Brian, I am of the opinion that the people that were living with prediabetes progressed to T2DM because they didn't maintain the behaviors. Remember, one of the outcomes was lifestyle modification (aka behavior change). From a theorectical perspective, (because this is what I do professionally) one can lapse or relapse into the very behaviors that predisposed them to "prediabetes."
One's motivation to change behavior as well as self-efficacy has to be assessed to determine whether the individual's self-efficacy is high enough to continue to engage in the behavior s/he recently adopted. Lifestyle as operationalized by the DPP may not be suitable approach for the participants once the trial was over. Why would anybody continue with a "lifestyle intervention" that didn't meet the needs of their "lifestyle."
As I mentioned to you at the AADE last year, I am very passionate about DPP implementation. Where I feel the challenge is is included the very health care providers who were on the DPP intervention team on the health care teams when the DPP is implemented in real life.
What gets my goat is that I have earned all the credential academic and otherwise, I am a clinical exercise physiologist yet it is very rare that you will see a clinical exercise physiologist/cde on a DSME or DPP team. The DPP used exercise physiologists.
If you look at every DPP intervention that has been translated into real life, very few (I can count them on one hand) have utilized the knowledge, skills of exercise professionals.
I genuinely respect the work that RNs do but for the most part they implement they DPP. That really gets my goat!