• change in fasting glucose [ Time Frame: 6, 12, 18, and 24 months from randomization ] [ Designated as safety issue: No ]
  

• Weight Loss [ Time Frame: 6, 12, 18, and 24 months from randomization ] [ Designated as safety issue: No ]
  
• waist circumference [ Time Frame: 6, 12 and 24 months from randomization ] [ Designated as safety issue: No ]
  

Social forces have promoted adverse behavioral patterns with respect to physical activity and nutrition resulting in the current epidemics of obesity, the metabolic syndrome and type 2 diabetes mellitus (DM). Unchecked, the human toll of these conditions will be staggering over the coming decades, especially in ethnic groups that are disproportionately affected, thereby contributing to health disparities. Results from clinical trials such as the Diabetes Prevention Program (DPP) have demonstrated a significant potential for prevention of type 2 DM through lifestyle interventions to promote physical activity, a healthy eating pattern and weight loss. Yet these approaches are not being applied in practice. In fact, whether these approaches can be successfully implemented in the community is an unanswered question. This project will address this critical gap in knowledge. The overall goal will be to create a Healthy Living Partnership to Prevent Diabetes (HELP Prevent Diabetes) in the community setting. This project will incorporate several key translations of prior research to enhance logistical and fiscal feasibility and long term dissemination: 1) case finding of persons at risk of diabetes based on adiposity and fasting glucose, rather than results from an oral glucose tolerance test, 2) the use of a group-based, rather than an individual-based, intensive lifestyle behavioral intervention employing professional and lay health counselors (LHCs), and 3) delivery of the intervention in the community setting via innovative expansion of an existing Diabetes Education Program (DEP) in collaboration with LHCs as empowered community partners. DEPs are logical potential homes for the expertise needed to establish community-based diabetes prevention programs, as DEPs have demonstrated effectiveness for improving the quality of care for patients with type 2 DM, are available in many communities, and have personnel with expertise in lifestyle interventions regarding physical activity and diet. If the planned approach is successful, health care policies could be implemented to provide for the reimbursement of community-based diabetes prevention program services, as is currently the case for DEP services. A program delivered through a collaborative effort between DEPs, LHCs, primary care sites providing care to the underserved, and local public health agencies may be the most promising strategy for reaching out to underserved and minority populations at risk for developing type 2 DM.