How Much Does Attendance Impact Weight Loss and Health Care Spending in a Diabetes Prevention Program Serving Older Adults?

PURPOSE: Measure attendance to the Young Men's Christian Association (YMCA) of the USA (Y-USA) diabetes prevention program (DPP) and show how attendance impacts weight loss and medical spending in a population of Medicare beneficiaries.

DESIGN: Observational study using a pre- and post-specification.

SETTING: A total of 17 participating YMCAs nationwide.

PARTICIPANTS: 3317 Medicare beneficiaries with prediabetes.

INTERVENTION: Community-based trainings of lifestyle intervention (National DPP).

MEASURES: We used weight measurements from the Y-USA DPP participants, and Medicare fee-for-service part A and B claims data (January 2011-December 2016) from Chronic Conditions Data Warehouse.

ANALYSIS: We used multivariate regression models to test the impact of class attendance on weight loss and Medicare expenditures.

RESULTS: From a maximum of 24 classes, participants on average attended 14 (standard deviation: 6). The relationship between attendance and both weight loss and savings were approximately linear. During each weekly class, participants lost an average of 0.72 (confidence interval [CI]: 0.67-0.77) pounds and saved on average $58 (CI: $38-78) in medical expenses per class attended.

CONCLUSIONS: Attendance to diabetes prevention programs is often challenging. To obtain both clinically relevant changes (weight loss greater than 5% of one's initial body weight) and economically relevant savings, completing at least 14 core sessions is essential. Steps to increase attendance and motivation across vulnerable groups may be an essential consideration for policymakers.