Background: The Diabetes Prevention Program (DPP) is a nationally disseminated lifestyle intervention shown to prevent type 2 diabetes (diabetes). However, enrollment has been variable. At the VA, women Veterans are more likely to have overweight/obesity and face unique barriers to engagement in preventive interventions. 

Objective: We identified characteristics associated with enrollment in virtual DPP among women Veterans to inform national diabetes prevention efforts.

Methods: We conducted a retrospective analysis of data collected through the VA EMPOWER 2.0 QUERI Program, an effectiveness-implementation trial to expand preventative health services for women Veterans. We included women meeting DPP eligibility criteria (BMI ≥25 kg/m2, or ≥23 if Asian with >1 diabetes risk factor [e.g., prediabetes]) who received care at six VA sites implementing DPP. We used logistic regression to examine the association between DPP enrollment and prior use of VA preventive services for weight management or diabetes prevention including MOVE!, Whole Health, weight loss medications, or metformin. We adjusted for sociodemographic factors, comorbidities, and number of recruitment contacts. 

Results: A total of 1473 women Veterans received DPP outreach. On average, their age was 53 years, BMI 34 kg/m2, A1c 5.9%, 0.7% were Asian, 44% Black, 2% Hispanic, and 44% White. Prior use of VA preventative services was not significantly associated with DPP enrollment. Younger women (OR:0.97, p=0.002) and those who received more recruitment contacts (OR:2.63, p<0.001), were significantly more likely to enroll in DPP.  Women with housing instability were significantly less likely to enroll (OR:0.44, p=0.029).

Conclusions: We found no association between women Veterans’ enrollment in DPP and prior use of VA lifestyle prevention services. Increased recruitment, younger age, and housing stability were associated with DPP participation. Virtual DPP may support engagement in preventive interventions for diverse groups of women Veterans, as a first program or as a complement to other VA services.