Sutter Health Receives $3.2 Million Grant to Evaluate Type 2 Diabetes Prevention
Investment will help enhance and expand research efforts
PALO ALTO, Calif.—Sutter Health’s Palo Alto Medical Foundation Research Institute has secured funding from the National Institute for Diabetes, Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health to conduct a five-year study, evaluating the not-for-profit healthcare network’s experience with implementing Group Lifestyle Balance (GLB)™—a group-based diabetes prevention program that has gained national attention for its success.
According to the Centers for Disease Control and Prevention (CDC), many adults in the United States are at high risk for developing type 2 diabetes, including the 70 percent of overweight or obese Americans. Additionally, 86 million—or one in three—Americans have pre-diabetes. These sobering statistics signal the need for help. Additionally, the increasing challenges of diabetes and obesity in our society coincide with a dynamic time in U.S. healthcare: changing consumer demands, delivering more evidence-based care, improving health outcomes, and making care more affordable. However, little is known about the effectiveness of how these elements impact healthcare policies and programs. Research is needed to evaluate how well these changes in healthcare delivery work to improve how diabetes prevention and treatment is implemented and spread across communities.
Fortunately, the CDC-recognized GLB™, which focuses on promoting healthy lifestyle behaviors, was specifically designed for people who are pre-diabetic, a condition that can be reversed and consequently delay or prevent the onset of type 2 diabetes—a promising development in research.
The GLB™ program is based on the lifestyle intervention used in the Diabetes Prevention Program (DPP) and was developed by the University of Pittsburgh. The DPP was a major multi-center randomized clinical trial aimed at discovering whether modest weight loss through healthy dietary changes, behavior modification and increased physical activity, or treatment with an oral diabetes medication could delay or prevent the onset of diabetes. The study enrolled people who were overweight or obese and had glucose levels that were higher than normal but not high enough to be diagnosed with diabetes. The intensive, one-on-one lifestyle intervention reduced the risk of developing diabetes by 58 percent and medication management reduced the risk by 31 percent when compared to a placebo group (no lifestyle or medication intervention). (N Engl J Med 2002; 346:393-403). Due to its large success, the DPP lifestyle program was adapted for use in community settings by changing the intensive, one-on-one intervention to a facilitated, group-based intervention, GLB™. The adapted group-based program involves lessons, handouts, and other resources for participants battling the same issues, creating a sense of community. A trained diabetes educator leads each session, motivating all participants to meet their goals of eating right and increasing physical activity to achieve weight loss. There has been a large effort to integrate GLB and programs like it into clinics and healthcare settings with the goal of improving access and effectiveness for patients who would benefit most.
“The effects of the group work is nothing short of transformative,” said Sutter Health’s Kristen Azar, R.N., MSN, MPH who is a nurse researcher and principal investigator of the NIDDK-funded study along with Robert Romanelli, Ph.D. “For some participants, the combination of tools and teachings are foundational, but the camaraderie they develop forms a support network like no other. Their shared experiences can ultimately become shared successes but success may be influenced by many other factors that we hope to understand more fully through this work.” GLB™ first launched at Sutter Health in 2010, and has been adopted across 19 Sutter Health clinic sites—ranging all the way from Auburn to Watsonville. Despite wide-spread use of the GLB program in community and clinic settings, limited data are available on its implementation and clinical effectiveness in real-world settings.
The study, “Evaluation of a Lifestyle Intervention Adopted for Clinical Practice for Diabetes Prevention (ELEVATE-DP)”, seeks to identify important barriers and facilitators for program success and effectiveness for clinicians, administrators and patients by examining the similarities and differences in the way the program operates as well as patient outcomes over the years from those who have participated.
“Given the size and scope of this study, the potential for national impact is great, both clinically and financially,” said Walter “Buzz” Stewart, Ph.D., MPH, Sutter Health’s chief research officer. “Diabetes alone is a serious diagnosis, but it is also at the root of many other costly health issues that puts immense strain on individuals and the healthcare system as a whole.”
The mixed method approach of this study will combine data analysis from electronic health records as well as qualitative interviews, to assess the impact of the GLB™. The study hopes to inform not only Sutter Health practices, but also GLB™ programs implemented in similar large healthcare settings nationwide. Offering the GLB™ program in a clinical setting, rather than a community setting, may improve the reach and ultimate effectiveness of the program for the people who need it most. The Sutter Health researchers hope that by understanding the program and patient characteristics associated with participant success, the results of the study might provide an additional important contribution towards curbing the growing national diabetes epidemic.