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. 2022 Nov 1;9(3):320-326.
doi: 10.1002/osp4.644. eCollection 2023 Jun.

Mental health diagnosis attenuates weight loss among older adults in a digital diabetes prevention program

Meghan Mayhew  1 , Ning Smith  1 , Stephen P Fortmann  1 , Stephanie L Fitzpatrick  1
Affiliations

Mental health diagnosis attenuates weight loss among older adults in a digital diabetes prevention program

Meghan Mayhew et al. Obes Sci Pract. .

Abstract

Objective: Diabetes Prevention Programs (DPP) are effective at reducing diabetes incidence via clinically significant weight loss. Co-morbid mental health condition(s) may reduce the effect of DPP administered in-person and telephonically but this has not been assessed for digital DPP. This report examines the moderating effect of mental health diagnosis on weight change among individuals who enrolled in digital DPP (enrollees) at 12 and 24 months.

Methods: Secondary analysis of prospective, electronic health record data from a study of digital DPP among adults (N = 3904) aged 65-75 with prediabetes (HbA1c 5.7%-6.4%) and obesity (BMI ≥30 kg/m2).

Results: Mental health diagnosis only moderated the effect of digital DPP on weight change during the first 7 months (p = 0.003) and the effect attenuated at 12 and 24 months. Results were unchanged after adjusting for psychotropic medication use. Among those without a mental health diagnosis, digital DPP enrollees lost more weight than non-enrollees: -4.17 kg (95% CI, -5.22 to -3.13) at 12 months and -1.88 kg (95% CI, -3.00 to -0.76) at 24 months, whereas among individuals with a mental health diagnosis, there was no difference in weight loss between enrollees and non-enrollees at 12 and 24 months (-1.25 kg [95% CI, -2.77 to 0.26] and 0.02 kg [95% CI, -1.69-1.73], respectively).

Conclusions: Digital DPP appears less effective for weight loss among individuals with a mental health condition, similar to prior findings for in-person and telephonic modalities. Findings suggest a need for tailoring DPP to address mental health conditions.

Keywords: diabetes prevention; lifestyle intervention; mental health.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

FIGURE 1
FIGURE 1
Estimated* (95% confidence intervals (CI)) weight trajectories by digital diabetes prevention programs (DPP) Enrollment and Mental Health Diagnosis Status. *Estimates (95% CIs) are marginal weights from a mixed effects model, with time since baseline modeled using a linear spline with a knot at 7 and 12 months. The model includes a random intercept and 3 random slopes (one for each time spline term); unstructured correlation structure was used for the random effects. The model was adjusted for age; race/ethnicity; sex; minutes of exercise per week; Charlson co‐morbidity index score; baseline tobacco use; census tract‐level proportion completing high school or less; census tract‐level median household income; estimated propensity score for enrolling in digital DPP; baseline weight; and metformin use. The model included two‐way interactions between each time spline with baseline weight, mental health diagnosis in the past year, and digital DPP enrollment status, and a three‐way interaction of mental health diagnosis, digital DPP enrollment status, and time. All covariates were held constant at their means to estimate marginal weights by mental health diagnosis at the time points of baseline and 7, 12 and 24 months from baseline.
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