Evaluating the Implementation of a Digital Diabetes Prevention Program in an Integrated Health Care Delivery System Among Older Adults: Results of a Natural Experiment
Open accessPublished version of a preprint
Abstract
The purpose of this natural experiment study was to assess the effectiveness of a 12-month digital Diabetes Prevention Program (DPP) for adults aged 65–75 years with prediabetes and obesity within a large, integrated health care system. Adjusting for propensity scores and covariates, patients who enrolled and participated in the digital DPP had a mean weight loss of 8.6 lb over 12 months and 5.7 lb by 24 months, compared with a steady, minimal weight loss of 1.3 lb over 12 months and 2.8 lb by 24 months among patients not enrolled. There was a significant difference in mean change in A1C between enrolled and nonenrolled patients over 12 months (−0.10%), but not by 24 months (−0.06%). Digital DPP appears to be an effective weight loss option and potential diabetes prevention intervention for older adults at high risk for type 2 diabetes.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Of 5 PHT studies on T2DM prevention, 1 (20%) posted a positive effect and 4 (80%) reported a neutral effect.
“Of the 5 (13.5%) studies on PHT reporting its effects on preventing T2DM, 1 (20%) study [39] posted a positive effect, with 4 (80%) other studies [35,36,40,41] reporting a neutral effect on T2DM development.”
From Digital Health Interventions to Prevent Type 2 Diabetes Mellitus: Systematic Review (2025) · cites this paper as [35]
Of 16 PPC studies, 2 reviewing T2DM prevention showed a neutral effect, with no significant difference in T2DM diagnosis compared to the control group.
“Of 16 (30.2%) studies, 2 (12.5%) studies reviewing the effects of PPC on T2DM prevention were by Fitzpatrick et al [35] and McKenzie et al [36]. Results showed a neutral effect, with no significant difference in the T2DM diagnosis compared to the control group.”
From Digital Health Interventions to Prevent Type 2 Diabetes Mellitus: Systematic Review (2025) · cites this paper as [35]
Of 5 TM studies on T2DM development, 1 by Sakane et al indicated TM is effective, and the other 4 did not show significant differences compared to the control group.
“Of the 5 (20%) studies reporting the effects of TM on T2DM development, only 1 (20%) study by Sakane et al [39] indicated that TM is effective. The other 4 (80%) studies [35,40,44,50] did not show any significant differences compared to the control group.”
From Digital Health Interventions to Prevent Type 2 Diabetes Mellitus: Systematic Review (2025) · cites this paper as [35]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin
(2002) · New England Journal of Medicine · doi:10.1056/nejmoa012512 · Cited by 19,011 · see citing works
Validation of a combined comorbidity index
Charlson, M., Szatrowski, T. P., Peterson, J., & Gold, J. (1994) · Journal of Clinical Epidemiology · doi:10.1016/0895-4356(94)90129-5 · Cited by 6,587 · see citing works
Austin, P. C. (2011) · Pharmaceutical Statistics · doi:10.1002/pst.433 · Cited by 3,949 · see citing works
Economic Costs of Diabetes in the U.S. in 2017
American Diabetes Association (2018) · Diabetes Care · doi:10.2337/dci18-0007 · Cited by 2,528 · see citing works
Eight-year weight losses with an intensive lifestyle intervention: The look AHEAD study
The Look AHEAD Research Group (2014) · Obesity · doi:10.1002/oby.20662 · Cited by 842 · see citing works
Ali, M. K., Echouffo-Tcheugui, J. B., & Williamson, D. F. (2012) · Health Affairs · doi:10.1377/hlthaff.2011.1009 · Cited by 594 · see citing works
Gerstein, H. C., Santaguida, P., Raina, P., Morrison, K. M., Balion, C., Hunt, D., Yazdi, H., & Booker, L. (2007) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2007.05.004 · Cited by 575 · see citing works
Dunkley, A. J., Bodicoat, D. H., Greaves, C. J., Russell, C., Yates, T., Davies, M. J., & Khunti, K. (2014) · Diabetes Care · doi:10.2337/dc13-2195 · Cited by 542 · see citing works
Ely, E. K., Gruss, S. M., Luman, E. T., Gregg, E. W., Ali, M. K., Nhim, K., Rolka, D. B., & Albright, A. L. (2017) · Diabetes Care · doi:10.2337/dc16-2099 · Cited by 386 · see citing works
Ross Middleton, K. M., Patidar, S. M., & Perri, M. G. (2012) · Obesity Reviews · doi:10.1111/j.1467-789x.2011.00972.x · Cited by 276 · see citing works
Joiner, K. L., Nam, S., & Whittemore, R. (2017) · Preventive Medicine · doi:10.1016/j.ypmed.2017.04.033 · Cited by 223 · see citing works
Sepah, S. C., Jiang, L., & Peters, A. L. (2015) · Journal of Medical Internet Research · doi:10.2196/jmir.4052 · Cited by 206 · see citing works
A systematic review of the translational research on the Diabetes Prevention Program
Whittemore, R. (2011) · Translational Behavioral Medicine · doi:10.1007/s13142-011-0062-y · Cited by 173 · see citing works
Mudaliar, U., Zabetian, A., Goodman, M., Echouffo-Tcheugui, J. B., Albright, A. L., Gregg, E. W., & Ali, M. K. (2016) · PLOS Medicine · doi:10.1371/journal.pmed.1002095 · Cited by 146 · see citing works
Sepah, S. C., Jiang, L., & Peters, A. L. (2014) · The Diabetes Educator · doi:10.1177/0145721714531339 · Cited by 139 · see citing works
Castro Sweet, C. M., Chiguluri, V., Gumpina, R., Abbott, P., Madero, E. N., Payne, M., Happe, L., Matanich, R., Renda, A., & Prewitt, T. (2018) · Journal of Aging and Health · doi:10.1177/0898264316688791 · Cited by 130 · see citing works
Engagement and outcomes in a digital Diabetes Prevention Program: 3-year update
Sepah, S. C., Jiang, L., Ellis, R. J., McDermott, K., & Peters, A. L. (2017) · BMJ Open Diabetes Research & Care · doi:10.1136/bmjdrc-2017-000422 · Cited by 122 · see citing works
Results From a Trial of an Online Diabetes Prevention Program Intervention
Moin, T., Damschroder, L. J., AuYoung, M., Maciejewski, M. L., Havens, K. L., Ertl, K., Vasti, E. C., Weinreb, J. E., Steinle, N., Billington, C. J., et al. (2018) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2018.06.028 · Cited by 108 · see citing works
Perri, M. G., Shankar, M. N., Daniels, M. J., Durning, P. E., Ross, K. M., Limacher, M. C., Janicke, D. M., Martin, A. D., Dhara, K., Bobroff, L. B., et al. (2020) · JAMA Network Open · doi:10.1001/jamanetworkopen.2020.6764 · Cited by 74 · see citing works
Chen, F., Su, W., Becker, S. H., Payne, M., Castro Sweet, C. M., Peters, A. L., & Dall, T. M. (2016) · PLOS ONE · doi:10.1371/journal.pone.0163627 · Cited by 60 · see citing works
Almeida, F. A., Michaud, T. L., Wilson, K. E., Schwab, R. J., Goessl, C. L., Porter, G. C., Brito, F. A., Evans, G., Dressler, E. V. M., Boggs, A. E., et al. (2019) · Contemporary Clinical Trials · doi:10.1016/j.cct.2019.105877 · Cited by 39 · see citing works
Evaluation of a Digital Diabetes Prevention Program Adapted for Low-Income Patients, 2016–2018
Kim, S. E., Castro Sweet, C. M., Cho, E., Tsai, J., & Cousineau, M. R. (2019) · Preventing Chronic Disease · doi:10.5888/pcd16.190156 · Cited by 34 · see citing works
Medical Record Versus Researcher Measures of Height and Weight
DiMaria-Ghalili, R. A. (2006) · Biological Research For Nursing · doi:10.1177/1099800406288903 · Cited by 26 · see citing works
Validity and usefulness of medical chart weights in the long-term evaluation of weight loss programs
Stevens, V. J., Wagner, E. L., Rossner, J., Craddick, S. R., & Greenlick, M. R. (1988) · Addictive Behaviors · doi:10.1016/0306-4603(88)90007-x · Cited by 23 · see citing works
Self-citationXiao, L., Lv, N., Rosas, L. G., Au, D. H., & Ma, J. (2017) · Obesity · doi:10.1002/oby.21737 · Cited by 23 · see citing works
A Simple Model for Predicting Two-Year Risk of Diabetes Development in Individuals with Prediabetes
Glauber, H. S., Vollmer, W. M., & Nichols, G. A. (2018) · The Permanente Journal · doi:10.7812/tpp/17-050 · Cited by 22 · see citing works
Self-citationValidity of Medical Chart Weights and Heights for Obese Pregnant Women
Leo, M. C., Lindberg, N. M., Vesco, K. K., & Stevens, V. J. (2014) · eGEMs (Generating Evidence & Methods to improve patient outcomes) · doi:10.13063/2327-9214.1051 · Cited by 17 · see citing works
Self-citationOlder Adults and Diabetes Prevention Programs in the Veterans Health Administration
Lee, P., Damschroder, L. J., Holleman, R. G., Moin, T., & Richardson, C. R. (2018) · Diabetes Care · doi:10.2337/dc18-1141 · Cited by 10 · see citing works
Fitzpatrick, S. L., Mayhew, M., Catlin, C., Firemark, A. J., Gruß, I., Nyongesa, D. B., O'Keeffe-Rosetti, M. C., Rawlings, A. M., Smith, D. H., Smith, N. X., et al. (2022) · The Permanente Journal · doi:10.7812/tpp/21.056 · Cited by 5 · see citing works
Self-citation
Flagged first, then by citations
Cited by
Sorted by citations
Digital interventions for self-management of prediabetes: A scoping review
Stowell, M., Dobson, R., Garner, K., Baig, M. M., Nehren, N., & Whittaker, R. (2024) · PLoS ONE · doi:10.1371/journal.pone.0303074 · Cited by 17 · see citing works
Digital Health Interventions to Prevent Type 2 Diabetes Mellitus: Systematic Review
Duong, T., Olsen, Q., Menon, A., Woods, L., Wang, W., Varnfield, M., Jiang, L., & Sullivan, C. (2025) · Journal of Medical Internet Research · doi:10.2196/67507 · Cited by 14 · see citing works
Mayhew, M., Smith, N. X., Fortmann, S. P., & Fitzpatrick, S. L. (2022) · Obesity Science & Practice · doi:10.1002/osp4.644 · Cited by 5 · see citing works
Self-citationUsing Digital Health Technology to Prevent and Treat Diabetes
Clements, M. A., Kaufman, N., & Mel, E. (2024) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2024.2506 · Cited by 1 · see citing works
Mekniran, W., & Kowatsch, T. (2026) · BMC Health Services Research · doi:10.1186/s12913-026-14075-3 · Cited by 1 · see citing works
- Authors
- Fitzpatrick, S. L., Mayhew, M., Rawlings, A. M., Smith, N., Nyongesa, D. B., Vollmer, W. M., Stevens, V. J., Grall, S. K., & Fortmann, S. P.
- Affiliations
- Kaiser Permanente Center for Health Research (US)
- 2Kaiser Permanente Northwest, Portland, OR
- Corresponding author
- Fitzpatrick, Stephanie L.
- ORCID
- Venue
- Clinical Diabetes
- Publisher
- American Diabetes Association
- Published
- 2022-07-01
- Volume
- 40
- Issue
- 3
- Pages
- 345-353
- ISSN
- 0891-8929 (ISSN-L)
- 1945-4953
- PMC
- PMC9331625
- OpenAlex
- W4220928318
- Cited by
- 5
- References
- 29
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 2 · 2022: 1
- FWCI
- 0.74
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Clinical Diabetes (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health
- National Institute of Diabetes and Digestive and Kidney Diseases (R01DK115237)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- prediabetes, obesity, older adults, type 2 diabetes prevention, weight loss, HbA1c, integrated health system, digital health interventions, natural experiment
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
