Sociodemographic, Clinical, and Psychosocial Predictors of Short- and Long-term Study Retention in Diabetes Prevention Program (DPP) Outcomes Study (DPPOS)

Ashley H. Tjaden, Biostatistics Center, Milken Institute of Public Health, George Washington University, Washington, DC.
Barbara H. Braffett, Biostatistics Center, Milken Institute of Public Health, George Washington University, Washington, DC.
Nicole M. Butera, Biostatistics Center, Milken Institute of Public Health, George Washington University, Washington, DC.
Maria Rosario Araneta, UC San Diego School of Medicine, San Diego, CA.
Owen Carmichael, Pennington Biomedical Research Center, Baton Rouge, LA.
Erik J. Groessl, Herbert Wertheim School of Public Health, University of California San Diego, San Diego, CA.
Helen P. Hazuda, University of Texas Health Science Center at San Antonio, San Antonio, TX.
Mary A. Hoskin, Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ.
Uzoma Ibebuogu, University of Tennessee Health Science Center, Memphis, TN.
Michelle F. Magee, Georgetown University School of Medicine, Washington, DC.
Marjorie Mau, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI.
Tamara Stich, Washington University School of Medicine, St. Louis, MO.
Diana Soliman, Leonard M. Miller School of Medicine, University of Miami, Miami, FL.
Amisha Wallia, Northwestern University Feinberg School of Medicine, Chicago, IL.
Marinella Temprosa, Biostatistics Center, Milken Institute of Public Health, George Washington University, Washington, DC.
Sherita H. Golden, Johns Hopkins University School of Medicine, Baltimore, MD.

Document Type

Journal Article

Publication Date

6-20-2025

Journal

Diabetes care

DOI

10.2337/dc25-0520

Abstract

OBJECTIVE: Success of longitudinal studies depends on retention of participants. We examined characteristics as predictors of retention among participants with prediabetes and type 2 diabetes (T2D) in the Diabetes Prevention Program (DPP) and the follow-up DPP Outcomes Study. RESEARCH DESIGN AND METHODS: A total of 3,234 adults at high risk of T2D joined the DPP (1996-1999, mean age 51 ± 10 years). They were randomized to lifestyle, metformin, or placebo intervention, and then followed through 2020. Logistic regression models estimated the association between baseline sociodemographic, clinical and psychosocial characteristics (life events, family functioning, social support), and short-term retention (∼3 years). Cox proportional hazards models, censoring at death, estimated the association between baseline and time-varying characteristics and time to dropout over the entire 20 years of follow-up. RESULTS: Among surviving participants (n = 3,218), 93% were retained after 3 years, and 75% of those surviving remained engaged over 20 years. Younger age was associated with dropout during DPP and over 20 years of follow-up. Female sex, non-White race/ethnicity, employment, and lack of baseline depressive symptoms were associated with better long-term retention. Over time, better health state (SF-36) (hazard ratio [HR]: 0.89 per 0.1 point; 95% CI: 0.83-0.95) was associated with retention. Greater BMI (HR: 1.06 per 5 kg/m2; 95% CI: 1.00-1.12), more recent life events (HR: 1.08; 95% CI: 1.02-1.14), and depressive symptoms (HR: 1.11 per 5 points; 95% CI: 1.05-1.18) were associated with reduced retention. Among adults 45-59 years of age at baseline, development of T2D was associated with better retention (HR: 0.75; 95% CI: 0.58-0.97). CONCLUSIONS: Twenty-year retention of a racially and geographically diverse cohort with prediabetes is possible. Retention was associated with age, psychosocial factors, T2D development, and BMI.

Department

Biostatistics and Bioinformatics

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