Perspectives on Diabetes Care

This is the official blog of the Association of Diabetes Care & Education Specialists where we share recent research and professional opinions on diabetes care and education.


Explore Helpful Views on Diabetes Care & Education

If you're looking for professional opinions on diabetes care and education, you're in the right place. Perspectives on Diabetes Care is the official ADCES® diabetes care and education blog that shares helpful views on diabetes care and education. 

This is where you'll find practical tips on working with people affected by prediabetes, diabetes and related cardiometabolic conditions and the latest research and viewpoints on issues facing diabetes care and education specialists and the people they serve.



Current & Past ADCES Blog Articles


ADCES24 Research Roundtables Series: When to Implement the Diabetes Prevention Program

Jun 13, 2024, 10:56 AM

By Melanie Xanttopoulos

Lillian Madrigal, PhD, will share her findings in conversation this August at the ADCES24 Annual Meeting, where she is a featured contributor to the Research Roundtables Sessions. She can be reached for questions at [email protected].

The Diabetes Prevention Program (DPP) is a lifestyle intervention for those with prediabetes which aims to delay the onset of Type 2 diabetes. Lillian Madrigal, PhD, and her team have studied, with multiple measures, the implementation of this program across delivery systems. Utilizing the Program Sustainability Assessment Tool (PSAT) and Consolidated Framework for Implementation Research (CFIR), Dr. Madrigal has assessed the organizational qualities that correlate with the sustainability of an organization’s implementation and an organization’s reach. Her findings may improve our understanding of how and when to best implement the DPP for more effective patient outcomes.

Madrigal et al. assert that evidence-based interventions must be scaled and sustained to make a population-level impact. They set out to measure sustainability in the delivery of the DPP among varied organizations. Among those programs evaluated by the PSAT, 70% were placed in the high or medium-high sustainability class. Several factors were identified as highly associated with sustainability. These included the use of grant funding, organizational capacity and communications domains, the environmental support domain (effective leadership and support from champions), virtual delivery mode options, and being a government or academic institution. Factors such as rural location and reliance on Medicare and Medicaid were less highly associated with sustainability. It was found that organizational type and sustainability were not significantly correlated.

Madrigal and team also measured delivery programs using the CFIR, assessing how inner and outer setting constructs impact implementation reach. Overall, the majority of interviewees rated using the CFIR were net positive in terms of their implementation examples across evaluated constructs. The following four inner setting constructs are demonstrative of how CFIR measurements were used to understand implementation reach. First, structural characteristics were negatively rated among those assessed as low reach, citing infrastructure, staffing, and administrative issues. Organization type and its effect on reach, available resources, administrative processes, and community reputation were most salient across all cases.

The inner setting of compatibility relates to the intervention’s fit into the organization. High and medium reach groups more often exemplified strong measures of compatibility impacting implementation. The goals and feedback setting, a measure of how goals are clearly communicated, acted upon and fed back to staff, and the alignment of feedback with goals was demonstrated with a high correlation between reach goals and high reach level organizations. Lastly, high and medium reach cases had strong positive examples of leadership engagement: commitment, involvement and accountability of leaders.

Dr. Madrigal’s findings illuminate the organizational qualities most associated with effective implementation of the DPP, key to understanding how best to administer this program. 


Lillian Madrigal, PhD, serves as the Director of Implementation Science & Practice at The Emory Centers for Public Health Training and Technical Assistance. Her work focuses on the implementation and evaluation of evidence-based interventions to promote health behaviors and outcomes. In her role at Emory Centers, she works on projects across all of the sub-centers (DTTAC, EnCORE, PEQI and TTAC) providing subject matter expertise on research and evaluation design, mixed-method data collection and analysis, project management, scientific writing, training and curriculum development, and technical assistance delivery.

Dr. Madrigal received her PhD from the Department of Behavioral, Social and Health Education Sciences at Emory University Rollins School of Public Health and also holds an MPH from the University of Michigan School of Public Health. Prior to joining Emory, she worked as a Senior Research Scientist at ICF, a global consulting company, and was an ORISE fellow in the CDC’s Office of Smoking and Health.