Patient-Centered Goal-Setting in the National Diabetes Prevention Program: A Pilot Study.

Abstract

Difficulty achieving preset goals (e.g., ≥5% weight loss, ≥150 min of weekly physical activity) in the yearlong National Diabetes Prevention Program (NDPP) can prompt dropout and diminish benefits. We piloted a more patient-centered NDPP adaptation (NDPP-Flex) that promotes a variety of attainable and individually tailored goals to reduce diabetes risks, along with flexibility to adjust goals each week as needed. Retention, physical activity, weight, and glycated hemoglobin (HbA_1c) were evaluated among diverse participants with diabetes risks who received our pilot of NDPP-Flex beginning in January and July 2018 (<i>n</i> = 95), with a planned comparison with standard NDPP delivery in preceding cohorts that launched between September 2016 and October 2017 (<i>n</i> = 245). Both the standard NDPP and NDPP-Flex interventions were 1 year in duration and implemented in phases (i.e., nonrandomized). Average adjusted retention (e.g., 158.90 ± 15.20 vs. 166.71 ± 9.38 days; <i>P</i> = 0.674), physical activity (157.97 ± 11.91 vs. 175.64 ± 7.54 weekly min; <i>P</i> = 0.231), and weight loss (1.46 ± 0.38% vs. 1.90 ± 0.24%; <i>P</i> = 0.396) were similar between NDPP-Flex versus standard NDPP. However, NDPP-Flex participants had greater HbA_1c reduction on average (0.22 ± 0.05% vs. 0.06 ± 0.03%; <i>P</i> = 0.018) and were more likely to have normoglycemia at follow-up (odds ratio 4.62; <i>P</i> = 0.013 [95% CI 1.38-15.50]) than participants in the standard NDPP. An adapted, more patient-centered NDPP that focuses on flexible, self-selected goals may be a promising strategy to improve glycemia even in the absence of substantial weight loss.