Individual-level outcomes
weight loss, T2DM
We will collect data at baseline, 6 months (by telephone), 12 months, and 24 months (a total of 3 in-person or virtual visits, plus a telephone visit) for participants in both the intervention and control arms of the evaluation. A baseline questionnaire was developed to ask participants about their risk awareness of T2DM and experience with preventative measures, as well as to assess patient activation and lifestyle choices around nutrition/physical activity. At the initial visit, the intervention participants will meet with pharmacists or registered nurses while the control participants will meet with research assistants. At 6 months, all participants will receive a telephone call from a research assistant to assess uptake of lifestyle change (yes/no) and/or uptake of metformin (yes/no). Attendance of a minimum of 9 of 16 weekly lifestyle change sessions will be the threshold for uptake of lifestyle change for both groups, as this reflects the CDC’s standard for DPP recognition from 2011 to 2020. Since some patients will not be able to tolerate metformin at the goal total daily dose of 2000 mg, we will encourage patients to take the maximum dose that they can tolerate and will count any metformin dose toward the yes/no outcome of “taking metformin.” We will backfill with EHR data on medication reconciliation as needed, since nurses and medical assistants at both systems verify and document current medications at each ambulatory and inpatient visit. At the 12-month and 24-month follow-ups, all participants will conduct an in-person or virtual follow-up visit with research assistants for weight measurement and follow-up surveys. The primary outcome (proportion of participants with ≥5% weight loss at 12 months) will be determined from weights recorded at study-related visits, but we will backfill missing weights from the EHR. We will include a variable in our analysis indicating whether weight was measured based on the patient’s home scale provided by the study or backfilled from the EHR. Additional outcomes are shown in 