Type 2 diabetes mellitus is one of the fastest growing public health problems in developed
and developing countries and imposes a large financial burden on health-care systems.
Preventing, delaying, and managing diabetes should be a priority for health-care systems.
Nationally, 38% of adults have prediabetes, with more than 80% of people with prediabetes
being unaware of their condition. In Maryland, an estimated 10.5% of adults report
prediabetes, and 33.7% of Baltimore City residents have obesity, an important risk factor for
prediabetes. There is racial disparity in obesity prevalence in the City, with obesity
prevalence at 22.2% among White, Non-Hispanic adults and 42.0% among Black, Non-Hispanic
adults. Several randomized controlled trials have successfully proven that an intensive
lifestyle intervention, like the one studied in the Diabetes Prevention Program, can delay
the onset of the progression from prediabetes to type 2 diabetes. These studies have shown a
decrease in relative risk of type 2 diabetes up to 60% by intensive lifestyle interventions.
The National Diabetes Prevention Program is a CDC-recognized yearlong lifestyle change
program that is based on these successful trials.
Type 2 diabetes is the leading cause of blindness, lower extremity amputations, and kidney
disease requiring dialysis. Diabetes and its complications are primary or secondary factors
in an estimated 9 percent of hospitalizations. According to the data from Maryland Behavioral
Risk Factor Surveillance System (BRFSS), 14.4% of Baltimore City adult residents and 26.9% of
residents aged 65 and older have diabetes, compared to 12.1% of adults statewide. The goals
of Diabetes Self-Management Training (DSMT) are to improve glycemic control and reduce the
risk of micro and macro-vascular complications as supported by numerous epidemiologic and
interventional studies.
Health inequities are present across the Baltimore Metropolitan region. In Baltimore City,
mortality rates from diabetes are almost twice as high for Black residents than for White
residents (44.5 vs 23.8 deaths per 100,000 population). The BMDRP aims to increase the
capacity of BMDRP hospitals and community partners to offer DPP and DSMT directly in
communities and will also increase the number of referrals into these programs. Wrap-around
services are critical elements of the BMDRP to mitigate the effects of poverty, food
insecurity, and transportation barriers. These services will support the success of
individuals in the target population and their ability to achieve diabetes prevention and
management goals which will support improved health outcomes.
Successful enrollment and completion of DPP has demonstrated reduced risk of developing type
2 diabetes for individuals with pre-diabetes. However, limited data exist on changes in body
composition and liver fat in individuals completing DPP. Individuals with pre-diabetes often
have obesity and non-alcoholic fatty liver disease. We will evaluate for changes in body fat
and liver fat in individuals completing the DPP program.