Ethnic and Racial Differences in Adoption of Evidence-based Diabetes Prevention Strategies and Weight Loss Outcomes in a Shared Decision-Making Intervention

Abstract Background: To promote health equity, interventions should achieve similar clinical outcomes among all subgroups. However, evidence from real-world Diabetes Prevention Program (DPP) translation studies suggests that adoption of diabetes prevention strategies and weight loss outcomes may vary by race and ethnicity.Methods: In this retrospective analysis, we examined adoption of diabetes prevention strategies and weight change outcomes among participants who received a shared decision making (SDM) intervention as part of the Prediabetes Informed Decisions and Education (PRIDE) study. We compared (1) uptake of DPP and/or metformin and (2) percent weight change at 12 months stratified by race/ethnicity using generalized linear mixed effects models. Results: SDM participants (n=515) were on average 56 years old (SD=11.0) with HbA1c 6.0% (SD=.20) and BMI of 30.3 (SD=5.2) who self-identified as non-Hispanic White (NHW) (39.2%), non-Hispanic Asian/Pacific Islander (NHAPI) (18.4%), Hispanic (16.7%), or non-Hispanic Black (NHB) (14.4%). There were no significant differences in adoption of DPP and/or metformin between racial/ethnic groups. NHB and Hispanic participants lost significantly less weight at 12 months as compared to NHW participants (-1.0% and -1.2%, respectively, vs. -3.3%, both comparisons p<.01). Conclusion: While adoption of evidence-based options for diabetes prevention did not vary, Hispanics and NHB lost significantly less weight than NHW at 12-months follow-up after SDM. Minority groups have a higher risk of type 2 diabetes and racial/ethnic disparities in weight change outcomes after adoption of diabetes prevention strategies can further compound risk. These findings have important implications for ongoing efforts to augment diabetes prevention and health equity nationally.