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To evaluate whether knowledge of a personalized Diabetes Risk Score (DRS) improved performance in a 12-week lifestyle change program for prediabetes.Randomized subjects at four clinics provided samples for a DRS at baseline, 12, and 24 weeks. The intervention group received scores at each point, whereas the control group only received this information at 12 and 24 weeks. Outcomes included attendance and changes in weight, abdominal circumference, blood pressure, fasting glucose, hemoglobin A1c, cholesterol, and risk score.Baseline characteristics were similar in the groups (n = 192) and within risk-stratified subgroups. At 12 weeks, there were no differences in outcomes, with mean weight loss of 4.61 kg in the intervention group and 4.43 kg in the control group (p = 0.79). Both groups were given 12-week risk scores, with previously unseen baseline scores for the control group. The control group continued to lose additional weight (1.21 kg) by 24 weeks, whereas the intervention group regained previously lost weight (0.33 kg) (p = 0.04).The knowledge of a single baseline personalized DRS did not affect performance in a lifestyle modification program. However, the knowledge of an improvement in risk score, and the timing of this information, may impact further adherence.

M ore than 50,000 active-duty U.S. Air Force (USAF) service members, retirees, and family members with diabetes receive care at more than 50 military treatment facilities (MTFs) throughout the continental United States.1 Although many of these patients are referred to civilian network diabetes specialists because of a scarcity of military endocrinologists, most are managed by USAF primary care providers (PCPs). In an effort to assist PCPs in managing complex diabetes cases, a team from the USAF Diabetes Center of Excellence (DCOE) in San Antonio, Tex., adopted the Extension for Community Healthcare Outcomes (ECHO) model of care. The ECHO model of health care delivery was developed and implemented originally by Dr. Sanjeev Aurora and his team at the University of New Mexico2 to treat underserved patient populations with hepatitis C. The model uses technology, specifically video teleconferencing, to provide support to PCPs in remote areas who may lack the experience, knowledge, or confidence needed to manage this complex condition. Results demonstrated that patients treated remotely through ECHO experienced similar clinical improvement with fewer adverse events than those treated at the university specialty clinic. The University of New Mexico has adapted the ECHO model for ~ 20 other chronic illnesses, including diabetes. After training with the New Mexico team, DCOE endocrinologists and support personnel adapted the ECHO model to address the unique needs of military PCPs and their patients with diabetes. The USAF ECHO initiative was designed such that sessions, open to all military …

Lifestyle modification in prediabetic patients has been shown to decrease the risk of progression to Type 2 diabetes. However, lifestyle intervention programs have historically had high attrition rates.