Article Title

What Factors Facilitate Weight Loss Among Medicaid Beneficiaries Participating in the Diabetes Prevention Program?

Publication Date



pragmatic trials, diabetes, health promotion, prevention, screening, Medicaid, SCHIP, incentives in health care


Background: The implementation of the Diabetes Prevention Program (DPP) with culturally diverse and low-income participants has had varied success. The We Can Prevent Diabetes study was a pragmatic three-arm cluster-randomized trial with Medicaid beneficiaries to evaluate the effectiveness of financial incentives on group-delivered DPP participation and weight loss. The purpose of this analysis is to identify participant and programmatic factors associated with 5% weight loss.

Methods: Among Medicaid participants attending at least 4 of the 16 DPP core sessions, we examined factors associated with 5% weight loss at any time during the DPP core session period or a sustained 5% weight loss over the 16 sessions. The latter was determined using a latent class trajectory analysis. Univariate associations with P < 0.2 were included in multivariable logistic models.

Results: Among the 658 Medicaid beneficiaries in our analysis, 23% met each of the two outcome measures, 62% were 45–64 years old, 72% were women, 82% were not white, 26% were non-English speakers (Spanish, Somali, Hmong), 76% were obese, 18% received DPP led by a community member as a lifestyle coach, and 68% were in a financial incentive intervention arm. After adjustment, attending 9 or more sessions (odds ratio: 5.7, 95% confidence interval: 2.6–12.7), reporting physical activity 9 or more times (2.9, 1.4–5.9) and being a non-English speaker (2.0, 1.2–3.7) were associated with achieving 5% weight loss at any time. Only the latter was associated with a sustained 5% weight loss (2.1, 1.3–3.6). After adjustment, allocation to a financial incentive arm was not associated with either of the 5% weight-loss metrics.

Conclusion: Session attendance and physical activity reporting may improve successful weight loss during the DPP. Non-English speaking participants had the most success in achieving a sustained 5% weight loss. This may be due to tailoring the DPP curriculum to the specific culture, and using members of the community as lifestyle coaches.




June 23rd, 2017


August 10th, 2017