Diabetes prevention is a public health priority that is dependent upon the reach effectiveness and cost of intervention strategies. contrast the effects of 3 interventions: (1) a standard care small group diabetes prevention education class (SG) (2) the small group intervention plus 12 months of interactive voice response telephone follow-up (SG-IVR) and (3) a DVD version of the small group intervention with the same IVR follow-up (DVD-IVR). Each intervention includes personal action planning with a focus on key elements of the lifestyle intervention from the Diabetes Prevention Program (DPP). Adult patients at risk for diabetes will be randomly assigned to either choice or RCT. Those assigned to choice (n=240) will have the opportunity to choose between SG-IVR and DVD-IVR. Those assigned to RCT group (n=360) will be randomly assigned to SG SG-IVR or DVD-IRV. Assessment of primary (weight loss reach & cost) and secondary (physical activity & dietary intake) outcomes will occur at baseline 6 12 and 18 months. This will be the Obeticholic Acid first diabetes prevention trial that will allow the research team to determine the relationships between reach effectiveness and cost of different interventions. Patients Obeticholic Acid who receive care at the Carilion Clinic Family and Community Medicine Clinics in the greater Roanoke Metropolitan area in southwest Virginia will be invited to participate in this study. The inclusion and exclusion criteria (see table 1 for detailed information) are as broad as possible to improve the likelihood of attracting a representative sample of patients at risk for type 2 diabetes to the study and increase the likelihood that our findings are generalizable and relevant to typical patient populations [22-24]. Initial eligibility will be determined using Carilion Clinic electronic medical records to identify potential participants (i.e. ≥18 years old BMI of 25 or greater ICD-9 codes for prediabetes glucose intolerance metabolic syndrome and obesity while excluding those with ICD-9 codes indicating diagnosed diabetes congestive heart failure and coronary artery disease). Finally all participants will be screened for information necessary to complete the Diabetes Risk Calculator  to ensure patients at risk for diabetes are enrolled in the study. those who are positively identified as having diabetes will be excluded from the study. Table 1 Overview and Research Design The Carilion Clinic Family and Community Medicine includes 12 practices in the recruitment area and 237 primary care physicians who provide care for over 150 0 patients patients will be randomized to prior to any study contact All participants who choose or are randomized to the DVD/IVR program will receive the DVD to take home following the baseline data collection. A DVD player will be provided at no cost to those participants without one. Those in the SC and SG/IVR will have their SG date scheduled within a month of the baseline visit. small group session that was designed to help patients develop a personal action plan for diabetes prevention [29-31]. This session is available to any Carilion Clinic patient who has been diagnosed with pre-diabetes or has blood glucose concentration ITGA2 between 100-125 mg/dL (i.e. IFG)session. Details of the content of this intervention have been fully described elsewhere [29-31]. Participants in the sessions are encouraged to set a goal of losing 10% of their current weight over 12 months and to established a goal to become physically energetic for 60 a few minutes 5 days weekly. This content of the non-public actions plan originated to handle the same working principles that supplied the foundation for the DPP life style periods  including list motivational reasons in order to avoid diabetes personal goals for weight reduction exercise and healthful consuming identifying barriers ways of overcome obstacles and upholding accountability for these goals through a committed action to enlist close friends and/or family in the alter procedure [29 30 An application outline and content material were created to facilitate debate among the individuals prompting group discussion enabling exchange of tips around public cues for living a wholesome lifestyle methods to consume healthfully when eating out the usage of stimulus handles and methods for getting back on the right track when Obeticholic Acid one slips out of a wholesome regular [29 30 this program was made to end up being longer you need to include more supportive telephone calls than our prior research . The.