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Background: Translational diabetes prevention lifestyle change programs can promote weight loss and reduce cardiometabolic risk factors in those at high risk for diabetes. Few studies have examined completion of such programs in the real world or the relationship between program completion and cardiometabolic outcomes. Methods: In this retrospective study, we identified program participants, ≥18 years of age, in the electronic health records (2010-2017) of a large, community-based healthcare system. We examined the number of classes completed during the 12-week intensive core phase of the program (12 sessions max) and the total number of sessions completed during the full 12-month curriculum (26 session max). We further examined the relationship between total session completion and changes in weight, systolic/diastolic blood pressure (SBP/DBP), and total cholesterol (TC) at 12 months (±3 months) follow-up, using linear regression with adjustment for baseline characteristics. Results: We identified 1,116 program participants meeting eligibility criteria. At baseline, mean weight = 99 kg, SBP/DBP = 126/76 mmHg, and TC = 192 mg/dL. Participants attended a mean of 9 of 12 sessions (median=11) during the intensive core phase, and 60% completed ≥10 sessions. Participants attended a mean of 14 sessions (median=15) over the full 12-month program. Each session completed was statistically significantly associated with, on average, a -0.39 kg change in weight (P Conclusion: In real-world clinical practice, lifestyle change program completion is suboptimal, yet evidence suggests that greater class attendance is associated with better outcomes. Strategies to promote program retention can have an important impact on cardiometabolic risk reduction. Disclosure H. Huang: None. K.M. Azar: None. S. Sudat: None. A. Pressman: None. R. Romanelli: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases