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Work-based diabetes prevention programs in San Francisco show promising results

Both in-person and online programs helped people at risk for diabetes lose weight, Kaiser Permanente analysis finds


A Kaiser Permanente randomized controlled trial comparing an in-person diabetes prevention program with an online version found both helped San Francisco City and County employees at risk for developing diabetes to lose weight.

Assiamira Ferrara, MD, PhD. Kaiser Permanente Division of Research

The study was published May 28 in the Centers for Disease Control and Prevention (CDC) journal Preventing Chronic Disease. It offers evidence that diabetes prevention can be provided through the workplace, the authors said.

“It is encouraging that both types of intervention show results, so these programs can reach people who prefer either an in-person or an online experience,” said lead author Assiamira Ferrara, MD, PhD, a senior research scientist with the Kaiser Permanente Division of Research. “Our findings also suggest the workplace can be an effective way to deliver these preventive services, which could make them available to more at-risk people.”

The analysis found participants in both groups lost a modest amount of weight at 6 months (mean loss of 2.7% of body weight for in-person program, 2.4% for the online program). At 12 months only those in the in-person group maintained the weight loss at statistically significant levels (2.46% vs. 1.59%). Previous research by the National Diabetes Prevention Program (NDPP) found that even modest weight loss can reduce type 2 diabetes risk.

The findings have relevance in the context of social distancing now required in employment situations, said Rick Dlott, MD, medical director of population care for The Permanente Medical Group. “In the COVID era, which limits group in-person meetings, having data supporting the effectiveness of on-line care options is critical,” Dlott said. “If these findings are confirmed, virtual Diabetes Prevention Program options may be an effective way to prevent diabetes until a COVID vaccine and herd immunity are achieved.”


“If these findings are confirmed, virtual Diabetes Prevention Program options may be an effective way to prevent diabetes until a COVID vaccine and herd immunity are achieved.”

–Rick Dlott, MD, medical director of population care, The Permanente Medical Group


The study enrolled 158 employees of the city and county of San Francisco considered at high risk for developing type 2 diabetes and who had a body mass index above 25 (23 if Asian). Recruitment took place between 2015 and 2017, when participants were randomly assigned to either an in-person prevention program provided by the YMCA at their work site or to an online program offered through Canary Health. Both programs are recognized by the CDC Diabetes Prevention Recognition Program.

The 78 participants in the YMCA program received 16 weekly one-hour group sessions and 8 follow-up sessions at their workplace during breaks or lunch, facilitated by YMCA lifestyle coaches. Participants were asked to self-monitor their food and physical activity each day. Meanwhile, the 80 participants in the Canary Health online program received an initial in-person group orientation, followed by 16 weekly educational sessions and 8 follow-up sessions. These included streaming audio and interactive visual material, with trained coaches engaging participants via secure messaging.

Those assigned to the YMCA program completed more sessions than those using the app (average 10 sessions vs. 6 sessions) and were more likely to complete 4 or more of 16 core sessions (88.5% versus 46.2%), a threshold indicative of engagement in the program.

“Strong engagement among participants is a key to the kind of lifestyle behavioral changes that are required to reduce risk of developing type 2 diabetes,” Ferrara said. “The greater engagement we found among participants taking the YMCA program suggest that employers could offer a prevention program at the worksite during a convenient time for employees.”

The study was funded by the Kaiser Foundation Health Plan.

Coauthors included Charles Quesenberry, PhD, Julia C. McDonald, MS, and Janet G. Alexander, MS, of the Division of Research; Susan D. Brown, PhD, an adjunct investigator with the Division of Research; Jennifer L. Christian-Herman, PhD, with Kaiser Foundation Health Plan; and Stephanie Fisher, MPH, with San Francisco Health Service System.

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About the Kaiser Permanente Division of Research

The Kaiser Permanente Division of Research conducts, publishes and disseminates epidemiologic and health services research to improve the health and medical care of Kaiser Permanente members and society at large. It seeks to understand the determinants of illness and well-being, and to improve the quality and cost-effectiveness of health care. Currently, DOR’s 600-plus staff is working on more than 450 epidemiological and health services research projects. For more information, visit or follow us @KPDOR.

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