The Diabetes Prevention Program (DPP)
The purpose of the present article is to provide a detailed description of the highly successful lifestyle intervention administered to 1,079 participants, which included 45% racial and ethnic minorities and resulted in a 58% reduction in the incidence rate of diabetes. The two major goals of the Diabetes Prevention Program (DPP) lifestyle intervention were a minimum of 7% weight loss/weight maintenance and a minimum of 150 min of physical activity similar in intensity to brisk walking. Both goals were hypothesized to be feasible, safe, and effective based on previous clinical trials in other countries. The methods used to achieve these lifestyle goals include the following key features: 1) individual case managers or "lifestyle coaches;" 2) frequent contact with participants; 3) a structured, state-of-the-art, 16-session core-curriculum that taught behavioral self-management strategies for weight loss and physical activity; 4) supervised physical activity sessions; 5) a more flexible maintenance intervention, combining group and individual approaches, motivational campaigns, and "restarts;" 6) individualization through a "toolbox" of adherence strategies; 7) tailoring of materials and strategies to address ethnic diversity; and finally 8) an extensive network of training, feedback, and clinical support.

The Diabetes Prevention Program (DPP) was a 27-center randomized clinical trial to determine whether lifestyle intervention or pharmacological therapy (metformin) would prevent or delay the onset of diabetes in individuals with impaired glucose tolerance (IGT) who are at high risk for the disease. Recently, it was reported that both the lifestyle intervention and metformin were effective in decreasing the incidence of diabetes. Lifestyle intervention decreased the incidence of type 2 diabetes by 58% compared with 31% in the metformin-treated group, and information on adherence to these interventions has already been reported. The purpose of this manuscript is to provide a more detailed description of the lifestyle intervention protocol used in the DPP. For further information about lifestyle sessions, materials, and learning objectives, please see http://www.bsc.gwu.edu/dpp/manuals.htmlvdoc.