To assess participant-level results from the first 4 years of implementation of the National Diabetes Prevention Program (National DPP), a national effort to prevent type 2 diabetes in those at risk ...through structured lifestyle change programs.
Descriptive analysis was performed on data from 14,747 adults enrolled in year-long type 2 diabetes prevention programs during the period February 2012 through January 2016. Data on attendance, weight, and physical activity minutes were summarized and predictors of weight loss were examined using a mixed linear model. All analyses were performed using SAS 9.3.
Participants attended a median of 14 sessions over an average of 172 days in the program (median 134 days). Overall, 35.5% achieved the 5% weight loss goal (average weight loss 4.2%, median 3.1%). Participants reported a weekly average of 152 min of physical activity (median 128 min), with 41.8% meeting the physical activity goal of 150 min per week. For every additional session attended and every 30 min of activity reported, participants lost 0.3% of body weight (
< 0.0001).
During the first 4 years, the National DPP has achieved widespread implementation of the lifestyle change program to prevent type 2 diabetes, with promising early results. Greater duration and intensity of session attendance resulted in a higher percent of body weight loss overall and for subgroups. Focusing on retention may reduce disparities and improve overall program results. Further program expansion and investigation is needed to continue lowering the burden of type 2 diabetes nationally.
To assess retention in the National Diabetes Prevention Program (DPP) lifestyle change program, which seeks to prevent type 2 diabetes in adults at high risk.
We analyzed retention among 41,203 ...individuals who enrolled in Centers for Disease Control and Prevention (CDC)-recognized in-person lifestyle change programs at organizations that submitted data to CDC's Diabetes Prevention Recognition Program during January 2012-February 2017.
Weekly attrition rates were typically <1-2% but were between 3.5% and 5% at week 2 and at weeks 17 and 18, where session frequency typically transitions from weekly to monthly. The percentage of participants retained through 18 weeks varied by age (45.9% for 18-29 year olds, 53.4% for 30-44 year olds, 60.2% for 45-54 year olds, 66.7% for 55-64 year olds, and 67.6% for ≥65 year olds), race/ethnicity (70.5% for non-Hispanic whites, 60.5% for non-Hispanic blacks, 52.6% for Hispanics, and 50.6% for other), mean weekly percentage of body weight lost (41.0% for ≤0% lost, 66.2% for >0% to <0.25% lost, 72.9% for 0.25% to <0.5% lost, and 73.9% for ≥0.5% lost), and mean weekly physical activity minutes (12.8% for 0 min, 56.1% for >0 to <60 min, 74.8% for 60 to <150 min, and 82.8% for ≥150 min) but not by sex (63.0% for men and 63.1% for women).
Our results demonstrate the need to identify strategies to improve retention, especially among individuals who are younger or are members of racial/ethnic minority populations and among those who report less physical activity or less early weight loss. Strategies that address retention after the first session and during the transition from weekly to monthly sessions offer the greatest opportunity for impact.
The Centers for Disease Control and Prevention’s Diabetes Prevention Recognition Program (DPRP) has helped organizations deliver the National Diabetes Prevention Program (National DPP) lifestyle ...change program for over 10 years. Four delivery modes are now approved: in person, online (self-paced, asynchronous delivery), distance learning (remote, synchronous delivery), and combination (hybrid delivery using more than one delivery mode). We assessed outcomes using data from 333,715 participants who started the 12-month program between January 1, 2012, and December 31, 2018. The average number of sessions attended was highest for in-person participants (15.0), followed by online (12.9), distance learning (12.2), and combination (10.7). The average number of weeks in the program was highest for in-person participants (28.1), followed by distance learning (20.1), online (18.7), and combination (18.6). The average difference between the first and last reported weekly physical activity minutes reflected an increase for in person (42.0), distance learning (27.1), and combination (15.0), but a decrease for online (-19.8). Among participants retained through session 6 or longer, average weekly physical activity minutes exceeded the program goal of 150 for all delivery modes. Average weight loss (percent of body weight) was greater for in person (4.4%) and distance learning (4.7%) than for online (2.6%) or combination (2.9%). Average participant weight loss increased gradually by session for all delivery modes; among participants who remained in the program for 22 sessions, average weight loss exceeded the program goal of 5% for all delivery modes. In summary, if participants stay in the program, most have positive program outcomes regardless of delivery mode; they have some outcome improvement even if they leave early; and their outcomes improve more the longer they stay. This highlights the benefits of better retention and increased enrollment in the National DPP lifestyle change programs, as well as enhancements to online delivery.
In January 2020, the Department of Health and Human Services (HHS) declared the COVID-19 pandemic to be a public health emergency (PHE). As a result of this declaration, organizations delivering the ...National DPP lifestyle change program (LCP) had to decide whether to hold program sessions virtually, in socially distanced spaces, or discontinue (temporarily or permanently). This analysis looks at how CDC-recognized organizations chose to deliver, or not deliver, the LCP during this time. As of data submitted by October 2022, 1,810 organizations had delivered at least one session since 2019, the year leading up to the PHE. At the start of 2020, 1,370 organizations were active: 1,251 in-person, 28 online, 44 distance learning, and 47 combination. The remaining 440 were either approved during the PHE or had gone inactive before the start of it. Of those active at the start of 2020, 219 (16%) had not submitted data on sessions held on or after this time, indicating a pause in delivery. Since the PHE began, 373 new organizations have been approved, 357 of which are still active. Of these new organizations, 241 have been mainly focused on delivery with at least one virtual component. Approval of new organizations in 2020 decreased for those delivering in-person, whereas approval of new online, distance learning, and combination organizations increased by 207%, 158%, and 122%, respectively. Data submitted by in-person organizations in 2020 and 2021 indicated that many of them delivered only virtual sessions during that time, which might explain the large increases in approval of virtual organizations. New enrollment after the start of 2020 among these organizations was 185,596 as of October 2022: 62,217 in in-person organizations, 99,688 in online, 14,859 in distance learning, and 8,832 in combination. As we move out of the PHE, we are mindful of the need to help organizations delivering the LCP adapt to more flexible delivery to accommodate participants’ evolving needs.
Disclosure
E.Ely: None.
The National Diabetes Prevention Program is a partnership of public and private organizations working to build a nationwide delivery system for a lifestyle change program (LCP) to prevent or delay ...type 2 diabetes. Using data submitted to the Diabetes Prevention Recognition Program (DPRP), this study examines the impact of the COVID-19 public health emergency (PHE) on delivery of the LCP by looking at how adapting delivery from in-person to virtual allowed the 12-month intervention to continue. Participant start dates were categorized into 3 groups: 1) enrolled/concluded pre-PHE start, 2) enrolled pre-PHE start/concluded post-PHE start, and 3) enrolled/will conclude post-PHE start. As of October 2022, enrollment was at 658,385: 348,672 in group 1, 124,077 in group 2, and 185,636 in group 3. Mean reported weekly physical activity (PA) minutes and mean weight loss (WL) were calculated for each quarter of the LCP for each group. Despite the PHE causing abrupt changes in daily life, results show that participants whose time in the LCP overlapped or was entirely within the PHE, had strong PA and WL outcomes. Regardless of phase, participants who attended sessions in the 3rd quarter and the 4th quarter, on average, met programmatic goals of 150 PA minutes and 5% weight loss. These outcomes are indicative of lifestyle change, contributing to reducing the risk of developing type 2 diabetes.
Disclosure
E.Ely: None.
The aim of the US Centers for Disease Control and Prevention’s (CDC) National Diabetes Prevention Program (National DPP) is to make an evidence-based lifestyle change program widely available to the ...more than 88 million American adults at risk for developing type 2 diabetes. The National DPP allows for program delivery using four delivery modes: in person, online, distance learning, and combination. The objective of this study was to analyze cumulative enrollment in the National DPP by delivery mode. We included all participants who enrolled in CDC-recognized organizations delivering the lifestyle change program between January 1, 2012, and December 31, 2019, and whose data were submitted to CDC’s Diabetes Prevention Recognition Program. During this time, the number of participants who enrolled was 455,954. Enrollment, by delivery mode, was 166,691 for in-person; 269,004 for online; 4,786 for distance-learning; and 15,473 for combination. In-person organizations enrolled the lowest proportion of men (19.4%) and the highest proportions of non-Hispanic Black/African American (16.1%) and older (65+ years) participants (28.2%). Online organizations enrolled the highest proportions of men (27.1%), younger (18-44 years) participants (41.5%), and non-Hispanic White participants (70.3%). Distance-learning organizations enrolled the lowest proportion of Hispanic/Latino participants (9.0%). Combination organizations enrolled the highest proportions of Hispanic/Latino participants (37.3%) and participants who had obesity (84.1%). Most in-person participants enrolled in organizations classified as community-centered entities (41.4%) or medical providers (31.2%). Online and distance-learning participants were primarily enrolled (93.3% and 70.2%, respectively) in organizations classified as for-profit businesses or insurers. Participants in combination programs were enrolled almost exclusively in organizations classified as medical providers (89%). The National DPP has reached nearly half a million participants since its inception in 2012, but continued expansion is critical to stem the tide of type 2 diabetes among the many Americans at high risk.
This report presents urinary iodine (UI) concentrations for the general U.S. population during 2005-2006 and 2007-2008. These findings are the fourth and fifth assessments of the population since ...National Health and Nutrition Examination Survey (NHANES) III (1988-1994), when the median UI concentration for the population decreased from NHANES I (1971-1974).
During 2005-2006 and 2007-2008, ~ 5000 participants per year were selected to participate in NHANES. The participants were interviewed and examined. UI concentration was measured on a random one third subsample of 2649 participants, aged 6 years and older in 2005-2006, and in all participants in 2007-2008. These urine iodine concentrations are representative of the general U.S. population by age, sex, and race/ethnicity.
(i) The median UI concentrations for the general U.S. population in 2005-2006 and 2007-2008 were 164 mg/L (95% confidence interval CI 154-174) and 164 mg/L (95% CI 154-173), respectively. Also, the proportions of the population with a UI concentration of < 50 mg/L during these survey periods were 9.8% ± 1.3% and 8.8% ± 0.4%, respectively. The median UI concentration and prevalence of ≥ 200 mg/L appeared to be higher in children and persons ≥ 70 years than in other age groups. (ii) In both surveys, children aged 6-11 years had median UI concentrations of ≥ 200 mg/L, and about 5% of them had a UI concentration of < 50 mg/L. (iii) All pregnant women (sample size 184) surveyed during 2005-2008 had a median UI concentration of 125 mg/L (95% CI 86-198), and 56.9% ± 7.9% of this group had a UI concentration of < 150 mg/L. UI concentrations were lower among non-Hispanic black survey participants than non-Hispanic white and Mexican-American participants.
These findings affirm the stabilization of UI concentration and adequate iodine nutrition in the general U.S. population since 2000. However, certain groups likely do not achieve a sufficient dietary iodine intake according to the World Health Organization. The needs of these vulnerable groups and the inadequacy of their dietary iodine intake should be addressed in future efforts.
In 2010, Congress authorized the creation of the National Diabetes Prevention Program to build a nationwide delivery system for a lifestyle change program (LCP) proven to prevent or delay the onset ...of type 2 diabetes. In 2012, the Diabetes Prevention Recognition Program (DPRP) approved its first CDC-recognized organization. Over the last years, CDC has recognized ∼4000 organizations to deliver the LCP to 500,000+ participants. This analysis looks at the impact of changes to the DPRP national quality standards on participant outcomes. The initial version of the DPRP Standards covered the period 1/1/12-12/31/14. Later versions were released on 1/1/15, 3/1/18, and 5/1/21. Data for participants who entered the LCP during each version were analyzed with respect to enrollment, starting body mass index (BMI) , and % weight change. Enrollment during version 1 climbed to 24,614 based on in-person delivery. Version 2 introduced virtual delivery and enrollment reached 227,329. Version 3 reflected changes to accommodate the Medicare Diabetes Prevention Program. In-person enrollment increased 36% from 2018 to 2019, while online enrollment decreased over that period. Version 3 saw the public health emergency that caused most in-person enrollment to halt while organizations shifted to virtual platforms. In-person enrollment during 2020 ranged from a low of 763 in April to almost normal numbers of 2000+/month by September. Mean BMI was highest for those who started the LCP in 2012 (version 1) and 2021 (version 4) at 36.2 and 36, respectively. Those enrolled in organizations using combination (in-person + virtual) delivery had the highest mean BMI, regardless of version. Mean % weight loss for those who completed 9+ months of the LCP was highest during version 1 (6.3) . Version 3 produced the lowest at 5.2, which was also the mean % in 2020. The DPRP has endured program changes, as well as external factors. The evidence-based LCP continues to enroll participants looking to reduce their risk of developing type 2 diabetes.
Disclosure
E.Ely: None.
Alarm fatigue from frequent nonactionable physiologic monitor alarms is frequently named as a threat to patient safety.
To critically examine the available literature relevant to alarm fatigue.
...Articles published in English, Spanish, or French between January 1980 and April 2015 indexed in PubMed, Cumulative Index to Nursing and Allied Health Literature, Scopus, Cochrane Library, Google Scholar, and ClinicalTrials.gov.
Articles focused on hospital physiologic monitor alarms addressing any of the following: (1) the proportion of alarms that are actionable, (2) the relationship between alarm exposure and nurse response time, and (3) the effectiveness of interventions in reducing alarm frequency.
We extracted data on setting, collection methods, proportion of alarms determined to be actionable, nurse response time, and associations between interventions and alarm rates.
Our search produced 24 observational studies focused on alarm characteristics and response time and 8 studies evaluating interventions. Actionable alarm proportion ranged from <1% to 36% across a range of hospital settings. Two studies showed relationships between high alarm exposure and longer nurse response time. Most intervention studies included multiple components implemented simultaneously. Although studies varied widely, and many had high risk of bias, promising but still unproven interventions include widening alarm parameters, instituting alarm delays, and using disposable electrocardiographic wires or frequently changed electrocardiographic electrodes.
Physiologic monitor alarms are commonly nonactionable, and evidence supporting the concept of alarm fatigue is emerging. Several interventions have the potential to reduce alarms safely, but more rigorously designed studies with attention to possible unintended consequences are needed.
Measurement of Acute Pain in Infants Hatfield, Linda A.; Ely, Elizabeth A.
Biological research for nursing,
01/2015, Volume:
17, Issue:
1
Journal Article
Peer reviewed
Background:
The use of non-validated pain measurement tools to assess infant pain represents a serious iatrogenic threat to the developing neonatal nervous system. One partial explanation for this ...practice may be the contradictory empirical data from studies that use newborn pain management tools constructed for infants of different developmental stages or exposed to different environmental stressors.
Purpose:
The purpose of this review is to evaluate the evidence regarding the physiologic and behavioral variables that accurately assess and measure acute pain response in infants.
Methodology:
A literature search was conducted using PUBMED and CINAHL and the search terms infant, neonate/neonatal, newborn, pain, assessment, and measurement to identify peer-reviewed studies that examined the validity and reliability of behavioral and physiological variables used for investigation of infant pain. Ten articles were identified for critical review. Principal findings: Strong evidence supports the use of the behavioral variables of facial expressions and body movements and the physiologic variables of heart rate and oxygen saturation to assess acute pain in infants.
Conclusion:
It is incumbent upon researchers and clinical nurses to ensure the validity, reliability, and feasibility of pain measures, so that the outcomes of their investigations and interventions will be developmentally appropriate and effective pain management therapies.
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