The DPP is not the answer

As much as the DPP forms the foundation of many current diabetes prevention efforts, we heard two main arguments against it as the long-term solution to type 2 diabetes prevention. First, while many claim that the DPP’s model for prevention is neither “magic” nor “rocket science,” numerous others reminded us that it can seem almost that difficult, at least when attempted at large scale. After all, if we truly knew how to get people to achieve and sustain weight loss and be more physically active, we would be doing it already. We may know what it takes to delay or prevent progression of prediabetes to type 2 diabetes, but we are still uncertain regarding how to help people get there in an affordable, scalable way. Even Dr. David Marrero, a lead investigator on the original DPP study, as well as a leader of the translation efforts that led to the YMCA DPP, said, “We’ve so far tried to fit everyone to one or two models,” and that just doesn’t work. Dr. W. Timothy Garvey, Chair of the Department of Nutrition Sciences at the University of Alabama – Birmingham notes that the shortcomings of a one-size-fits-all are, “not surprising when you consider that obesity is a disease, and there are multiple pathophysiological mechanisms that patients must fight against to prevent weight regain following lifestyle interventions.”

The second, perhaps more persuasive argument against the DPP is that it fundamentally fails to address health at the population level. While the DPP may be effective in preventing diabetes among those already at high risk, it does little to address the broad factors underlying the high prediabetes prevalence in the first place. Prof. Paul Zimmet, who helped author the Australian National Diabetes Strategy, said, “We need to look 30 or 40 years down the track at the people who are going to get diabetes.” In this sense, the DPP, while crucial to those already at high risk, is little more than a Band-Aid solution at the population level; to truly address the rapidly growing diabetes epidemic, we need to address social determinants of health. This means changing our food systems, our norms, our education, our living spaces, and much more.