What does this research mean for the field?

Adults who participate in at least one session of the National Diabetes Prevention Program/Intensive Lifestyle Intervention (N-DPP/ILI) have an 11% lower risk of incident type 2 diabetes compared to matched non-enrollees in real-world settings. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

June 7, 2026

1639-P: Reduction in Incident Type 2 Diabetes with National Diabetes Prevention Program/Intensive Lifestyle Intervention: Results from the Reality Research Network

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Type 2 Diabetes (n=10668980). Intervention: National Diabetes Prevention Program/Intensive Lifestyle Interventions (N-DPP/ILI) vs. matched non-enrollees. Primary outcome: incident T2D (HR 0.89, 95% CI 0.88-0.91).

Key Result

Participation in ≥1 session of the National Diabetes Prevention Program/Intensive Lifestyle Intervention was associated with an 11% lower risk of incident type 2 diabetes (HR 0.89; 95% CI 0.88-0.91).

Key Points

To evaluate the real-world effectiveness of the National Diabetes Prevention Program/Intensive Lifestyle Interventions in reducing incident type 2 diabetes risk.
Conducted a two-step analysis using claims and electronic health record data.
Compared incident type 2 diabetes risk among N-DPP/ILI enrollees vs. matched non-enrollees.
Utilized Cox regression models and random-effects meta-analysis for data synthesis.
N-DPP/ILI enrollees had a significantly lower risk of incident T2D (HR 0.89, 95% CI [0.88, 0.91]).
This reduction corresponds to an 11% lower risk compared to non-enrollees.
Analysis included 472,906 enrollees and 10,196,074 matched non-enrollees.

Study Design

Type

Cohort (n=10,668,980)

Multicenter

Yes

Structured PICO

Does participation in the National Diabetes Prevention Program/Intensive Lifestyle Intervention reduce the risk of incident Type 2 Diabetes in adults?

Population

10,668,980 adults (472,906 N-DPP/ILI enrollees and 10,196,074 matched non-enrollees) followed for a median of 3.2 and 2.5 years to assess the risk of incident type 2 diabetes.

Exposure

National Diabetes Prevention Program/Intensive Lifestyle Interventions (N-DPP/ILI) participation (≥1 session)

Comparator

Matched non-enrollees (matched on age, sex, clinical factors, diabetes risk score, N-DPP/ILI eligibility date, and data type)

Outcome

Incident Type 2 Diabetes (T2D)hard clinical

Participation in at least one session of the National Diabetes Prevention Program/Intensive Lifestyle Intervention is associated with an 11% lower risk of incident Type 2 Diabetes in a real-world setting.

Main Result

Hazard Ratio: 0.89 (95% CI 0.88–0.91)

Abstract

Introduction and Objective: Real-World Effectiveness of Interventions for Type 2 Diabetes Prevention (REALITY) is a multicenter research network examining the long-term effectiveness of National Diabetes Prevention Program/Intensive Lifestyle Interventions (N-DPP/ILI) in real-world settings. Methods: We conducted a prospectively planned, two-step analysis of individual-level claims/electronic health record (EHR) data to estimate N-DPP/ILI effects, followed by a meta-analysis to pool effect estimates. We compared risk of incident T2D among N-DPP/ILI enrollees (≥1 session) vs. matched non-enrollees. We used sequential matching to construct the control cohort and assign proxy enrollment dates, matching on confounders (age, sex, clinical factors, diabetes risk score, N-DPP/ILI eligibility date, and data type claims and/or EHR). Cox regression models using a doubly robust augmented inverse probability weighting were fit with baseline hazard stratified by propensity score quintiles. We used random-effects meta-analysis to pool results across sites. Results: We included 472,906 N-DPP/ILI enrollees and 10,196,074 matched non-enrollees. After weighing, N-DPP/ILI enrollees’ mean age was 52.3 years, 53.7% had obesity, and 31% had prediabetes. Non-enrollees’ mean age was 52.8 years, 48.1% had obesity, and 29.6% had prediabetes. Pooled analysis over a median censoring time of 3.2 and 2.5 years for enrollees and non-enrollees with a median time-to-event of 1.7 and 1.0 years showed a significant reduction in incident T2D risk (HR 0.89, 95% confidence interval 0.88, 0.91) with minimal between-site heterogeneity (I2=0.07%). Conclusion: Adults who participated in ≥1 N-DPP/ILI session had an 11% lower risk of incident T2D compared to similar non-enrollees. Our findings underscore the benefits of N-DPP/ILI participation across real-world populations and settings. Disclosure T. Moin: None. N. Jackson: None. O. Duru: Consultant; Current; Boehringer Ingelheim International GmbH. U.R. Chung: None. C.W. Jones: None. T. Belnap: None. H. Shao: None. P. Li: None. L.S. Phillips: Research Support; Ended; Janssen Pharmaceuticals, Inc. Research Support; Current; Boehringer Ingelheim International GmbH. Other - Diasyst, Inc. is a startup. It produces software for providers, aimed to improve diabetes care. I am cofounder, Medical Director, Board member, and stockholder. Its debts are much larger than its revenue, and in the past year, I received no income from it.; Current; Diasyst Inc. R. Ackermann: None. R. Kang: None. A. Rivera: None. W. Herman: Other - Member, Data Safety Monitoring Board; Ended; Merck Sharp Current; National Committee for Quality Assurance. C. Villatoro Santos: None. L. McEwen: None. S. Kuo: None. S.R. Jacobs: None. B.D. Tyndall: None. S. Neuwahl: Other - Working on a project for this client as part of my normal duties as a health economist at my employer (RTI international).; Current; Eli Lilly and Company, Sanofi. P. Zhang: None. R. Li: None. M. Pavkov: None. Funding DHHS-CDC CENTERS FOR DISEASE CONTROL AND PREVENTION (U18DP006708-01-00)

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