Background

Adults with prediabetes (PreDM) and a mental health diagnosis (MHdx) are more likely to progress to diabetes than those with PreDM alone. Recent studies suggest that those with PreDM and MHdx participating in an in-person Diabetes Prevention Program (DPP) lose less weight compared to those without a MHdx. We examined the effect of MHdx on weight change among older adults invited to participate in a virtual DPP.

Methods

In 2017, 4,124 Kaiser Permanente Northwest members, age 65-75, A1C 5.7-6.4%, and BMI≥30, were invited to participate in the Omada Health virtual DPP as part of a larger natural experiment. Weights, demographics, and clinical factors were extracted from the electronic health record. MHdx was defined as having one or more encounters with a diagnosis of depression, anxiety, or bipolar disorder in the 12 months prior to the invitation. We modeled 12-month weight trajectories using a piecewise linear mixed effects model with a knot at 7 months and included a three-way interaction of time, DPP enrollment status, and MHdx (yes or no). We adjusted for propensity scores, demographics, and clinical measures.

Results

There were 511 enrolled (63% female; ~30% with MHdx) and 3,613 not enrolled (56% female; ~30% with MHdx). DPP enrolled participants with no MHdx lost significantly more weight (12.7lbs; 95% CI 10.2,15.2) than those enrolled with MHdx (3.6lb; 0.9, 6.3) over 12 months. Among those not enrolled in DPP, there was no significant difference in the 12-month weight trajectories between those with MHdx vs. those without MHdx (0.2lbs; -0.8,1.3).

Conclusions

Older adults with a MHdx appear to have less success with weight management than those without a MHdx participating in a virtual DPP program. Since DPP is now covered by Medicare and Medicaid, screening and referral to treatment for mental illness in combination with offering DPP seems warranted.