in body weight , glucose concentrations , physical activity and dietary intake [ weight : intervention group , -0.8 ( 5.1 ) kg , usual care group , -0.4 ( 4.7 ) kg , ( P=0.69 ) ; fasting plasma glucose : intervention group , -0.17 ( 0.4 ) mmol/l , usual care group , -0.10 ( 0.5 ) mmol/l , ( P=0.10 ) ] . Differences between groups were significant only for total physical activity and fibre intake . In the intervention group , self-efficacy was significantly higher in individuals successful at losing weight compared with unsuccessful individuals . No significant differences in participant weight loss were found between general practitioners and nurse practitioners with different levels of motivation or self-efficacy . CONCLUSIONS Diabetes risk factors could significantly be reduced by lifestyle counselling in Dutch primary care . However , intervention effects above the effects attributable to usual care were modest . Higher participant self-efficacy seemed to facilitate weight loss . Lack of motivation or self-efficacy of professionals did not negatively influence participant guidance Objective : To investigate whether the effects on weight loss and cardiometabolic risk factor reduction of two technology-mediated lifestyle interventions for 15 months in a primary care-based translation trial sustained at 24 months ( that is , 9 months after the end of intervention ) . Design : This study analyzed data from an extended follow-up of participants in the original ‘ E-LITE ’ ( Evaluation of Lifestyle Interventions to Treat Elevated Cardiometabolic Risk in Primary Care)-r and omized controlled trial , which demonstrated the effectiveness of two adapted Diabetes Prevention Program ( DPP ) lifestyle interventions compared with usual primary care . Subjects : E-LITE r and omized 241 overweight or obese participants with pre-diabetes and /or metabolic syndrome to receive usual care alone  ( n=81 ) or usual care plus a coach-led ( n=79 ) or self-directed intervention ( n=81 ) . The interventions provided coach-led group behavioral weight-loss treatment or a take-home , self-directed DVD using the same 12-week curriculum , followed by 12 additional months of technology-mediated coach contact and self-monitoring support . Participants received no further intervention after month 15 . A blinded assessor conducted 24-month visits by following the measurement protocol s of the original trial . Measurements include weight and cardiometabolic risk factors ( waist circumference , fasting plasma glucose , resting blood pressure , triglycerides , high- and low-density lipoprotein cholesterol , total cholesterol and triglyceride to high-density lipoprotein cholesterol ratio ) . Results : At month 24 , mean±s.e . changes in body mass index ( trial primary outcome ) and weight ( kg ) from baseline were –1.9±0.3 ( P=0.001 ) and –5.4±0.9 ( P<0.001 ) in the coach-led intervention , and –1.6±0.3 ( P=0.03 ) and –4.5±0.9 ( P=0.001 ) in the self-directed intervention , compared with –0.9±0.3 and 2.4±0.9 in the usual care group . In addition , both interventions led to a greater percentage of participants maintaining ⩾7 % weight loss and sustained improvements in waist circumference and fasting plasma glucose levels than usual care . Conclusion : This study shows sustained benefits of the two primary care-based , technology-mediated DPP lifestyle interventions . The findings warrant replication in long-term studies involving diverse population OBJECTIVE To pilot test the feasibility and effectiveness of interactive voice response ( IVR ) calls targeting physical activity and healthful eating as strategies for weight loss for patients with pre-diabetes . METHODS Participants ( N=77 ) who engaged in a 90-min diabetes prevention class were r and omly assigned to receive IVR support targeting physical activity and nutrition weight loss strategies or to a no-contact control .  Physical activity , dietary intake , and body weight were assessed prior to and following the 3-month intervention . RESULTS Eighty-five percent of the intervention participants completed at least half of the intervention . Participants assigned to receive the intervention lost an average of 2.6 % of body weight during the 3 months while control participants lost an average of 1.6 % . To determine the effect of the calls when used we found that those who used the system lost approximately 3 % of body weight which approached significance when compared to controls ( p<.06 ) . CONCLUSION IVR holds promise for follow-up encounters with patients with pre-diabetes . PRACTICE IMPLICATION S IVR can be used to provide physical activity and nutrition counseling that can enhance the potential reach and effectiveness of health professionals working with patients who have diabetes while placing a minimal burden on financial re sources and staff time AIMS To evaluate the effectiveness and feasibility of implementing a linguistically and culturally tailored Diabetes Prevention Program among Chinese immigrants with prediabetes living in New York City . METHODS A total of 60 Chinese immigrants with prediabetes were r and omized into either a Diabetes Prevention Program lifestyle intervention ( n = 30 ) consisting of 12 bi-weekly core sessions and six monthly post-core sessions or the control intervention ( n = 30 ) , consisting of quarterly mailing of diabetes prevention information . Each Diabetes Prevention Program intervention session lasted 1.5 - 2 h and covered topics such as healthy eating , physical activity , stress reduction and problem-solving skills . Outcomes such as percent change in weight , BMI , and HbA1c concentration were assessed at baseline , 6 and 12 months . A mixed-effects linear regression was applied to test the intervention effect at months 6 and 12 . Data were collected in the period 2012 - 2013 and analysed in 2014 . RESULTS The participant attrition rate was < 5 % ( 2 out of 60 ) at 12 months . There was a significantly greater percent weight loss in the intervention group ( -3.5 vs. -0.1 % ; P = 0.0001 ) at 6 months , which was largely maintained at 12 months ( -3.3 vs. 0.3 % ; P = 0.0003 ) . CONCLUSIONS Participants in a Diabetes Prevention Program-based intervention achieved greater weight loss and improvements in HbA1c concentration than control participants . Evaluation of the Chinese Diabetes Prevention Program curriculum in a larger trial is warranted Objective To investigate the effects of pharmacy based counselling on changes in lifestyle and body weight . Methods Three months after screening a stratified sample of 3,800 r and omly chosen overweight persons were addressed with question naires . Half a year and 1 year later the assessment was repeated . St and ard counselling ( SC ; non-specific recommendations towards lifestyle ) , intensive counselling ( IC ; additional advice to reduce body weight ) and counselling for persons at high risk for type 2 diabetes ( HRC ; recommendation to contact a physician ) were compared . Results All counselling groups ( SC ; n = 557 , IC ; n = 568 , HRC ; n = 245 ) showed significant weight loss three months after screening ( 0.6–1.9 kg ) . A further weight reduction was observed at 1 year follow up ( 1.1–2.4 kg ) . The HRC group showed a higher percentage of weight loss than the IC or SC group after 3 months ( −2.25 % vs. −1.20 % and −0.67 % ; P < 0.001 ) and at 1 year of follow-up ( −2.74 % vs. −1.54 % and −1.29 % ; P < 0.01 ) . Lifestyle changes in physical activity and /or nutrition were reported by 81.2 % in the HRC group , 74.1 % in the IC group and 67.0 % in the SC group . Conclusion Immediate counselling in community pharmacies after screening for type 2 diabetes can result in significant lifestyle changes and weight loss in overweight individuals OBJECTIVES The purpose of this study was to determine the feasibility of implementing a diabetes prevention program ( DPP ) in a rural African-American church . METHODS A six-session DPP , modeled after the successful National Institutes of Health ( NIH ) DPP , was implemented in a rural African-American church . Adult members of the church identified as high risk for diabetes , based on results of a risk question naire , were screened with a fasting glucose . Persons with prediabetes , a fasting glucose of 100 - 125 mg/dL , participated in the six-session , Lifestyle Balance Church DPP . The primary outcomes were attendance rates and changes in fasting glucose , weight and body mass index measured at baseline , six- and 12-month follow-up . RESULTS Ninety-nine adult church members were screened for diabetes risk . Eleven had impaired fasting glucose .  Ten of 11 participated in the six-session intervention , for an attendance rate of 78 % . After the intervention and 12-month follow-up , there was a mean weight loss of 7.9 lbs and 10.6 lbs , respectively . CONCLUSIONS This pilot project suggests that a modified six-session DPP can be translated to a group format and successfully implemented in a church setting . Further r and omized studies are needed to determine the effectiveness of such an intervention BACKGROUND The susceptibility to type 2 diabetes of people of south Asian descent is established , but there is little trial-based evidence for interventions to tackle this problem . We assessed a weight control and physical activity intervention in south Asian individuals in the UK . METHODS We did this non-blinded trial in two National Health Service ( NHS ) regions in Scotl and ( UK ) . Between July 1 , 2007 , and Oct 31 , 2009 , we recruited men and women of Indian and Pakistani origin , aged 35 years or older , with waist circumference 90 cm or greater in men or 80 cm or greater in women , and with impaired glucose tolerance or impaired fasting glucose determined by oral glucose tolerance test . Families were r and omised ( using a r and om number generator program , with permuted blocks of r and om size , stratified by location [ Edinburgh or Glasgow ] , ethnic group [ Indian or Pakistani ] , and number of participants in the family [ one vs more than one ] ) to intervention or control . Participants in the same family were not r and omised separately . The intervention group received 15 visits from a dietitian over 3 years and the control group received four visits in the same period . The primary outcome was weight change at 3 years . Analysis was by modified intention to treat , excluding participants who died or were lost to follow-up . We used linear regression models to provide mean differences in baseline-adjusted weight at 3 years . This trial is registered , number IS RCT N25729565 . FINDINGS Of 1319 people who were screened with an oral glucose tolerance test , 196 ( 15 % ) had impaired glucose tolerance or impaired fasting glucose and 171 entered the trial . Participants were in 156 family clusters that were r and omised ( 78 families with 85 participants were allocated to intervention ; 78 families with 86 participants were allocated to control ) . 167 ( 98 % ) participants in 152 families completed the trial .  Mean weight loss in the intervention group was 1.13 kg ( SD 4.12 ) , compared with a mean weight gain of 0.51 kg ( 3.65 ) in the control group , an adjusted mean difference of -1.64 kg ( 95 % CI -2.83 to -0.44 ) . INTERPRETATION Modest , medium-term changes in weight are achievable as a component of lifestyle-change strategies , which might control or prevent adiposity-related diseases . FUNDING National Prevention Research Initiative , NHS Research and Development ; NHS National Services Scotl and ; NHS Health Scotl and INTRODUCTION Gestational diabetes mellitus ( GDM ) increases risks for type 2 diabetes and cardiovascular diseases . Low glycaemic index ( GI ) diets improve cardio-metabolic outcomes in insulin-resistant individuals . We examined the feasibility of lowering GI through GI-based-education among Asian post-GDM women . METHODS A 3-month investigation was carried out on 60 Malaysian women with a mean age of 31.0 + /- 4.5 years and a history of GDM . Subjects were r and omised into two groups : LGIE and CHDR . The CHDR group received conventional healthy dietary recommendations only . The LGIE group received GI based-education in addition to conventional healthy dietary recommendations . At baseline and after 3-months , dietary intake of energy and macronutrient intakes including GI diet and glycaemic load was assessed using 3-day food records .  Diabetes-Diet and GI-concept scores and physical activity levels were assessed using a question naire . Adherence to dietary instructions was measured at the end of 3 months . RESULTS At the end of 3 months , the LGIE group had significant reductions in energy intake ( 241.7 + /- 522.4Kcal , P = 0.037 , ES=0.463 ) , total carbohydrate ( 48.7 + /- 83.5 g , P = 0.010 , ES = 0.583 ) , GI ( 3.9 + /- 7.1 , P = 0.017 , ES = 0.549 ) and GL ( 39.0 + /- 55.3 , P = 0.003 , ES = 0.705 ) and significant increases in protein ( 3.7 + /- 5.4 g , 0.003 , ES = 0.685 ) and diet fibre ( 4.6 + /- 7.3 g , P = 0.06 ) . The CHDR group had a significant reduction in fat only ( 5.7 + /- 9.4 g , P = 0.006 , ES = 0.606 ) . There was a 30 % increase in GI-concept scores in the LGIE group ( p < 0.001 ) . Changes in GI-concept scores correlated significantly to the reduction in dietary GI ( r = -0.642 , P = 0.045 ) . Dietary adherence was comparable in both groups . CONCLUSION GI-education improves GI-concept knowledge and helps lower dietary glycaemic index among women with a history of GDM Background / Objectives : To evaluate the effect of a 4.1-year ( range 3–6 years ) lifestyle intervention according to general public health recommendations on glucose tolerance and dropout in a Dutch population with impaired glucose tolerance (IGT).Subjects/ Methods : In the Study on Lifestyle intervention and Impaired glucose tolerance Maastricht , 147 Caucasian IGT subjects were r and omized to an intervention group ( INT : n=74 ; 38 male , 36 female ) and control group ( CON : n=73 ; 37 male , 36 female ) . Annually , subjects underwent measurements of body weight , anthropometry , glucose tolerance ( oral glucose tolerance test ) , insulin resistance ( homeostasis model assessment -insulin resistance ) , maximal aerobic capacity ( VO2 max ) , blood lipids and blood pressure . INT received individual advice regarding a healthy diet and physical activity . Results : INT decreased their saturated fat intake , increased their carbohydrate intake ( P<0.05 ) and VO2 max ( P=0.04 ) compared with CON . Body weight did not change significantly ( P=0.20 ) between the groups . After an initial decrease , 2-h glucose levels overall increased in INT ( + 0.11 mmol/l ) , but significantly less than CON ( + 1.18 mmol/l ; P=0.04 ) . Diabetes incidence was lower in INT versus CON ( 30 versus 56 % , P=0.04 ) . Change in body weight was associated with change in 2-h glucose levels ( β=0.399 mmol/l per kg , P=0.02 ) . Dropouts had a lower aerobic fitness and socioeconomic status , and a higher body mass index ( BMI ) and 2-h glucose compared with non-dropouts . Conclusions : Prolonged feasible changes in diet and physical activity prevent deterioration of glucose tolerance and reduce diabetes risk . Low socioeconomic status , low aerobic fitness and high BMI and 2-h glucose are indicative of dropout to the program OBJECTIVES We evaluated a community-based , translational lifestyle program to reduce diabetes risk in lower-socioeconomic status ( SES ) and ethnic minority adults . METHODS Through an academic-public health department partnership , community-dwelling adults at risk for diabetes were r and omly assigned to individualized lifestyle counseling delivered primarily via telephone by health department counselors or a wait-list control group . Primary outcomes ( 6 and 12 months ) were fasting glucose level , triglycerides , high- and low-density lipoprotein cholesterol , weight , waist circumference , and systolic blood pressure . Secondary outcomes included diet , physical activity , and health-related quality of life . RESULTS Of the 230 participants , study retention was 92 % . The 6-month group differences for weight and triglycerides were significant . The intervention group lost 2 pounds more than did the control group ( P=.03 ) and had decreased triglyceride levels ( difference in change , 23 mg/dL ; P=.02 ) . At 6 months , the intervention group consumed 7.7 fewer grams per day of fat ( P=.05 ) and more fruits and vegetables ( P=.02 ) than did control participants . CONCLUSIONS Despite challenges design ing effective translational interventions for lower-SES and minority communities , this program modestly improved some diabetes risk factors . Thus , individualized , telephone-based models may be a promising alternative to group-based interventions Purpose The purpose of this pilot study was to examine the feasibility and preliminary efficacy of an age-specific diabetes prevention program in young adults with prediabetes . Methods A one-group pretest-posttest design was used . The inclusion criteria were age 18 to 29 years and the presence of prediabetes ( either impaired fasting glucose of 100 - 125 mg/dL [ 5.55 - 6.94 mmol/L ] or A1C of 5.7%-6.4 % ) . Fifteen participants were enrolled in the study . A technology-based lifestyle coaching program focused on diet and physical activity and incorporating a h and held device and digital platforms was developed and tested . Psychosocial factors ( health literacy , illness perception , self-efficacy , therapeutic efficacy ) based on social cognitive theory , changes in diet and physical activity , and cardiometabolic risk factors were assessed at baseline and week 12 after the intervention . A paired- sample s t test was performed to examine changes between baseline and postintervention on each psychosocial and physical variable . Results Participants ’ ( n = 13 completers ) mean age was 24.4 ± 2.2 years , 23.1 % were male , and 53.8 % were African American . Overall , the participants were satisfied with the intervention ( mean score , 4.15 on a 5-point , Likert-type scale ) . Between pre- and posttesting , mean body mass index and mean A1C decreased from 41.0 ± 7.3 kg/m2 and 6.0 ± 0.5 % to 40.1 ± 7.0 kg/m2 and 5.6 ± 0.5 % , respectively , whereas mean fasting glucose did not significantly change ( from 92.6 ± 11 to 97.6 ± 14.3 mg/dL [ 5.14 ± 0.61 to 5.42 ± 0.79 mmol/L ] ) . Conclusions The intervention result ed in reduced A1C and a trend toward decreased body mass index in obese sedentary young adults with prediabetes after 12 weeks . Further study through a r and omized clinical trial with a longer intervention period is warranted Summary : Women with impaired glucose tolerance are at high risk of developing noninsulin dependent diabetes mellitus ( NIDDM ) . The Mercy Hospital for Women has a long‐term follow‐up programme for women with gestational diabetes , which identifies many women with impaired glucose tolerance . Two hundred of these women were entered into a r and omized controlled trial of intensive versus routine dietary advice . Seven women were lost to follow‐up . The annual incidence rates of diabetes mellitus for the 2 groups were 6.1 % ( intervention ) and 7.3 % ( control ) , an incident rate ratio of 0.83 , 95 % confidence interval 0.47–1.48 , p = 0.50 . Overall , there was a return to normal glucose tolerance in 44 % of patients . Multivariate analysis showed that body mass index , fasting and 2‐hour plasma glucose levels at trial entry were significantly associated with an increased risk of diabetes mellitus . Impaired glucose tolerance is an important condition that should be treated with advice about lifestyle modification ( diet and /or exercise ) . We consider that future trials in the management of women with previous gestational diabetes who have impaired glucose tolerance should investigate the effect of pharmacological intervention in addition to diet and /or exercise , the latter providing a therapy that it would be unethical to exclude on the evidence presently available AIM To evaluate the effectiveness of lifestyle interventions in people with impaired glucose tolerance ( IGT ) . METHODS Participants with IGT ( n=78 ) , diagnosed on two consecutive oral glucose tolerance tests ( OGTTs ) , were r and omly assigned to a 2-year lifestyle intervention or to a control group . Main outcome measures were changes from baseline in : nutrient intake ; physical activity ; anthropometry , glucose tolerance and insulin sensitivity . Measurements were repeated at 6 , 12 and 24 months follow-up . RESULTS After 24 months follow-up , there was a significant fall in total fat consumption ( difference in change between groups ( Delta intervention-Delta control)= -17.9 , 95 % confidence interval ( CI ) -33.6 to -2.1g/day ) as a result of the intervention . Body mass was significantly lower in the intervention group compared with controls after 6 months ( -1.6 , 95 % CI -2.9 to -0.4 kg ) and 24 months ( -3.3 , 95 % CI -5.7 to -0.89 kg ) . Whole body insulin sensitivity , assessed by the short insulin tolerance test ( ITT ) , improved after 12 months in the intervention group ( 0.52 , 95 % CI 0.15 - 0.89%/min ) . CONCLUSIONS These findings complement the findings of the Finnish Diabetes Prevention Study and the American Diabetes Prevention Study , both of which tested intensive interventions , by showing that pragmatic lifestyle interventions result in improvements in obesity and whole body insulin sensitivity in individuals with IGT , without change in other cardiovascular risk factors Purpose . The purpose of this study was to provide further information about preferences for types and formats ( e.g. , correspondence vs. face to face ) of eating and exercise programs , actual participation rates in a variety of offered programs , and characteristics of program participants vs. non participants . Design . Over a 3-year period , a large sample of community volunteers was given the opportunity to participate in various forms of diet and exercise programs as part of a weight gain prevention study . Setting . The study was conducted at a university and three local health department sites . Subjects . Subjects in the study were 616 individuals participating in the Pound of Prevention study ( POP ) , a 3-year r and omized evaluation of an intervention for preventing weight gain.1 Measures . The primary outcomes assessed were participation rates for each program offering . Program participants were also compared to those who did not participate on demographic characteristics , smoking , diet behavior , exercise behavior , and weight concern . Results . Survey results indicated that correspondence formats for delivery of health education programs were rated as more desirable than face-to-face formats . Participation for program offerings ranged from 0 to 16 % of the study population . Participation data were consistent with survey results and showed participants ' preference for correspondence formats even more strongly . Program offerings attracted health-conscious participants with higher education and income levels . Conclusions . These data suggest that some community members will get interested and take part in low-cost , minimal contact programs for exercise and weight control . Future research efforts should focus on investigating ways to increase participation in brief or minimal contact programs , particularly among groups that may be difficult to reach and at high risk for the development of obesity Some slight departures from the protocol of individual r and omization affecting only a small subset of participants in the Prevencion con Dieta Mediterranea ( PREDIMED ) trial ( at most 14 % ) occurred and prompted a thorough re analysis of data and republication of the main PREDIMED paper ( see Estruch et al. , Primary prevention of cardiovascular disease with a  Mediterranean diet supplemented with extra-virgin olive oil or nuts . N Engl J Med 2018;378:e34 ) . The authors report the Purpose With growing numbers of people at risk for diabetes and cardiovascular disease , diabetes educators report increasing referrals for intervention in prevention of these conditions . Diabetes educators have expertise in diabetes self-management education ; however , they are generally not prepared for delivery of chronic disease primary prevention . The purpose of this project was to determine if individuals at risk for diabetes who participate in an intervention delivered by trained diabetes educators in existing diabetes self-management education community-based programs can reduce risk factors for diabetes and cardiovascular disease . Methods Diabetes educators in 3 outpatient-hospital programs ( urban , suburban , and rural ) received training and support for implementation of the Group Lifestyle Balance program , an adaptation of the Diabetes Prevention Program lifestyle intervention , from the Diabetes Prevention Support Center of the University of Pittsburgh . Adults with prediabetes and /or the metabolic syndrome were eligible to enroll in the program with physician referral . With use of existing diabetes educator networks , recruitment was completed via on-site physician in-services , informative letters , and e-mail contact as well as participant-directed newspaper advertisement . Results Eighty-one participants enrolled in the study ( 71 women , 10 men ) .  Mean overall weight loss was 11.3 lb ( 5.1 % , P < .001 ) ; in addition , significant decreases were noted in fasting plasma glucose , low-density lipoprotein cholesterol , triglycerides , and blood pressure . Conclusions These results suggest that the Group Lifestyle Balance program delivered by diabetes educators was successful in reducing risk for diabetes and cardiovascular disease in high-risk individuals . Furthermore , diabetes educators , already integrated within the existing health care system , provide yet another re source for delivery of primary prevention programs in the community Purpose The purpose of this study is to evaluate the effectiveness of a nutrition-based shared medical appointment ( SMA ) intervention in the treatment of prediabetes compared to the individualized counseling st and ard of care . Methods A r and omized controlled trial design comparing health outcomes in patients with prediabetes attending either an individualized counseling ( control group ) or three 90-minute nutrition SMA ( intervention group ) sessions .  Demographic , anthropometric ( weight and body mass index ) , clinical ( blood pressure ) , and biochemical ( lipid profile , fasting blood sugar , glycated hemoglobin , albumin-to-creatinine ratio ) measures were obtained from all participants at baseline , at 3 months , and at 1 year . Results Ninety-four participants were r and omized into the 2 study groups with a 69 % completion rate at 1 year ( n = 34 SMA , n = 31 control ) . The average participant was Caucasian ( 64 % ) , male ( 54 % ) , 58.3 ± 9.6 years , had a BMI of 30.8 ± 4.9 kg/m2 ( obese ) , and fasting blood glucose of 109 ± 9.5 mg/dL. The SMA and control participants lost a mean of 6.6 pounds and 3.6 pound , respectively ; neither group met the 5 % modest weight loss expected . The SMA and control group experienced a mean drop in fasting blood glucose of 6 mg/dL. Conclusions As dem and s on health care providers continue to rise , finding innovative ways to manage the patient load while providing quality health care is increasingly important . SMA health outcomes were equivalent to individual counseling outcomes , while increasing the provider ’s productivity by treating 6 to 8 people with prediabetes in 90 minutes compared to 1 patient in 60 minutes AIMS This study was conducted to compare the effects of two years of lifestyle intervention to no intervention or one year of intervention on diabetes risk factors in male workers with impaired fasting glucose ( IFG ) or diabetes . METHODS We conducted a r and omized lifestyle intervention trial design ed to alter personal lifestyles among 123 industrial male workers ( CG ; control group , n=75 ; OIG ; one-year intervention group , n=23 ; TIG ; two-year intervention group , n=25 ) . The intervention consisted of two parts , the main program ( face-to-face counseling five times/12 weeks ) and a follow-up program ( e-mail counseling ten times/30 weeks ) . Assessment s included biochemical characteristics , anthropometry and nutrient intake at baseline and after two years . RESULTS After two years , systolic blood pressure , HOMA-IR , HDL cholesterol and total energy intake ( p<0.05 ) were reduced in the OIG group , while weight , body mass index , waist circumference , blood pressure , fasting plasma glucose ( FPG ) , HbA1c and nutrient intake ( total energy , carbohydrate , protein and sodium ) were significantly decreased ( p<0.05 , respectively ) in the TIG group . When compared to the CG , subjects in OIG and TIG showed significant improvements in the level of FPG and HbA1c ( p<0.05 ) . CONCLUSIONS Continuous lifestyle intervention for two years is more effective at improving diabetes risk factors than OIG
target: The cost of intervention per participant delivered by dietitians was lower than interventions delivered by non-dietitians , although few studies reported costs .
  Lifestyle interventions are effective in reducing body weight and glucose-related outcomes .
  Dietitian-delivered interventions , compared with those delivered by other personnel , achieved greater weight reduction .
  No consistent trend was identified across different delivery channels
background: BACKGROUND Type 2 diabetes is a significant public health concern .
  With the completion of the Diabetes Prevention Program , there has been a proliferation of studies attempting to translate this evidence base into practice .
  However , the cost , effectiveness , and cost-effectiveness of these adapted interventions is unknown .
  OBJECTIVE The purpose of this systematic review was to conduct a comprehensive meta- analysis to synthesize the effectiveness , cost , and cost-effectiveness of lifestyle diabetes prevention interventions and compare effects by intervention delivery agent ( dietitian vs non-dietitian ) and channel ( in-person vs technology-delivered ) .