The DPP is Less Effective for Those with Mental Disease
The National
Diabetes Prevention Program (DPP), a key
component of diabetes preventive efforts over the
past ten years, effectively lowers the incidence
of diabetes. However, not a lot is known about how
well the DPP can treat people with prediabetes and
typical mental health issues like depression or
anxiety. Weight loss is a primary targeted outcome
in the DPP. So, a study
was done to determine if a virtually delivered DPP
would motivate weight loss in individuals with
prediabetes, obesity and mental health issues.
The study was carried out at Kaiser Permanente
Northwest (KPNW), a large integrated health care
organization that serves around 600,000 members in
southwest Washington and Oregon. All information
used in the analysis was gathered in the course of
administering healthcare as usual. And the
information was entered into the electronic health
record (EHR) system used by KPNW (Epic®).
Patients who met the following inclusion criteria
in the EHR were contacted in 2017 and invited to
participate in a digital DPP: they had to be current
KPNW health plan members, be between the ages of
65 and 75, have a BMI ≥30 kg/m2, have a HbA1c
between 5.7% and 6.4%, have never been diagnosed
with diabetes before, and have access to and be
actively using the electronic patient portal
(roughly 80% of all KPNW health plan members meet
this requirement). Through the patient portal, a
secure email message was delivered to eligible
patients with a special online link that allowed
them to sign up for the digital DPP at no cost to
themselves.
Utilizing a validated translation of the DPP
lifestyle intervention by the Centers for Disease
Control and Prevention (CDC), Omada Health offered
the digital DPP intervention to KPNW patients.
There were 3904 participants in the analysis, 472
enrollees in the DPP, and 3432 study participants
who were not enrolled in the DPP. At baseline,
about the same percentage of participants and
non-enrollees in the digital DPP had a mental
health diagnosis: 24.8% of enrollees and 22.8% of
non-enrollees. Additionally, there were no changes
in patient usage of psychiatric medications based on DPP
enrollment status (4.9% for participants and 6.5%
for non-enrollees).
The researchers concluded that having a mental
health diagnosis substantially lessened the effect
of the digital DPP on weight change for persons with
obesity, mental health issues and prediabetes.
There was no significant weight loss in DPP
participants who had mental health issues compared
to non-DPP enrollees. These results for digital
the DPP are broadly in line with other research that
evaluated DPP delivered via telephone and
in-person. Lastly, the researchers suggested that
the current DPP curriculum might need to be modified for
participants with mental health issues.
-------------------------------------------------------
