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Population and need
The project serves adults who attend a neighborhood community center, many of whom have overweight or obesity and no regular primary care. The US Preventive Services Task Force (USPSTF, 2021) recommends screening adults aged 35 to 70 who have overweight or obesity for prediabetes and type 2 diabetes, and offering or referring people with prediabetes to effective preventive interventions (a B recommendation). It notes that about 13% of US adults have diabetes and 34.5% meet the criteria for prediabetes. The center and its participants are illustrative.
The evidence for lifestyle change
The Diabetes Prevention Program randomly assigned 3,234 adults with raised fasting and post-load glucose to placebo, metformin or an intensive lifestyle program. The lifestyle goals were at least 7% weight loss and at least 150 minutes of physical activity a week. Over an average of 2.8 years, diabetes developed in 11.0, 7.8 and 4.8 people per 100 person-years in the placebo, metformin and lifestyle groups. The lifestyle program cut the incidence by 58% compared with placebo, and metformin cut it by 31%. About 7 people needed to take part in the lifestyle program for three years to prevent one case of diabetes (Diabetes Prevention Program Research Group, 2002).
Goal and objectives
Goal: Reduce the risk of type 2 diabetes among center members with prediabetes.
- By week 4, 30 members aged 35 to 70 with overweight or obesity will have been screened, with consent, using the center's partner clinic.
- By week 26, enrolled participants will average at least 150 minutes of moderate activity a week, recorded in step or activity logs.
- By week 26, at least half of the participants will have lost 5% or more of their starting weight, working toward the program's 7% goal.
Program plan
| Component | Detail |
|---|---|
| Format | 16 weekly 1-hour group sessions, then monthly sessions to week 26 |
| Content | Healthy eating on a budget, reading food labels, building activity into the day, sleep and stress, and problem-solving setbacks |
| Activity | A 30-minute group walk after each session, and a chair-based option for people with joint pain |
| Support | Weekly weigh-ins in private, a text message check-in midweek, and referrals for glucose results that suggest diabetes |
| Partners | The partner clinic for screening and follow-up, and a local food bank for produce boxes |
Evaluation
- Process: number screened and enrolled, attendance at each session, and how many participants stay to week 26.
- Outcome: change in weight and weekly activity minutes, and repeat HbA1c at 12 months through the partner clinic.
- Satisfaction: a short survey at weeks 8 and 26 on what helped and what got in the way.
The nurse's role
The BSN nurse leads screening days, teaches sessions using teach-back, tracks outcomes and coordinates referrals. Because lifestyle programs work through habits built over months, the nurse plans for retention from the start: sessions at times that suit working adults, childcare during groups and quick follow-up when someone misses a week.
References
Diabetes Prevention Program Research Group. (2002). Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. New England Journal of Medicine, 346(6), 393–403. https://doi.org/10.1056/NEJMoa012512
US Preventive Services Task Force. (2021). Screening for prediabetes and type 2 diabetes: US Preventive Services Task Force recommendation statement. JAMA, 326(8), 736–743. https://doi.org/10.1001/jama.2021.12531
