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.
