Dose Matters: The Diabetes Prevention Program in Rural and Urban Montana

Objectives: To compare a 12- with a 16-week Diabetes Prevention Program, a national program to prevent type 2 diabetes and cardiovascular disease among high-risk patients, and to compare lifestyle change outcomes between rural telehealth and urban in-person participants by intervention dose.

Methodology: A 16-week face-to-face urban Diabetes Prevention Program was compared with a 12-week rural telehealth program. Pre- and post-program comparisons were made on average baseline body weight loss, dietary and physical activity goals met, and quality of life.

Results: Thirty-two urban and 91 rural participants enrolled in the program. A total of 10.4% of rural and 21.4% of urban participants lost more than 7% of their baseline body weight (p=.19). Nearly 19% of individuals who attended at least two-thirds of the sessions met the weight loss goal compared with 3.2% who attended fewer sessions. At 12 weeks, daily fat gram goals were met 48.7% and 50.4% of the time for the rural and urban groups, respectively (p=0.851).  Urban participants met physical activity goals (>150 minutes) 72.8% of the time as compared with 36.4% for rural participants (p < 0.01).  Rural participants reported improved quality of life (p<0.05) in feeling healthy, satisfaction, self-worth, social engagement, and approach to food.

Conclusions: The Diabetes Prevention Program can be successfully administered in 12 weeks to participants living in rural/frontier communities. Similar lifestyle change outcomes observed between rural and urban groups suggests telehealth technology may increase access to high-risk individuals for developing diabetes and cardiovascular disease in rural areas with limited healthcare resources.