• % Change in Blood Total Cholesterol [ Time Frame: 12 months ] [ Designated as safety issue: No ]
• % Change in A1C [ Time Frame: 12 months ] [ Designated as safety issue: No ]
• % Change in Blood Pressures [ Time Frame: 12 months ] [ Designated as safety issue: No ]
• Changes in Dietary Composition [ Time Frame: 12 months ] [ Designated as safety issue: No ]
• Changes in Physical Activity [ Time Frame: 12 months ] [ Designated as safety issue: No ]
• Incremental Costs [ Time Frame: 12 months ] [ Designated as safety issue: No ]
• Incremental Health State Utility [ Time Frame: 12 months ] [ Designated as safety issue: No ]
• % Change in Body Weight [ Time Frame: 6 months ] [ Designated as safety issue: No ]
• % Change in Body Weight [ Time Frame: 24 months ] [ Designated as safety issue: No ]

The purpose of this study is to determine if providing free-of-charge access to a group-based lifestyle intervention delivered in partnership with the YMCA is cost-effective for the prevention of type 2 diabetes.

Randomized controlled trials have shown that modest lifestyle changes can prevent or delay the onset of diabetes in adults with pre-diabetes. Unfortunately, despite the increasing prevalence of pre-diabetes and diabetes in all facets of the population, intervention programs needed to achieve these goals are costly and remain unavailable in most clinical settings. Over the past 3 years, we have demonstrated the feasibility of training YMCA instructors to deliver a group-based adaptation of the Diabetes Prevention Program (DPP) lifestyle intervention. In this pilot research, this new delivery model achieves a level of weight reduction that was associated with diabetes prevention and improved cardiometabolic risk factor control in the DPP. This new, large-scale randomized effectiveness trial is designed to evaluate the costs and effectiveness of a partnered approach to identify adults with pre-diabetes in primary care settings, deliver brief advice for diabetes prevention, and provide access to a group-based adaptation of the DPP lifestyle intervention offered by the YMCA. This study will compare costs and outcomes to a standard care, brief clinical counseling approach delivered by Registered Dietitians.

• Hyperglycemia
• Obesity
• Diabetes Mellitus

• Behavioral: Registered Dietitian Counseling Alone
• Behavioral: Registered Dietitian Counseling Plus YMCA Group Lifestyle Intervention

• Active Comparator: Primary care-based identification of pre-diabetes with brief counseling by a dedicated registered dietitian
• Experimental: Primary care-based identification of pre-diabetes with brief counseling by a dedicated registered dietitian, PLUS free-of-charge access to a group-based DPP lifestyle intervention offered by the YMCA

Inclusion Criteria:

• 18 years of age or older
• Body-mass index of 24 kg/m2 or greater
• Fasting Blood Glucose 100 - 125 mg/dl, OR 2-hour Post-challenge Capillary Glucose 140 - 199 mg/dl

Exclusion Criteria:

• Cancer requiring treatment in the past 5 years
• Uncontrolled hypertension: SBP >180 mmHg or DBP >105 mmHg
• Heart attack, stroke, or transient ischemic attack in the past 6 months,
• Chronic obstructive airways disease or asthma requiring home oxygen
• Other chronic disease or condition, such as advanced arthritis, that could limit ability to become physically active or limit life span to <5 years
• Pregnancy
• Existing diagnosis of diabetes mellitus
• Fasting capillary blood glucose > 125 mg/dl
• 2-hour post-challenge capillary blood glucose > 199 mg/dl
• History of anti-diabetic medication use (oral agents or insulin) except during gestational diabetes
• Self-report of a medication known to lead to hyperglycemia (oral steroids, antipsychotics, anti-epileptics)
• Self-report of disease associated with disordered glucose metabolism: Cushing's syndrome; acromegaly; pheochromocytoma; chronic pancreatitis