Appendix C. What Is a Diabetes Prevention Program?
The YMCA Diabetes Prevention Program (YDPP) served as the community partner for this AHRQ-sponsored project. The YDPP is part of a National Diabetes Prevention Program led by the Centers for Disease Control and Prevention (CDC). The CDC program is intended to help communities offer evidence-based lifestyle-change programs for preventing type 2 diabetes.
Programming for YDPP s based on research conducted by the Diabetes Prevention Program Research Group led by the National Institutes of Health (NIH) and supported by the CDC. NIH trials have demonstrated that making modest behavior changes, such as improving food choices and increasing physical activity to at least 150 minutes per week, helped participants lose 5 percent to 7 percent of their body weight. These lifestyle changes reduced the risk of developing type 2 diabetes by 58 percent in people at high risk for diabetes.17-20
Participants in the YDPP work with a trained lifestyle coach in a group setting as part of a lifestyle change program that includes 16 core sessions (usually 1 per week) and 6 post-core sessions (1 per month). The sessions focus on healthy eating and increased physical activity with the goal of losing 5 percent to 7 percent body weight. Participants are given practical tools to help with everyday health changes, and sessions are often taught in a way that maximizes peer-to-peer learning. The DEPLOY study, described in detail below, served as the springboard for the current model offered in YMCAs across the country.
Overall, the National Diabetes Prevention Program (www.cdc.gov/diabetes/prevention) encourages collaboration among Federal agencies, community-based organizations, employers, insurers, health care professionals, academia, and other stakeholders to promote and sustain the program. The inaugural partners of the National Diabetes Prevention Program were the YMCA of the USA and the UnitedHealth Group. These partner organizations were instrumental in starting the national program and continue to expand the reach of evidence-based lifestyle programs.
DEPLOY and the YMCA's Diabetes Prevention Program
In 2008, the American Journal of Preventive Medicine published a study on the DEPLOY (Diabetes Education and Prevention With a Lifestyle Intervention Offered at the YMCA) project. The aim of the DEPLOY project was to test the feasibility of offering a community-based diabetes prevention program in partnership with the YMCA.
A randomized trial compared a group based intervention with a brief (2 to 5 minutes), one-time counseling session. Significant differences between the two groups were reported, in favor of the YMCA program. DEPLOY was a promising first step, particularly for cost savings. While the original diabetes prevention program research study cost more than $5,000 per participant (due to personalized counseling and incentives), the group-based DEPLOY model averaged less than $500 per participant with similar clinical results.17
The results from DEPLOY evolved into the current YMCA Diabetes Prevention Program, now accredited by the CDC, and partially funded by the CDC and UnitedHealthCare. Following the National Diabetes Prevention Program guidelines, the YMCA program is specifically designed for people with prediabetes according to the guidelines set by the American Diabetes Association. Individuals in the 4-month program meet in a group once a week for an hour at a time. A trained lifestyle coach facilitates participant learning around lifestyle changes through healthy eating, physical activity, and moderate weight loss. After the initial 16 sessions, participants meet monthly for an additional 4 months for added support during the maintenance phase. Program goals include reducing body weight by 7 percent and participation in 150 minutes of physical activity per week.
YMCA Diabetes Prevention Program courses are taught by trained laypersons rather than health care professionals, such as registered dieticians or exercise physiologists. However, the training is extremely thorough and focuses on helping individuals make decisions to change rather than offering information in a typical didactic style. YMCA Diabetes Prevention Program lifestyle coaches complete a 13-hour motivational interviewing course, "Listen First," and a 16-hour certification course based on the building blocks of the program. They are encouraged to take an additional 13-hour course, "Advanced Relationship Building," which focuses on goal setting and assessment of readiness to change.
The cost of the program (ydiabetes.org) varies by each independent YMCA. However, costs for the 16 weeks of core classes and 4 months of monthly maintenance sessions typically range from $99 to $149. Members receive a reduced rate, and nonmembers receive a YMCA membership for 16 weeks so they can use the exercise facilities while participating in the program. The YMCA also offers financial assistance for qualified individuals; part of the YMCA's overall mission is to never to turn anyone away due to inability to pay.