An iterative mindset approach as an adjunct to the national diabetes prevention program: a randomized trial assessing retention, engagement and weight loss

Retention and engagement continue to be a challenge for the National Diabetes Prevention Program lifestyle change program (LCP). This challenge is especially stark for persons living in medically-underserved, economically-disadvantaged communities. In the current work, we sought to investigate if a digital solution—an adjunct habit formation app (Fresh Tri ® ) grounded in neuroscience theory around iteration (i.e., changing one’s approach to a problem when encountering challenges)—could improve these metrics, as well as weight loss, in these populations. We conducted a randomized study using a three-level, nested hierarchical structure, with 364 participants (212 intervention; 152 control) across 33 sites from February 1, 2021-October 13, 2022. We examined retention, engagement (number of sessions attended) and ≥ 5% body weight loss for participants in the intervention condition (standard LCP curriculum plus the Fresh Tri iterative mindset app) compared to the control condition (standard LCP curriculum) and also to a nationally representative group (National DPP LCP data from the United States Centers for Disease Control and Prevention (CDC)). Intervention participants reported higher retention than controls at 6 months (79.7% vs. 67.1%; OR = 2.06; 95% CI = 1.15–3.68; P =.01) and 12 months (78.3% vs. 53.1%; OR = 3.14; 95% CI = 1.11–8.88; P =.03). Engagement at 6 and 12 months was not statistically different. Compared to the National DPP LCP participants overall, both the intervention and control arms had higher retention ( P