4. Discussion and conclusion
obesity, Obesity, T2D, Diabetes, weight loss, diabetes
OBESITY, DIABETES, OBESITY, DIABETES
The randomized control trial arm of our study demonstrated that two technology-enhanced diabetes prevention programs both led to modest reductions in body weight over an 18-month period. Most importantly, the DVD/IVR group showed significant reductions in BMI when compared to the SC group confirming our original hypothesis. However, there were no significant differences between Class/IVR and SC groups. Participants in the DVD/IVR group lost a mean 2.79 kg over 12 months with 26.9% of participants losing 5% or more of initial body weight in ITT analyses. These numbers improve for both technology-enhanced groups as the number of sessions attended increased.Our results support the findings of several recent reviews on technology mediated DPPs (When investigating the effects of eHealth obesity interventions, Hutchesson et al. (Taken altogether, our results support existing evidence on the effectiveness of technology mediated DPPs (Additionally, while not the original purpose of this study, results from this trial seem to indicate that both the DVD/IVR and the Class/IVR groups could meet CDC recognition standards (These are important findings when considering that several barriers to large scale implementation remain for technology enhanced DPPs (The present trial is not without limitations. First, study participants in the DVD/IVR group presented significantly higher BMI with a higher proportion being at Class III Obesity status at baseline. While we used randomization procedures, we did not stratify by BMI status. Nevertheless, we accounted for these initial differences by using baseline BMI values as control variable in our models. Second, we had an overall high attrition rate. As such, our results must be seen with caution as up to 38% of our participants did not complete follow-up assessments. These numbers were particularly higher among Class/IVR participants reaching 50% at 18 months. Nonetheless, we used Intent-to-treat analysis to include all participants with a baseline value in our models. When comparing with other studies, we also see similar attrition rates for weight loss programs in primary care (In closing, our findings show that a technology-enhanced diabetes prevention program was effective in reducing BMI at 6 months and maintaining these results at 12 and 18 months in a group of primary care patients at risk for developing T2D. The DiaBEAT-it interventions respond to the need for scalable, effective methods to manage obesity and prevent diabetes in primary care settings that do not over burden primary care clinics and providers. Further, the CDC requires the inclusion of a lifestyle coach in any in-person or technology-based program as one of the standards for recognition in its National Diabetes Prevention Program (