Over 24 million Americans are over 65 years and have prediabetes. Prediabetes can be addressed using a public health approach: among the 20% of participants in the Diabetes Prevention Program (DPP) who were ages 60 and over, the diet and physical activity intervention conferred a 71% risk reduction of diabetes after an average follow-up of 3 years. The population of older adults is projected to more than double from 52.5 million in 2019 to ~100 million by 2060, and if projections hold, about half (48.3%) will have prediabetes. The proposed hybrid effectiveness implementation type 1 design will compare a DPP program Tailored for Older Adults and delivered via Telehealth (DPP-TOAT arm) to an in person DPP tailored for older adults (DPP arm) using a randomized, controlled trial design (n=230). The preliminary data suggests DPP-TOAT is a feasible and acceptable way to deliver the DPP to older adults, and this will be the first study to compare the effectiveness and implementation of two strategies (telehealth versus in-person) to deliver a tailored DPP for the unique needs of the growing population of older adults.

Eligible patients will be recruited through electronic health records (Epic and MyChart) and randomized to the 12-month DPP-TOAT or the in-person DPP program. Primary effectiveness outcome will be 6-month weight loss and implementation outcome will be attendance. A pragmatic approach will be used in order to inform future studies conducted in community-based and rural settings. Findings will inform best practices in the delivery of an evidence-based intervention that could reach the 30+ million adults aged 65 and over with prediabetes.

Inclusion Criteria:

• Men and women aged 65 years and older
• Diagnosis of pre-diabetes (A1c between 5.7-6.4%, fasting glucose between 100-125 mg/dL, or oral glucose tolerance test between 140-199 mg/dL within past 12 months)
• BMI of greater than or equal to 30
• English-speaking
• Under the care of a Primary care provider (PCP) in the NYU Langone Health system
• Able to travel to NYU Langone for in-person evaluations
• Access to a telephone
• Informed consent

Exclusion Criteria:

• Prevalent diabetes or end-stage renal disease
• Prior participation in the Diabetes Prevention Program
• A documented current history of active psychosis or other cognitive issues via International Classification of Diseases (ICD) -10 codes
• Taking FDA-approved weight loss medications
• PCP stating that patient should not participate
• Inability to communicate due to severe, uncorrectable hearing loss or speech disorder
• Severe visual impairment that precludes completion of assessments and/or intervention

Data collected from this study include anthropometric and blood draw data that will be uploaded to the participants' electronic medical record and questionnaire data that will only be used for study-related purposes.