1
|
Cabré JJ, Barrio F, Vizcaíno J, Martínez A, Mur T, Sagarra R, Dalmau S. Results of the implementation of the DP-TRANSFERS project in Catalonia: a translational method to improve diabetes screening and prevention in primary care. Rev Clin Esp 2024:S2254-8874(24)00112-7. [PMID: 39216807 DOI: 10.1016/j.rceng.2024.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Accepted: 06/25/2024] [Indexed: 09/04/2024]
Abstract
INTRODUCTION DP-TRANSFERS is a translational lifestyle intervention project, which follows a previous protocol described in the DE-PLAN-CAT study. OBJECTIVE Analyze the feasibility of reproducing the intensive intervention and estimating the effect of translation in real conditions of clinical practice in primary care. METHODOLOGY Implementation of the face-to-face group intervention adjusted to 2 years. After screening, the intervention consisted of a basic module and a continuity module. Stratifying by clusters (health centers), a representative sample (centers, professionals and participants) was evaluated (FINDRISC > 11 and/or prediabetes) from 2016 to 2020. The effect of the intervention on the incidence of diabetes was analyzed. RESULTS The intervention, feasible in 95 of 123 centers, involved 343 of 647 professionals. Of 2381 subjects screened, 1713 participated in the basic module, with 1186 participants completing the first year and 776 completing the second. 121 participants (7.06%) were diagnosed with diabetes: 77 (4.49%) during the first year; 44 (2.57%) during the second. The bivariate analysis showed that those subjects in whom diabetes affected differed in: previous glycemic status, A1c, HDL-cholesterol, FINDRISC score and adherence to the Mediterranean diet, and in the differences between the beginning and end of the study of: body weight, BMI and abdominal circumference. CONCLUSIONS The intensive intervention substantially reduced (23.6%) the incidence of diabetes compared to that previously estimated in standardized intervention. The following acted as protective factors: a better glycemic status, lower baseline risk, elevated HDL-cholesterol, or achieving a reduction in weight or abdominal circumference during the study.
Collapse
Affiliation(s)
- J J Cabré
- Instituto de Investigación en Atención Primaria IDIAP Jordi Gol, Institut Català de la Salut, División de Atención Primaria, Reus, Barcelona, Spain; CAP Sant Pere de Reus, Institut Català de la Salut, División de Atención Primaria. Reus, Tarragona, Spain.
| | - F Barrio
- Instituto de Investigación en Atención Primaria IDIAP Jordi Gol, Institut Català de la Salut, División de Atención Primaria, Reus, Barcelona, Spain; CAP Sant Pere de Reus, Institut Català de la Salut, División de Atención Primaria. Reus, Tarragona, Spain
| | - J Vizcaíno
- Instituto de Investigación en Atención Primaria IDIAP Jordi Gol, Institut Català de la Salut, División de Atención Primaria, Reus, Barcelona, Spain; CAP Salou, Institut Català de la Salut, División de Atención Primaria, Salou, Tarragona, Spain
| | - A Martínez
- CAP El Carmel, Institut Català de la Salut, División de Atención Primaria, Barcelona, Spain
| | - T Mur
- CAP Rubí, Atención Primaria Mútua de Terrassa, Terrassa, Barcelona, Spain
| | - R Sagarra
- Instituto de Investigación en Atención Primaria IDIAP Jordi Gol, Institut Català de la Salut, División de Atención Primaria, Reus, Barcelona, Spain
| | - S Dalmau
- Instituto de Investigación en Atención Primaria IDIAP Jordi Gol, Institut Català de la Salut, División de Atención Primaria, Reus, Barcelona, Spain
| |
Collapse
|
2
|
Montes YD, Vergara TA, Molina RT, Guerrero GM, Arrieta LAA, Aschner P, Acosta-Reyes J, Florez-Garcia V, Lechuga EN, Barengo NC. The association between sociodemographic characteristics, clinical indicators and body mass index in a population at risk of type 2 diabetes: A cross-sectional study in two Colombian cities. Prim Care Diabetes 2024; 18:458-465. [PMID: 38862312 DOI: 10.1016/j.pcd.2024.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 05/25/2024] [Accepted: 06/02/2024] [Indexed: 06/13/2024]
Abstract
AIMS To assess the association between sociodemographic and clinical factors with body mass index (BMI) in a population at risk of type 2 diabetes (T2D) in Bogotá and Barranquilla, Colombia. METHODS This cross-sectional study used data from the PREDICOL Study. Participants with a FINDRISC ≥ 12 who underwent an Oral Glucose Tolerance Test (OGTT) were included in the study (n=1166). The final analytical sample size was 1101 participants. Those with missing data were excluded from the analysis (n=65). The main outcome was body mass index (BMI), which was categorized as normal, overweight, and obese. We utilized unadjusted and adjusted ordinal logistic regression analysis to calculate odds ratios (OR) and 95 % confidence intervals (CI). RESULTS The prevalence of overweight and obesity was 41 % (n=449) and 47 % (n=517), respectively. Participants with a 2-hour glucose ≥139 mg/dl had 1.71 times higher odds of being overweight or obese (regarding normal weight) than participants with normal 2-hour glucose values. In addition, being a woman, waist circumference altered, and blood pressure >120/80 mmHg were statistically significantly associated with a higher BMI. CONCLUSION Strategies to control glycemia, blood pressure, and central adiposity are needed in people at risk of T2D. Future studies should be considered with a territorial and gender focus, considering behavioral, and sociocultural patterns.
Collapse
Affiliation(s)
- Yenifer Diaz Montes
- Department of Preventive Medicine and Public Health. School of Medicine, Universidad Autónoma de Madrid, 28029 Madrid, Spain; Department of Public Health, Division of Health Sciences, Universidad del Norte, Km 5 vía Puerto Colombia, Barranquilla, Colombia; Faculty of Nursing Sciences, Universidad Cooperativa de Colombia, Santa Marta, Colombia.
| | - Tania Acosta Vergara
- Department of Public Health, Division of Health Sciences, Universidad del Norte, Km 5 vía Puerto Colombia, Barranquilla, Colombia
| | - Rafael Tuesca Molina
- Department of Public Health, Division of Health Sciences, Universidad del Norte, Km 5 vía Puerto Colombia, Barranquilla, Colombia; ScienceFlows Research Group, Universidad de Valencia, Valencia, Spain
| | - Gillian Martinez Guerrero
- Department of Public Health, Division of Health Sciences, Universidad del Norte, Km 5 vía Puerto Colombia, Barranquilla, Colombia
| | - Luis A Anillo Arrieta
- Department of Public Health, Division of Health Sciences, Universidad del Norte, Km 5 vía Puerto Colombia, Barranquilla, Colombia; College of Basic Sciences, Department of Mathematics and Statistics, Universidad del Norte, Barranquilla, Colombia
| | - Pablo Aschner
- Colombian Association for Diabetes, Bogotá, Colombia; Universidad Javeriana, Bogotá, Colombia; San Ignacio University Hospital, Bogotá, Colombia
| | - Jorge Acosta-Reyes
- Department of Preventive Medicine and Public Health. School of Medicine, Universidad Autónoma de Madrid, 28029 Madrid, Spain; Department of Public Health, Division of Health Sciences, Universidad del Norte, Km 5 vía Puerto Colombia, Barranquilla, Colombia
| | - Victor Florez-Garcia
- Department of Public Health, Division of Health Sciences, Universidad del Norte, Km 5 vía Puerto Colombia, Barranquilla, Colombia; Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, WI 53211, USA
| | - Edgar Navarro Lechuga
- Department of Public Health, Division of Health Sciences, Universidad del Norte, Km 5 vía Puerto Colombia, Barranquilla, Colombia
| | - Noël C Barengo
- Department of Medical Education, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA; Escuela Superior de Medicina, Universidad Nacional de Mar del Plata, Mar del Plata, Argentina
| |
Collapse
|
3
|
Batalha MJ, Gabriel T, Valentim A, Soledade A, Gomes C, Alves B, Dos Santos ES, Passadouro R, Dias SS. Health literacy - study protocol for LiSa cohort study. BMC Public Health 2024; 24:1737. [PMID: 38951815 PMCID: PMC11218293 DOI: 10.1186/s12889-024-19148-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 06/14/2024] [Indexed: 07/03/2024] Open
Abstract
BACKGROUND Health literacy is the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others, whether at home, at the workplace, in the community, marketplace, healthcare sector, or the political arena. The main aim of this project is to measure health literacy in the adult population living in the municipality of Leiria over the next 10 years. As secondary objectives it is intended to characterize anxiety and depression, metabolic risk and health behaviors in the same population and over the same period. METHODS This is a prospective cohort study that collects data on HL, anxiety and depression, health characteristics, health behavior and sociodemographic data. The study population will be composed by adults (≥ 18 years old) who are non-institutionalized and living in private households in Leiria. The random sample is stratified by gender and age groups. A face-to-face interview will be conducted with the Computer Assisted Personal Interview at baseline. Follow-up will be carried out every 2 years via telephone call. The association between independent variables and health literacy is examined by means of variance analysis with measurement repetition, and taking into consideration follow-up. DISCUSSION The LiSa project is a population-based study, derived from a random sampling technique that will allow the analysis of health outcomes in a representative sample of the population of the municipality of Leiria. The LiSa study will be a valuable resource for epidemiological research, as it will provide fundamental information to improve public health policies regarding health literacy in Portugal. TRIAL REGISTRATION Clinical trials: NCT05558631 (registered on 26/09/2022).
Collapse
Affiliation(s)
- Maria João Batalha
- ciTechCare - Center for Innovative Care and Health Technology, Polytechnic of Leiria, Leiria, Portugal
| | - Tiago Gabriel
- Unidade Local de Saúde da Região de Leiria, Leiria, Portugal
| | | | | | - Cátia Gomes
- Câmara Municipal de Leiria, Leiria, Portugal
| | | | | | - Rui Passadouro
- ciTechCare - Center for Innovative Care and Health Technology, Polytechnic of Leiria, Leiria, Portugal
- Unidade Local de Saúde da Região de Leiria, Leiria, Portugal
| | - Sara Simões Dias
- ciTechCare - Center for Innovative Care and Health Technology, Polytechnic of Leiria, Leiria, Portugal.
- School of Health Sciences, Polytechnic of Leiria, Leiria, Portugal.
| |
Collapse
|
4
|
Skurk T, Grünerbel A, Hummel S, Kabisch S, Keuthage W, Müssig K, Nussbaumer H, Rubin D, Simon MC, Tombek A, Weber KS. Nutritional Recommendations for the Prevention of Type 2 Diabetes Mellitus. Exp Clin Endocrinol Diabetes 2024; 132:68-82. [PMID: 38232741 DOI: 10.1055/a-2166-6943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Affiliation(s)
- Thomas Skurk
- ZIEL - Institute for Food & Health, Core Facility Human Studies, Technical University Munich, Freising, Germany
| | | | - Sandra Hummel
- Helmholtz Diabetes Centre Institute of Diabetes Research Munich, Research Centre for Health and Environment (GmbH), Munich-Neuherberg, Germany
| | - Stefan Kabisch
- German Institute of Human Nutrition Potsdam-Rehbrücke, Potsdam, Germany
| | - Winfried Keuthage
- Specialist Practice for Diabetes and Nutritional Medicine, Münster, Germany
| | - Karsten Müssig
- Department of Internal Medicine, Gastroenterology and Diabetology, Niels Stensen Hospitals, Franziskus Hospital Harderberg, Georgsmarienhütte, Germany
| | | | - Diana Rubin
- Vivantes Hospital Spandau, Berlin, Germany
- Vivantes Humboldt Hospital, Berlin, Germany
| | - Marie-Christine Simon
- Institute of Nutrition and Food Sciences, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - Astrid Tombek
- Diabetes Centre Bad Mergentheim, Bad Mergentheim, Germany
| | - Katharina S Weber
- Institute for Epidemiology, Christian-Albrechts University of Kiel, Kiel, Germany
| |
Collapse
|
5
|
Parkinson J, Clark K, McIntosh T. The Collaborative Service Design Playbook to plan, design, and implement sustainable health services for impact. Health Mark Q 2024; 41:11-32. [PMID: 37195673 DOI: 10.1080/07359683.2023.2211853] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
This paper sets out the Collaborative Service Design Playbook, to guide planning, design, and implementation of co-created health services. Successful health service development and implementation is best guided by theoretically informed approaches; however, organisations often lack design and implementation know-how and have difficulty applying it. This study seeks to improve health service design and potential for scale-up by proposing a tool to guide an end-to-end process, drawing together service design, co-design, and implementation science; and exploring the tool's feasibility to establish a sustainable service solution developed with participants and experts that is scalable and sustainable. The Collaborative Service Design Playbook phases include, (1) Define the opportunity and initiatives, (2) Design the concept and prototype, (3) Deliver to scale and evaluate; and (4) Optimise to transform and sustain. This paper has implications for health marketing through providing an end-to-end approach with phased guidance for health service development, implementation, and scale up.
Collapse
Affiliation(s)
- Joy Parkinson
- Australian eHealth Research Centre, CSIRO, Griffith Business School, Griffith University, Brisbane, Australia
| | - Kristen Clark
- Diabetes Queensland, Health and Wellbeing Queensland, Brisbane, Australia
| | - Tegan McIntosh
- Diabetes Queensland, Institute for Urban Indigenous Health, Brisbane, Australia
| |
Collapse
|
6
|
Huttunen-Lenz M, Raben A, Adam T, Macdonald I, Taylor MA, Stratton G, Mackintosh K, Martinez JA, Handjieva-Darlenska T, Bogdanov GA, Poppitt SD, Silvestre MP, Fogelholm M, Jalo E, Brand-Miller J, Muirhead R, Schlicht W. Socio-economic factors, mood, primary care utilization, and quality of life as predictors of intervention cessation and chronic stress in a type 2 diabetes prevention intervention (PREVIEW Study). BMC Public Health 2023; 23:1666. [PMID: 37649005 PMCID: PMC10466828 DOI: 10.1186/s12889-023-16569-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 08/20/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Sedentary lifestyle and unhealthy diet combined with overweight are risk factors for type 2 diabetes (T2D). Lifestyle interventions with weight-loss are effective in T2D-prevention, but unsuccessful completion and chronic stress may hinder efficacy. Determinants of chronic stress and premature cessation at the start of the 3-year PREVIEW study were examined. METHODS Baseline Quality of Life (QoL), social support, primary care utilization, and mood were examined as predictors of intervention cessation and chronic stress for participants aged 25 to 70 with prediabetes (n = 2,220). Moderating effects of sex and socio-economic status (SES) and independence of predictor variables of BMI were tested. RESULTS Participants with children, women, and higher SES quitted intervention earlier than those without children, lower SES, and men. Lower QoL, lack of family support, and primary care utilization were associated with cessation. Lower QoL and higher mood disturbances were associated with chronic stress. Predictor variables were independent (p ≤ .001) from BMI, but moderated by sex and SES. CONCLUSIONS Policy-based strategy in public health should consider how preventive interventions may better accommodate different individual states and life situations, which could influence intervention completion. Intervention designs should enable in-built flexibility in delivery enabling response to individual needs. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01777893.
Collapse
Affiliation(s)
- Maija Huttunen-Lenz
- Institute of Nursing Science, University of Education Schwäbisch Gmünd, Oberbettringerstraße 200, 73525, Schwäbisch Gmünd, Germany.
| | - Anne Raben
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958, Frederiksberg, Denmark
- Clinical Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Tanja Adam
- Department of Nutrition and Movement Sciences, NUTRIM, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Ian Macdonald
- MRC/ARUK Centre for Musculoskeletal Ageing Research, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, University of Nottingham, School of Life Sciences, Nottingham, NG7 2UH, UK
- Nestle Institute of Health Sciences, Nestle Research, Route du Jorat 57, 1000, Lausanne 26, CH, Switzerland
| | - Moira A Taylor
- University of Nottingham, School of Life Sciences, Nottingham, NG7 2UH, UK
| | - Gareth Stratton
- Sport and Exercise Sciences, Swansea University, Swansea, West Glamorgan, UK
| | - Kelly Mackintosh
- Applied Sports, Technology, Exercise and Medicine Research Centre, Swansea University, Swansea, West Glamorgan, UK
| | - J Alfredo Martinez
- Department of Medicine and Endocrinology, University of Valladolid, Valladolid, Spain
- CIBER Fisiopatología Obesidad Y Nutrición (CIBERobn), Instituto de Salud Carlos III, IMDEAfood Madrid, 28029, Madrid, Spain
| | | | - Georgi Assenov Bogdanov
- Department of Pharmacology and Toxicology, Medical University of Sofia, Sofia, 1000, Bulgaria
| | - Sally D Poppitt
- Department of Medicine, University of Auckland, Human Nutrition Unit, School of Biological Sciences, Auckland, 1024, New Zealand
| | - Marta P Silvestre
- Human Nutrition Unit, School of Biological Sciences, University of Auckland, Auckland, 1024, New Zealand
- Nutrition & Metabolism, CINTESIS, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Mikael Fogelholm
- Department of Food and Nutrition, University of Helsinki, 00014, Helsinki, Finland
| | - Elli Jalo
- Department of Food and Nutrition, University of Helsinki, 00014, Helsinki, Finland
| | - Jennie Brand-Miller
- School of Life and Environmental Sciences and Charles Perkins Centre, University of Sydney, Camperdown, NSW, 2006, Australia
| | - Roslyn Muirhead
- School of Life and Environmental Sciences and Charles Perkins Centre, University of Sydney, Camperdown, NSW, 2006, Australia
| | - Wolfgang Schlicht
- Department of Exercise and Health Sciences, University of Stuttgart, 70569, Stuttgart, Germany
| |
Collapse
|
7
|
Golovaty I, Ritchie ND, Tuomilehto J, Mohan V, Ali MK, Gregg EW, Bergman M, Moin T. Two decades of diabetes prevention efforts: A call to innovate and revitalize our approach to lifestyle change. Diabetes Res Clin Pract 2023; 198:110195. [PMID: 36470316 PMCID: PMC10079599 DOI: 10.1016/j.diabres.2022.110195] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 11/07/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022]
Abstract
The impact of global diabetes prevention efforts has been modest despite the promise of landmark diabetes prevention trials nearly twenty years ago. While national and regional initiatives show potential, challenges remain to adapt large-scale strategies in the real-world that fits individuals and their communities. Additionally, the sedentary lifestyle changes during the COVID-19 pandemic and guidelines that now call for earlier screening (e.g., US Preventative Task Force) will increase the pool of eligible adults worldwide. Thus, a more adaptable, person-centered approach that expands the current toolkit is urgently needed to innovate and revitalize our approach to diabetes prevention. This review identifies key priorities to optimize the population-level delivery of diabetes prevention based on a consensus-based evaluation of the current evidence among experts in global translational programs; key priorities identified include (1) participant eligibility, (2) intervention intensity, (3) delivery components, (4) behavioral economics, (5) technology, and (6) the role of pharmacotherapy. We offer a conceptual framework for a broader, person-centered approach to better address an individual's risk, readiness, barriers, and digital competency.
Collapse
Affiliation(s)
- Ilya Golovaty
- Division of General Internal Medicine, University of Washington School of Medicine, Seattle, WA, USA; General Medicine Service, VA Puget Sound Health Care System, Seattle, WA, USA.
| | - Natalie D Ritchie
- Office of Research, Denver Health and Hospital Authority, Denver, CO. Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO. University of Colorado College of Nursing, Aurora, CO, USA
| | - Jaakko Tuomilehto
- Public Health Promotion Unit, Finnish Institute for Health and Welfare, Helsinki, Finland; Department of Public Health, University of Helsinki, Helsinki, Finland; Saudi Diabetes Research Group, King Abdulaziz University Jeddah, Saudi Arabia; Department of International Health, National School of Public Health, Instituto de Salud Carlos III. Madrid, Spain
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation & Chairman, Dr. Mohan's Diabetes Specialties Centre, Chennai, India
| | - Mohammed K Ali
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA, USA; Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Edward W Gregg
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
| | - Michael Bergman
- Division of Endocrinology and Metabolism, Department of Medicine and of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Tannaz Moin
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA; VA Greater Los Angeles Health System and HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, CA, USA
| |
Collapse
|
8
|
Gabriel R, Boukichou-Abdelkader N, Gilis-Januszewska A, Makrilakis K, Gómez-Huelgas R, Kamenov Z, Paulweber B, Satman I, Djordjevic P, Alkandari A, Mitrakou A, Lalic N, Egido J, Más-Fontao S, Calvet JH, Pastor JC, Lindström J, Lind M, Acosta T, Silva L, Tuomilehto J. Reduction in the Risk of Peripheral Neuropathy and Lower Decrease in Kidney Function with Metformin, Linagliptin or Their Fixed-Dose Combination Compared to Placebo in Prediabetes: A Randomized Controlled Trial. J Clin Med 2023; 12:jcm12052035. [PMID: 36902821 PMCID: PMC10004435 DOI: 10.3390/jcm12052035] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 02/18/2023] [Accepted: 02/27/2023] [Indexed: 03/08/2023] Open
Abstract
OBJECTIVE To compare the effect of glucose-lowering drugs on peripheral nerve and kidney function in prediabetes. METHODS Multicenter, randomized, placebo-controlled trial in 658 adults with prediabetes treated for 1 year with metformin, linagliptin, their combination or placebo. Endpoints are small fiber peripheral neuropathy (SFPN) risk estimated by foot electrochemical skin conductance (FESC < 70 μSiemens) and estimated glomerular filtration rate (eGFR). RESULTS Compared to the placebo, the proportion of SFPN was reduced by 25.1% (95% CI:16.3-33.9) with metformin alone, by 17.3% (95% CI 7.4-27.2) with linagliptin alone, and by 19.5% (95% CI 10.1-29.0) with the combination linagliptin/metformin (p < 0.0001 for all comparisons). eGFR remained +3.3 mL/min (95% CI: 0.38-6.22) higher with the combination linagliptin/metformin than with the placebo (p = 0.03). Fasting plasma glucose (FPG) decreased more with metformin monotherapy -0.3 mmol/L (95%CI: -0.48; 0.12, p = 0.0009) and with the combination metformin/linagliptin -0.2 mmol/L (95% CI: -0.37; -0.03) than with the placebo (p = 0.0219). Body weight (BW) decreased by -2.0 kg (95% CI: -5.65; -1.65, p = 0.0006) with metformin monotherapy, and by -1.9 kg (95% CI: -3.02; -0.97) with the combination metformin/linagliptin as compared to the placebo (p = 0.0002). CONCLUSIONS in people with prediabetes, a 1 year treatment with metformin and linagliptin, combined or in monotherapy, was associated with a lower risk of SFPN, and with a lower decrease in eGFR, than treatment with placebo.
Collapse
Affiliation(s)
- Rafael Gabriel
- Departamento de Salud Internacional, Escuela Nacional de Sanidad, Instituto de Salud Carlos III, 28029 Madrid, Spain
- World Community for Prevention of Diabetes Foundation (WCPD), 28001 Madrid, Spain
- Asociación para la Investigación y Prevención de la Diabetes y Enfermedades Cardiovasculares (PREDICOR), 28001 Madrid, Spain
- Correspondence:
| | - Nisa Boukichou-Abdelkader
- Asociación para la Investigación y Prevención de la Diabetes y Enfermedades Cardiovasculares (PREDICOR), 28001 Madrid, Spain
- EVIDEM CONSULTORES, 28030 Madrid, Spain
| | | | | | - Ricardo Gómez-Huelgas
- Internal Medicine Department, Regional University Hospital of Málaga, Biomedical Research Institute of Málaga (IBIMA), University of Málaga (UMA), 29018 Málaga, Spain
| | - Zdravko Kamenov
- Clinic of Endocrinology, University Multi-Profile Hospital for Active Treatment Alexandrovska EAD, Medical University of Sofia, 1431 Sofia, Bulgaria
| | - Bernhard Paulweber
- Gemeinnuetzige Salzburger Landeskliniken Betriebsgesellschaft (SALK), 5020 Salzburg, Austria
| | - Ilhan Satman
- Division of Endocrinology & Metabolism, Department of Internal Medicine, Istanbul University, 34093 Istanbul, Turkey
| | | | | | | | - Nebojsa Lalic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Jesús Egido
- Renal, Vascular and Diabetes Research Laboratory, Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Universidad Autónoma, 28040 Madrid, Spain
| | - Sebastián Más-Fontao
- Renal, Vascular and Diabetes Research Laboratory, Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Universidad Autónoma, 28040 Madrid, Spain
| | | | - José Carlos Pastor
- Instituto Universitario de Oftalmobiología Aplicada (IOBA), Hospital Clínico Universitario, Universidad de Valladolid, 47011 Valladolid, Spain
| | - Jaana Lindström
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, 00271 Helsinki, Finland
| | - Marcus Lind
- Department of Molecular and Clinical Medicine, University of Gothenburg, 413 45 Gothenburg, Sweden
- Department of Medicine, NU-Hospital Group, 451 53 Uddevalla, Sweden
- Department of Internal Medicine, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden
| | - Tania Acosta
- Department of Public Health, Universidad del Norte, Barranquilla 080001, Colombia
| | | | - Jaakko Tuomilehto
- Departamento de Salud Internacional, Escuela Nacional de Sanidad, Instituto de Salud Carlos III, 28029 Madrid, Spain
- World Community for Prevention of Diabetes Foundation (WCPD), 28001 Madrid, Spain
- Asociación para la Investigación y Prevención de la Diabetes y Enfermedades Cardiovasculares (PREDICOR), 28001 Madrid, Spain
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, 00271 Helsinki, Finland
- Department of Public Health, University of Helsinki, 00014 Helsinki, Finland
- Diabetes Research Group, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | | |
Collapse
|
9
|
Type 2 Diabetes Prevention Programs-From Proof-of-Concept Trials to National Intervention and Beyond. J Clin Med 2023; 12:jcm12051876. [PMID: 36902668 PMCID: PMC10003211 DOI: 10.3390/jcm12051876] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 02/19/2023] [Accepted: 02/21/2023] [Indexed: 03/08/2023] Open
Abstract
The prevention of type 2 diabetes (T2D) in high-risk people with lifestyle interventions has been demonstrated by several randomized controlled trials. The intervention effect has sustained up to 20 years in post-trial monitoring of T2D incidence. In 2000, Finland launched the national T2D prevention plan. For screening for high T2D risk, the non-laboratory Finnish Diabetes Risk Score was developed and widely used, also in other countries. The incidence of drug-treated T2D has decreased steadily since 2010. The US congress authorized public funding for a national diabetes prevention program (NDPP) in 2010. It was built around a 16-visit program that relies on referral from primary care and self-referral of persons with either prediabetes or by a diabetes risk test. The program uses a train-the-trainer program. In 2015 the program started the inclusion of online programs. There has been limited implementation of nationwide T2D prevention programs in other countries. Despite the convincing results from RCTs in China and India, no translation to the national level was introduced there. T2D prevention efforts in low-and middle-income countries are still limited, but results have been promising. Barriers to efficient interventions are greater in these countries than in high-income countries, where many barriers also exist. Health disparities by socioeconomic status exist for T2D and its risk factors and form a challenge for preventive interventions. It seems that a stronger commitment to T2D prevention is needed, such as the successful WHO Framework Convention on Tobacco Control, which legally binds the countries to act.
Collapse
|
10
|
Parsons J, Forde R, Brackenridge A, Hunt KF, Ismail K, Murrells T, Reid A, Rogers H, Rogers R, Forbes A. The gestational diabetes future diabetes prevention study (GODDESS): A partially randomised feasibility controlled trial. PLoS One 2022; 17:e0273992. [PMID: 36584120 PMCID: PMC9803154 DOI: 10.1371/journal.pone.0273992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 08/19/2022] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES To assess the feasibility of an ante- and post-natal lifestyle intervention for women with gestational diabetes mellitus (GDM) to reduce type 2 diabetes risk. DESIGN A partially randomised patient preference feasibility trial. SETTING Diabetes antenatal clinics in two inner-London hospitals, UK. PARTICIPANTS Pregnant women ≥18 years with a GDM diagnosis and pre-pregnancy body mass index of ≥25kg/m2. INTERVENTION Participants in the intervention group were offered four motivational interview-based sessions (two antenatally and two postnatally, at 3 and 6 months postpartum), a WhatsApp support group, a FitBit and electronic self-help resources. OUTCOME MEASURES Recruitment; retention; intervention dose received; data completion; adaptions; proportion achieving ≥5% weight loss; weight change, blood glucose; blood pressure; diet, physical activity, breastfeeding and depression. Clinical outcomes were measured at baseline and 6 months postpartum. RESULTS 50 participants were recruited from 155 eligible women (32% recruitment rate). Thirty-four were recruited to the intervention group (23 following randomisation (RI-group) and 11 based on preference (PI-group)); and 16 to the control group (13 randomised (RC-group) and 3 preference (PC-group)). Attrition was 44% (n = 22/50). Forty-six percent (n = 6) of the intervention group (25% (n = 2) of the RI-group and 80% (n = 4) of the PI-group) achieved ≥5% weight loss compared to 8% (n = 1) in the control group (95% confidence interval (CI) -0.69 to 0.07). Mean weight change was -2.1kg±9.0 in the intervention group (0kg±5.4 in the RI-group and -5.4kg±13.0 in the PI-group) compared to +4.4kg±4.9 in the control group (RC +4.4kg ±5.3 and PC +4.7kg ±3.1, 95% CI -12.4 to 0.2). CONCLUSIONS Recruitment was feasible, but strategies to improve retention are needed. The findings suggest the intervention can support women with GDM to lose weight. The observed weight loss was primarily in women who preferred the intervention. Therefore, future trials may need to adopt a preference design and consider factors associated with preference. TRIAL REGISTRATION Trial registration: ISRCTN52675820 https://www.isrctn.com/ISRCTN52675820?q=ISRCTN52675820&filters=&sort=&offset=1&totalResults=1&page=1&pageSize=10&searchType=basic-search.
Collapse
Affiliation(s)
- Judith Parsons
- Care in Long Term Conditions Research Division, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, United Kingdom
- * E-mail:
| | - Rita Forde
- Care in Long Term Conditions Research Division, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, United Kingdom
| | | | - Katharine F. Hunt
- Diabetes & Nutritional Sciences Division, Diabetes Research Group, King’s College London, London, United Kingdom
| | - Khalida Ismail
- Department of Psychological Medicine, Institute of Psychiatry, King’s College London, London, United Kingdom
| | - Trevor Murrells
- Methodologies Research Division, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, United Kingdom
| | - Anna Reid
- Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Helen Rogers
- Diabetes & Nutritional Sciences Division, Diabetes Research Group, King’s College London, London, United Kingdom
| | - Rebecca Rogers
- Care in Long Term Conditions Research Division, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, United Kingdom
| | - Angus Forbes
- Care in Long Term Conditions Research Division, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, United Kingdom
| |
Collapse
|
11
|
Predicting Factors for Metabolic Non-Response to a Complex Lifestyle Intervention-A Replication Analysis to a Randomized-Controlled Trial. Nutrients 2022; 14:nu14224721. [PMID: 36432409 PMCID: PMC9699496 DOI: 10.3390/nu14224721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/17/2022] [Accepted: 11/07/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND T2DM heterogeneity affects responsiveness to lifestyle treatment. Beta-cell failure and nonalcoholic fatty liver disease (NAFLD) independently predict T2DM, but NAFLD inconsistently predicts metabolic response to lifestyle intervention. AIM We attempt to replicate a prediction model deducted from the Tübinger Lifestyle Intervention Program by assessing similar metabolic factors to predict conversion to normal glucose regulation (NGR) in a comparable lifestyle intervention trial. METHODS In the Optimal Fiber Trial (OptiFiT), 131 Caucasian participants with prediabetes completed a one-year lifestyle intervention program and received a fiber or placebo supplement. We compared baseline parameters for responders and non-responders, assessed correlations of major metabolic changes and conducted a logistic regression analysis for predictors of remission to NGR. RESULTS NGR was achieved by 33 participants, respectively. At baseline, for the placebo group only, 1 h and 2 h glucose levels, glucose AUC and Cederholm index predicted conversion to NGR. HOMA-beta, HOMA-IR or liver fat indices did not differ between responders and non-responders of the placebo or the fiber group. Changes in waist circumference or fatty liver index correlated with changes in glycemia and insulin resistance, but not with changes in insulin secretion. Insulin-resistant NAFLD did not predict non-response. Differences in compliance did not explain the results. CONCLUSIONS Higher post-challenge glucose levels strongly predicted the metabolic non-response to complex lifestyle intervention in our cohort. Depending on the specific intervention and the investigated cohort, fasting glucose levels and insulin sensitivity might contribute to the risk pattern. Beta-cell function did not improve in accordance with other metabolic improvements, qualifying as a potential risk factor for non-response. We could not replicate previous data suggesting that an insulin-resistant fatty liver is a specific risk factor for treatment failure. Replication studies are required.
Collapse
|
12
|
Tully L, Arthurs N, Wyse C, Browne S, Case L, McCrea L, O’Connell JM, O’Gorman CS, Smith SM, Walsh A, Ward F, O’Malley G. Guidelines for treating child and adolescent obesity: A systematic review. Front Nutr 2022; 9:902865. [PMID: 36313105 PMCID: PMC9597370 DOI: 10.3389/fnut.2022.902865] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 09/13/2022] [Indexed: 11/13/2022] Open
Abstract
Obesity is a chronic disease that compromises the physical and mental health of an increasing proportion of children globally. In high-income countries, prevalence of paediatric obesity is increasing faster in those from marginalised populations such as low-income households, suggesting the disease as one that is largely systemic. Appropriate treatment should be prioritised in these settings to prevent the development of complications and co-morbidities and manage those that already exist. An array of clinical practice guidelines are available for managing overweight and obesity in children and adolescents, but no systematic review has yet compared their quality or synthesised their recommendations. We aimed to narratively review clinical practice guidelines published in English for treating child and adolescent obesity, to identify the highest quality guidelines, and assess similarities, conflicts, and gaps in recommendations. We systematically searched academic databases and grey literature for guidelines published. We used the AGREE II tool to assess the quality, and identified nine high quality guidelines for inclusion in a narrative review of recommendations. Guidelines predominantly recommended the delivery of multi-component behaviour-change interventions aimed at improving nutrition and physical activity. Treatment outcomes were generally focussed on weight, with less emphasis on managing complications or improving quality-of-life. There was no evidence-based consensus on the best mode of delivery, setting, or treatment format. The guidelines rarely included recommendations for addressing the practical or social barriers to behaviour change, such as cooking skills or supervised physical activity. There is insufficient evidence to evaluate pharmaceutical and surgical interventions in children, and these were generally not recommended. It should be noted that this review addressed documents published in English only, and therefore the included guidelines were applicable predominantly to high-resource settings.
Collapse
Affiliation(s)
- Louise Tully
- Obesity Research and Care Group, School of Physiotherapy, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Niamh Arthurs
- Obesity Research and Care Group, School of Physiotherapy, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- W82GO Child and Adolescent Obesity Service, Children’s Health Ireland at Temple Street, Dublin, Ireland
| | - Cathy Wyse
- Obesity Research and Care Group, School of Physiotherapy, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Sarah Browne
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Lucinda Case
- W82GO Child and Adolescent Obesity Service, Children’s Health Ireland at Temple Street, Dublin, Ireland
| | - Lois McCrea
- W82GO Child and Adolescent Obesity Service, Children’s Health Ireland at Temple Street, Dublin, Ireland
| | - Jean M. O’Connell
- St. Columcille’s Hospital Weight Management Service, St.Vincent’s University Hospital, Dublin, Ireland
| | - Clodagh S. O’Gorman
- School of Medicine, University of Limerick, Limerick, Ireland
- Department of Paediatrics, University Hospital Limerick, Limerick, Ireland
| | - Susan M. Smith
- Discipline of Public Health and Primary Care, Trinity College Dublin, Dublin, Ireland
| | - Aisling Walsh
- Department of Epidemiology, Division of Population Health Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Fiona Ward
- Department of Clinical Nutrition and Dietetics, Children’s Health Ireland at Crumlin, Dublin, Ireland
| | - Grace O’Malley
- Obesity Research and Care Group, School of Physiotherapy, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- W82GO Child and Adolescent Obesity Service, Children’s Health Ireland at Temple Street, Dublin, Ireland
| |
Collapse
|
13
|
Kivelä J, Meinilä J, Uusitupa M, Tuomilehto J, Lindström J. Longitudinal Branched-Chain Amino Acids, Lifestyle Intervention, and Type 2 Diabetes in the Finnish Diabetes Prevention Study. J Clin Endocrinol Metab 2022; 107:2844-2853. [PMID: 35917829 PMCID: PMC9516128 DOI: 10.1210/clinem/dgac463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Indexed: 12/05/2022]
Abstract
CONTEXT Circulating branched-chain amino acids (BCAAs) are associated with the risk of type 2 diabetes (T2D). OBJECTIVE We examined to what extent lifestyle intervention aiming to prevent T2D interacts with this association and how BCAA concentrations change during the intervention. METHODS We computed trajectory clusters by k-means clustering of serum fasting BCAAs analyzed annually by mass spectrometry during a 4-year intervention. We investigated whether baseline BCAAs, BCAA trajectories, and BCAA change trajectories predicted T2D and whether BCAAs predicted T2D differently in the intervention (n = 198) and control group (n = 196). RESULTS Elevated baseline BCAAs predicted the incidence of T2D in the control group (hazard ratio [HR] 1.05 per 10 μmol/L, P = 0.01), but not in the intervention group. BCAA concentration decreased during the first year in the whole cohort (mean -14.9 μmol/L, P < 0.001), with no significant difference between the groups. We identified 5 BCAA trajectory clusters and 5 trajectory clusters for the change in BCAAs. Trajectories with high mean BCAA levels were associated with an increased HR for T2D compared with the trajectory with low BCAA levels (trajectory with highest vs lowest BCAA, HR 4.0; P = 0.01). A trajectory with increasing BCAA levels had a higher HR for T2D compared with decreasing trajectory in the intervention group only (HR 25.4, P < 0.001). CONCLUSION Lifestyle intervention modified the association of the baseline BCAA concentration and BCAA trajectories with the incidence of T2D. Our study adds to the accumulating evidence on the mechanisms behind the effect of lifestyle changes on the risk of T2D.
Collapse
Affiliation(s)
- Jemina Kivelä
- Correspondence: Jemina Kivelä, MSc, Finnish Institute for Health and Welfare (THL), Mannerheimintie 166, PO Box 30, FI-00271 Helsinki, Finland.
| | - Jelena Meinilä
- Department of Food and Nutrition, University of Helsinki, 00014 Helsinki, Finland
| | - Matti Uusitupa
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70211 Kuopio, Finland
| | - Jaakko Tuomilehto
- Population Health Unit, Finnish Institute of Health and Welfare, 00271 Helsinki, Finland
- Department of Public Health, University of Helsinki, 00014 Helsinki, Finland
- Saudi Diabetes Research Group, King Abdulaziz University, 80200 Jeddah, Saudi Arabia
- Department of International Health, National School of Public Health, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Jaana Lindström
- Population Health Unit, Finnish Institute of Health and Welfare, 00271 Helsinki, Finland
| |
Collapse
|
14
|
Identifying Glucose Metabolism Status in Nondiabetic Japanese Adults Using Machine Learning Model with Simple Questionnaire. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:1026121. [PMID: 36118835 PMCID: PMC9481387 DOI: 10.1155/2022/1026121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 08/01/2022] [Accepted: 08/29/2022] [Indexed: 11/17/2022]
Abstract
We aimed to identify the glucose metabolism statuses of nondiabetic Japanese adults using a machine learning model with a questionnaire. In this cross-sectional study, Japanese adults (aged 20–64 years) from Tokyo and surrounding areas were recruited. Participants underwent an oral glucose tolerance test (OGTT) and completed a questionnaire regarding lifestyle and physical characteristics. They were classified into four glycometabolic categories based on the OGTT results: category 1: best glucose metabolism, category 2: low insulin sensitivity, category 3: low insulin secretion, and category 4: combined characteristics of categories 2 and 3. A total of 977 individuals were included; the ratios of participants in categories 1, 2, 3, and 4 were 46%, 21%, 14%, and 19%, respectively. Machine learning models (decision tree, support vector machine, random forest, and XGBoost) were developed for identifying the glycometabolic category using questionnaire responses. Then, the top 10 most important variables in the random forest model were selected, and another random forest model was developed using these variables. Its areas under the receiver operating characteristic curve (AUCs) to classify category 1 and the others, category 2 and the others, category 3 and the others, and category 4 and the others were 0.68 (95% confidence intervals: 0.62–0.75), 0.66 (0.58–0.73), 0.61 (0.51–0.70), and 0.70 (0.62–0.77). For external validation of the model, the same dataset of 452 Japanese adults in Hokkaido was obtained. The AUCs to classify categories 1, 2, 3, and 4 and the others were 0.66 (0.61–0.71), 0.57 (0.51–0.62), 0.60 (0.50–0.69), and 0.64 (0.57–0.71). In conclusion, our model could identify the glucose metabolism status using only 10 factors of lifestyle and physical characteristics. This model may help the larger general population without diabetes to understand their glucose metabolism status and encourage lifestyle improvement to prevent diabetes.
Collapse
|
15
|
Sampson M, Clark A, Bachmann M, Garner N, Irvine L, Howe A, Greaves C, Auckland S, Smith J, Turner J, Rea D, Rayman G, Dhatariya K, John WG, Barton G, Usher R, Ferns C, Pascale M. Effects of the Norfolk diabetes prevention lifestyle intervention (NDPS) on glycaemic control in screen-detected type 2 diabetes: a randomised controlled trial. BMC Med 2021; 19:183. [PMID: 34407811 PMCID: PMC8375190 DOI: 10.1186/s12916-021-02053-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 07/06/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The purpose of this trial was to test if the Norfolk Diabetes Prevention Study (NDPS) lifestyle intervention, recently shown to reduce the incidence of type 2 diabetes in high-risk groups, also improved glycaemic control in people with newly diagnosed screen-detected type 2 diabetes. METHODS We screened 12,778 participants at high risk of type 2 diabetes using a fasting plasma glucose and glycosylated haemoglobin (HbA1c). People with screen-detected type 2 diabetes were randomised in a parallel, three-arm, controlled trial with up to 46 months of follow-up, with a control arm (CON), a group-based lifestyle intervention of 6 core and up to 15 maintenance sessions (INT), or the same intervention with additional support from volunteers with type 2 diabetes trained to co-deliver the lifestyle intervention (INT-DPM). The pre-specified primary end point was mean HbA1c compared between groups at 12 months. RESULTS We randomised 432 participants (CON 149; INT 142; INT-DPM 141) with a mean (SD) age of 63.5 (10.0) years, body mass index (BMI) of 32.4 (6.4) kg/m2, and HbA1c of 52.5 (10.2) mmol/mol. The primary outcome of mean HbA1c at 12 months (CON 48.5 (9.1) mmol/mol, INT 46.5 (8.1) mmol/mol, and INT-DPM 45.6 (6.0) mmol/mol) was significantly lower in the INT-DPM arm compared to CON (adjusted difference -2.57 mmol/mol; 95% CI -4.5, -0.6; p = 0.007) but not significantly different between the INT-DPM and INT arms (-0.55 mmol/mol; 95% CI -2.46, 1.35; p = 0.57), or INT vs CON arms (-2.14 mmol/mol; 95% CI -4.33, 0.05; p = 0.07). Subgroup analyses showed the intervention had greater effect in participants < 65 years old (difference in mean HbA1c compared to CON -4.76 mmol/mol; 95% CI -7.75, -1.78 mmol/mol) than in older participants (-0.46 mmol/mol; 95% CI -2.67, 1.75; interaction p = 0.02). This effect was most significant in the INT-DPM arm (-6.01 mmol/mol; 95% CI -9.56, -2.46 age < 65 years old and -0.22 mmol/mol; 95% CI -2.7, 2.25; aged > 65 years old; p = 0.007). The use of oral hypoglycaemic medication was associated with a significantly lower mean HbA1c but only within the INT-DPM arm compared to CON (-7.0 mmol/mol; 95% CI -11.5, -2.5; p = 0.003). CONCLUSION The NDPS lifestyle intervention significantly improved glycaemic control after 12 months in people with screen-detected type 2 diabetes when supported by trained peer mentors with type 2 diabetes, particularly those receiving oral hypoglycaemics and those under 65 years old. The effect size was modest, however, and not sustained at 24 months. TRIAL REGISTRATION ISRCTN34805606 . Retrospectively registered 14.4.16.
Collapse
Affiliation(s)
- Michael Sampson
- Elsie Bertram Diabetes Centre, Department of Diabetes and Endocrinology, Norfolk and Norwich University Hospital NHS Trust, Colney Lane, Norwich, NR4 7UY, UK.
- Norwich Medical School, University of East Anglia, Norwich, UK.
| | - Allan Clark
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Max Bachmann
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Nikki Garner
- Elsie Bertram Diabetes Centre, Department of Diabetes and Endocrinology, Norfolk and Norwich University Hospital NHS Trust, Colney Lane, Norwich, NR4 7UY, UK
| | - Lisa Irvine
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Amanda Howe
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Colin Greaves
- School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Sara Auckland
- Elsie Bertram Diabetes Centre, Department of Diabetes and Endocrinology, Norfolk and Norwich University Hospital NHS Trust, Colney Lane, Norwich, NR4 7UY, UK
| | - Jane Smith
- University of Exeter Medical School, College of Medicine & Health, University of Exeter, Exeter, UK
| | - Jeremy Turner
- Elsie Bertram Diabetes Centre, Department of Diabetes and Endocrinology, Norfolk and Norwich University Hospital NHS Trust, Colney Lane, Norwich, NR4 7UY, UK
| | - Dave Rea
- Elsie Bertram Diabetes Centre, Department of Diabetes and Endocrinology, Norfolk and Norwich University Hospital NHS Trust, Colney Lane, Norwich, NR4 7UY, UK
| | - Gerry Rayman
- Department of Diabetes and Endocrinology, Ipswich General Hospital NHS Trust, Ipswich, UK
| | - Ketan Dhatariya
- Elsie Bertram Diabetes Centre, Department of Diabetes and Endocrinology, Norfolk and Norwich University Hospital NHS Trust, Colney Lane, Norwich, NR4 7UY, UK
| | - W Garry John
- Norwich Medical School, University of East Anglia, Norwich, UK
- Department Clinical Biochemistry, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
| | - Garry Barton
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Rebecca Usher
- Elsie Bertram Diabetes Centre, Department of Diabetes and Endocrinology, Norfolk and Norwich University Hospital NHS Trust, Colney Lane, Norwich, NR4 7UY, UK
| | - Clare Ferns
- Elsie Bertram Diabetes Centre, Department of Diabetes and Endocrinology, Norfolk and Norwich University Hospital NHS Trust, Colney Lane, Norwich, NR4 7UY, UK
| | - Melanie Pascale
- Elsie Bertram Diabetes Centre, Department of Diabetes and Endocrinology, Norfolk and Norwich University Hospital NHS Trust, Colney Lane, Norwich, NR4 7UY, UK
| |
Collapse
|
16
|
Lindström J, Aittola K, Pölönen A, Hemiö K, Ahonen K, Karhunen L, Männikkö R, Siljamäki-Ojansuu U, Tilles-Tirkkonen T, Virtanen E, Pihlajamäki J, Schwab U. Formation and Validation of the Healthy Diet Index (HDI) for Evaluation of Diet Quality in Healthcare. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2362. [PMID: 33670967 PMCID: PMC7967771 DOI: 10.3390/ijerph18052362] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/13/2021] [Accepted: 02/22/2021] [Indexed: 12/17/2022]
Abstract
Lack of tools to evaluate the quality of diet impedes dietary counselling in healthcare. We constructed a scoring for a validated food intake questionnaire, to measure the adherence to a healthy diet that prevents type 2 diabetes (T2D). The Healthy Diet Index (HDI) consists of seven weighted domains (meal pattern, grains, fruit and vegetables, fats, fish and meat, dairy, snacks and treats). We studied the correlations of the HDI with nutrient intakes calculated from 7-day food records among 52 men and 25 women, and associations of HDI with biomarkers and anthropometrics among 645 men and 2455 women. The HDI correlated inversely with total fat (Pearson's r = -0.37), saturated fat (r = -0.37), monounsaturated fat (r = -0.37), and the glycaemic index of diet (r = -0.32) and positively with carbohydrates (r = 0.23), protein (r = 0.25), fibre (r = 0.66), magnesium (r = 0.26), iron (r = 0.25), and vitamin D (r = 0.27), (p < 0.05 for all). In the linear regression model adjusted for BMI and age, HDI is associated inversely with waist circumference, concentrations of fasting and 2-h glucose and triglycerides in men and women, total and LDL cholesterol in women, and fasting insulin in men (p < 0.05 for all). The HDI proved to be a valid tool to measure adherence to a health-promoting diet and to support individualised dietary counselling.
Collapse
Affiliation(s)
- Jaana Lindström
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, 00271 Helsinki, Finland
| | - Kirsikka Aittola
- School of Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70211 Kuopio, Finland
| | - Auli Pölönen
- Division 1, Tampere University Hospital, 33520 Tampere, Finland
| | - Katri Hemiö
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, 00271 Helsinki, Finland
| | - Kirsti Ahonen
- Clinical Nutrition Unit, Tampere University Hospital, 33520 Tampere, Finland
| | - Leila Karhunen
- School of Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70211 Kuopio, Finland
| | - Reija Männikkö
- School of Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70211 Kuopio, Finland
- Department of Medicine, Endocrinology and Clinical Nutrition, Kuopio University Hospital, 70029 Kuopio, Finland
| | | | - Tanja Tilles-Tirkkonen
- School of Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70211 Kuopio, Finland
| | - Eeva Virtanen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, 00271 Helsinki, Finland
| | - Jussi Pihlajamäki
- School of Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70211 Kuopio, Finland
- Department of Medicine, Endocrinology and Clinical Nutrition, Kuopio University Hospital, 70029 Kuopio, Finland
| | - Ursula Schwab
- School of Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70211 Kuopio, Finland
- Department of Medicine, Endocrinology and Clinical Nutrition, Kuopio University Hospital, 70029 Kuopio, Finland
| |
Collapse
|
17
|
Grace J, Biggs C, Naicker A, Moss S. Effect of Physical Activity and Nutrition Education on Body Mass Index, Blood Pressure and Biochemical Variables in Overweight and Obese Adolescents. Ann Glob Health 2021; 87:9. [PMID: 33569283 PMCID: PMC7845469 DOI: 10.5334/aogh.3147] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background The majority of obese children lives in developing countries. The ten-fold increase in obesity during the last four decades necessitates the implementation of interventions to mitigate the longterm effect of obesity into adulthood. The study aimed to determine the impact of physical activity and nutrition intervention on the body mass index (BMI), blood pressure and selected biochemical factors of overweight and obese children aged 13.0 to 16.1 years from eThekweni, South Africa. Methods Participants (N = 41) with a BMI >85th percentile were included in the 10-week controlled trial of physical activity and nutrition education intervention. Baseline and end measurements included BMI, blood pressure, and fasting biochemical variables (glucose, cholesterol, insulin resistance and alanine aminotransferase). BMI was classified according to the WHO BMI z-scores. The 10-week intervention entailed combined aerobic and resistance exercises supervised twice a week together with a once a week nutrition intervention. Participants performed additional unsupervised aerobic exercises three times a week. Findings Elevated systolic blood pressure (52%), low-density lipoprotein levels (29%), insulin (17%) and insulin resistance values (15%) were identified. The 10-week intervention programme significantly decreased BMI (30.8 ± 5.4 kg/m2 to 29.8 ± 5.7 kg/m2; p < 0.01), systolic blood pressure (125.9 ± 15.7 mmHg to 115.2 ± 12.4 mmHg; p < 0.05), and low-density lipoprotein cholesterol (2.63 mmol/L to 2.37 mmol/L; p < 0.05). Controlling for pre-testing variables as covariates, additional ANCOVA analysis highlighted significantly lower BMI (M = 28.33, F = 7.88, p < 0.05) and BMI z-scores (M = 2.08, F = 4.99, p < 0.05) in the intervention group post-testing. Conclusion A 10-week physical activity and nutrition education intervention in overweight and obese adolescents significantly reduced BMI and showed trends of a decrease in blood pressure and low-density lipoprotein cholesterol.
Collapse
|
18
|
Huys N, Van Stappen V, Shadid S, De Craemer M, Androutsos O, Wikström K, Makrilakis K, Moreno LA, Iotova V, Tankova T, Nánási A, Manios Y, Cardon G. Effectiveness of a family-, school- and community-based intervention on physical activity and its correlates in Belgian families with an increased risk for type 2 diabetes mellitus: the Feel4Diabetes-study. BMC Public Health 2020; 20:1231. [PMID: 32787943 PMCID: PMC7425007 DOI: 10.1186/s12889-020-09336-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 08/03/2020] [Indexed: 11/23/2022] Open
Abstract
Background The study aimed to investigate the effectiveness of the European Feel4Diabetes intervention, promoting a healthy lifestyle, on physical activity and its correlates among families at risk for type 2 diabetes mellitus (based on the Finnish Diabetes Risk Score) in Belgium. Methods The Feel4Diabetes intervention involved three components: family, school and community component, with the family component consisting of 6 counseling sessions for families at risk. Main outcomes were objectively measured physical activity levels and its subjectively measured correlates. The final sample consisted of 454 parents (mean age 39.4 years; 72.0% women) and 444 children (mean age 8.0 years; 50.1% girls). Multilevel repeated measures analyses were performed to assess intervention effectiveness after 1 year. Results In parents, there was no significant intervention effect. In children, there were only significant negative effects for moderate to vigorous physical activity (p = 0.05; ηp2 = 0.008) and steps (p = 0.03; ηp2 = 0.006%) on weekdays, with physical activity decreasing (more) in the intervention group. Conclusions The F4D-intervention lacks effectiveness on high-risk families’ physical activity and its correlates in Belgium. This could partially be explained by low attendance rates and a large drop-out. To reach vulnerable populations, future interventions should invest in more appropriate recruitment (e.g. more face-to-face contact) and more bottom-up development of the intervention (i.e. co-creation of the intervention with the target group). Trial registration The Feel4Diabetes-study was prospectively registered at clinicaltrials.gov as NCT02393872 on 20 March 2015.
Collapse
Affiliation(s)
- Nele Huys
- Department of Movement and Sport Sciences, Ghent University, Watersportlaan 2, 9000, Ghent, Belgium.
| | - Vicky Van Stappen
- Department of Movement and Sport Sciences, Ghent University, Watersportlaan 2, 9000, Ghent, Belgium
| | - Samyah Shadid
- Department of Endocrinology and Metabolic Diseases, Ghent University Hospital, Corneel Heymanslaan, 10, Ghent, Belgium
| | - Marieke De Craemer
- Department of Rehabilitation Sciences, Ghent University, Corneel Heysmanslaan, 10, Ghent, Belgium.,Research Foundation Flanders, Egmontstraat 5, Brussels, Belgium
| | - Odysseas Androutsos
- Department of Nutrition and Dietetics, School of Health Sciences & Education, Harokopio University, El. Venizelou 70, Kallithea, Athens, Greece
| | - Katja Wikström
- Department of Public Health Solutions, National Institute for Health and Welfare, Mannerheimintie, 166, Helsinki, Finland
| | - Konstantinos Makrilakis
- First Department of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias str, Athens, Greece
| | - Luis A Moreno
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, Instituto Agroalimentario de Aragón (IA2), Instituto de Investigación Sanitaria Aragón (IIS Aragón), University of Zaragoza, Calle Pedro Cerbuna, 12, Zaragoza, Spain
| | - Violeta Iotova
- Department of Paediatrics, Medical University of Varna, 55 Marin Drinov str, Varna, Bulgaria
| | - Tsvetalina Tankova
- Clinical Center of Endocrinology, Medical University of Sofia, Boulevard "Akademik Ivan Evstratiev Geshov, 15, Sofia, Bulgaria
| | - Anna Nánási
- Department of Family and Occupational Medicine, University of Debrecen, Egyeterm tér 1, Debrecen, Hungary
| | - Yannis Manios
- Department of Nutrition and Dietetics, School of Health Sciences & Education, Harokopio University, El. Venizelou 70, Kallithea, Athens, Greece
| | - Greet Cardon
- Department of Movement and Sport Sciences, Ghent University, Watersportlaan 2, 9000, Ghent, Belgium
| | | |
Collapse
|
19
|
Virtanen E, Kivelä J, Wikström K, Lambrinou CP, De Miguel-Etayo P, Huys N, Vraukó-Tóth K, Moreno LA, Usheva N, Chakarova N, Rado SA, Iotova V, Makrilakis K, Cardon G, Liatis S, Manios Y, Lindström J. Feel4Diabetes healthy diet score: development and evaluation of clinical validity. BMC Endocr Disord 2020; 20:46. [PMID: 32370805 PMCID: PMC7201941 DOI: 10.1186/s12902-020-0521-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 03/05/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The aim of this paper is to present the development of the Feel4Diabetes Healthy Diet Score and to evaluate its clinical validity. METHODS Study population consisted of 3268 adults (63% women) from high diabetes risk families living in 6 European countries. Participants filled in questionnaires at baseline and after 1 year, reflecting the dietary goals of the Feel4Diabetes intervention. Based on these questions the Healthy Diet Score was constructed, consisting of the following components: breakfast, vegetables, fruit and berries, sugary drinks, whole-grain cereals, nuts and seeds, low-fat dairy products, oils and fats, red meat, sweet snacks, salty snacks, and family meals. Maximum score for each component was set based on its estimated relative importance regarding T2DM risk, higher score indicating better quality of diet. Clinical measurements included height, weight, waist circumference, heart rate, blood pressure, and fasting blood sampling, with analyses of glucose, total cholesterol, HDL-cholesterol, LDL-cholesterol, and triglycerides. Analysis of (co) variance was used to compare the Healthy Diet Score and its components between countries and sexes using baseline data, and to test differences in clinical characteristics between score categories, adjusted for age, sex and country. Pearson's correlations were used to study the association between changes from baseline to year 1 in the Healthy Diet Score and clinical markers. To estimate reproducibility, Pearson's correlations were studied between baseline and 1 year score, within the control group only. RESULTS The mean total score was 52.8 ± 12.8 among women and 46.6 ± 12.8 among men (p < 0.001). The total score and its components differed between countries. The change in the Healthy Diet Score was significantly correlated with changes in BMI, waist circumference, and total and LDL cholesterol. The Healthy Diet Score as well as its components at baseline were significantly correlated with the values at year 1, in the control group participants. CONCLUSION The Feel4Diabetes Healthy Diet Score is a reproducible method to capture the dietary information collected with the Feel4Diabetes questionnaire and measure the level of and changes in the adherence to the dietary goals of the intervention. It gives a simple parameter that associates with clinical risk factors in a meaningful manner. TRIAL REGISTRATION Clinicaltrials.gov NCT02393872. Registered March 20, 2015.
Collapse
Affiliation(s)
- Eeva Virtanen
- Department of Public Health Solutions, National Institute for Health and Welfare, PO BOX 30, 00270 Helsinki, Finland
| | - Jemina Kivelä
- Department of Public Health Solutions, National Institute for Health and Welfare, PO BOX 30, 00270 Helsinki, Finland
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Katja Wikström
- Department of Public Health Solutions, National Institute for Health and Welfare, PO BOX 30, 00270 Helsinki, Finland
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | | | - Pilar De Miguel-Etayo
- Growth, Exercise, Nutrition and Development Research Group, University of Zaragoza, GENUD, Zaragoza, Spain
| | - Nele Huys
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | | | - Luis A. Moreno
- Growth, Exercise, Nutrition and Development Research Group, University of Zaragoza, GENUD, Zaragoza, Spain
| | - Natalya Usheva
- Department of Social Sciences and Public Health, Medical University of Varna, Varna, Bulgaria
| | - Nevena Chakarova
- Department of Diabetology, Clinical Center of Endocrinology, Medical University of Sofia, Sofia, Bulgaria
| | - Sándorné A. Rado
- Debreceni Egyetem (UoD), University of Debrecen, Debrecen, Hungary
| | - Violeta Iotova
- Department of Pediatrics, Clinic of Paediatric Endocrinology, Medical University Varna, Varna, Bulgaria
| | | | - Greet Cardon
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - Stavros Liatis
- National and Kapodistrian University of Athens, Athens, Greece
| | - Yannis Manios
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
| | - Jaana Lindström
- Department of Public Health Solutions, National Institute for Health and Welfare, PO BOX 30, 00270 Helsinki, Finland
| | | |
Collapse
|
20
|
Van Rhoon L, Byrne M, Morrissey E, Murphy J, McSharry J. A systematic review of the behaviour change techniques and digital features in technology-driven type 2 diabetes prevention interventions. Digit Health 2020; 6:2055207620914427. [PMID: 32269830 PMCID: PMC7093696 DOI: 10.1177/2055207620914427] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 02/21/2020] [Indexed: 12/14/2022] Open
Abstract
Objectives Our aim was to conduct a systematic review to determine which technology-driven diabetes prevention interventions were effective in producing clinically significant weight loss, and to identify the behaviour change techniques and digital features frequently used in effective interventions. Methods We searched five databases (CINAHL, EMBASE, MEDLINE, PsychINFO, and Pubmed) from inception to September 2018 and reviewed 19 experimental and non-experimental studies of 21 technology-driven diet plus physical activity interventions for adults (≥18 years) at risk of developing type 2 diabetes. Behaviour change techniques were coded using the BCT taxonomy v1, and digital features were identified via thematic analysis of intervention descriptions. Results Sixty-three per cent of interventions were effective in the short term (achieving ≥3% weight loss at ≤6 months), using an average of 5.6 more behaviour change techniques than non-effective interventions, and 33% were effective in the long term (achieving ≥5% weight loss at ≥12 months), using 3.7 more behaviour change techniques than non-effective interventions. The techniques of social support (unspecified), goal setting (outcome/behaviour), feedback on behaviour, and self-monitoring of outcome(s) of behaviour were identified in over 90% of effective interventions. Interventions containing digital features that facilitated health and lifestyle education, behaviour/outcome tracking, and/or online health coaching were most effective. Conclusion The integration of specific behaviour change techniques and digital features may optimise digital diabetes prevention interventions to achieve clinically significant weight loss. Additional research is needed to identify the mechanisms in which behaviour change techniques and digital features directly influence physical activity, dietary behaviours, and intervention engagement.
Collapse
Affiliation(s)
- Luke Van Rhoon
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland Galway, Ireland
| | - Molly Byrne
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland Galway, Ireland
| | - Eimear Morrissey
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland Galway, Ireland
| | - Jane Murphy
- Medication Adherence Across the Lifespan Research Group, School of Psychology, National University of Ireland Galway, Ireland
| | - Jenny McSharry
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland Galway, Ireland
| |
Collapse
|
21
|
Kyrou I, Tsigos C, Mavrogianni C, Cardon G, Van Stappen V, Latomme J, Kivelä J, Wikström K, Tsochev K, Nanasi A, Semanova C, Mateo-Gallego R, Lamiquiz-Moneo I, Dafoulas G, Timpel P, Schwarz PEH, Iotova V, Tankova T, Makrilakis K, Manios Y. Sociodemographic and lifestyle-related risk factors for identifying vulnerable groups for type 2 diabetes: a narrative review with emphasis on data from Europe. BMC Endocr Disord 2020; 20:134. [PMID: 32164656 PMCID: PMC7066728 DOI: 10.1186/s12902-019-0463-3] [Citation(s) in RCA: 101] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 11/28/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) comprises the vast majority of all diabetes cases in adults, with alarmingly increasing prevalence over the past few decades worldwide. A particularly heavy healthcare burden of diabetes is noted in Europe, where 8.8% of the population aged 20-79 years is estimated to have diabetes according to the International Diabetes Federation. Multiple risk factors are implicated in the pathogenesis of T2DM with complex underlying interplay and intricate gene-environment interactions. Thus, intense research has been focused on studying the role of T2DM risk factors and on identifying vulnerable groups for T2DM in the general population which can then be targeted for prevention interventions. METHODS For this narrative review, we conducted a comprehensive search of the existing literature on T2DM risk factors, focusing on studies in adult cohorts from European countries which were published in English after January 2000. RESULTS Multiple lifestyle-related and sociodemographic factors were identified as related to high T2DM risk, including age, ethnicity, family history, low socioeconomic status, obesity, metabolic syndrome and each of its components, as well as certain unhealthy lifestyle behaviors. As Europe has an increasingly aging population, multiple migrant and ethnic minority groups and significant socioeconomic diversity both within and across different countries, this review focuses not only on modifiable T2DM risk factors, but also on the impact of pertinent demographic and socioeconomic factors. CONCLUSION In addition to other T2DM risk factors, low socioeconomic status can significantly increase the risk for prediabetes and T2DM, but is often overlooked. In multinational and multicultural regions such as Europe, a holistic approach, which will take into account both traditional and socioeconomic/socioecological factors, is becoming increasingly crucial in order to implement multidimensional public health programs and integrated community-based interventions for effective T2DM prevention.
Collapse
Affiliation(s)
- Ioannis Kyrou
- Aston Medical Research Institute, Aston Medical School, Aston University, B4 7ET, Birmingham, UK.
- WISDEM, University Hospital Coventry and Warwickshire NHS Trust, Coventry, CV2 2DX, UK.
- Translational & Experimental Medicine, Division of Biomedical Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.
- Department of Nutrition and Dietetics, School of Health Science and Education Harokopio University, Athens, Greece.
| | - Constantine Tsigos
- Department of Nutrition and Dietetics, School of Health Science and Education Harokopio University, Athens, Greece
| | - Christina Mavrogianni
- Department of Nutrition and Dietetics, School of Health Science and Education Harokopio University, Athens, Greece
| | - Greet Cardon
- Department of Movement and Sports Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Vicky Van Stappen
- Department of Movement and Sports Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Julie Latomme
- Department of Movement and Sports Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Jemina Kivelä
- Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
| | - Katja Wikström
- Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
| | - Kaloyan Tsochev
- Department of Paediatrics, Medical University Varna, Varna, Bulgaria
| | - Anna Nanasi
- Department of Family and Occupational Medicine, University of Debrecen, Debrecen, Hungary
| | - Csilla Semanova
- Department of Family and Occupational Medicine, University of Debrecen, Debrecen, Hungary
| | - Rocío Mateo-Gallego
- Unidad Clínica y de Investigación en Lípidos y Arteriosclerosis, Hospital Universitario Miguel Servet, Instituto de Investigación Sanitaria Aragón (IIS Aragón) CIBERCV, Zaragoza, Spain
- Universidad de Zaragoza, Zaragoza, Spain
| | - Itziar Lamiquiz-Moneo
- Unidad Clínica y de Investigación en Lípidos y Arteriosclerosis, Hospital Universitario Miguel Servet, Instituto de Investigación Sanitaria Aragón (IIS Aragón) CIBERCV, Zaragoza, Spain
| | - George Dafoulas
- National and Kapodistrian University of Athens, 17 Ag. Thoma St, 11527, Athens, Greece
| | - Patrick Timpel
- Department for Prevention and Care of Diabetes, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Peter E H Schwarz
- Department for Prevention and Care of Diabetes, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
- German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany
- Paul Langerhans Institute Dresden of the Helmholtz Center Munich at University Hospital and Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Violeta Iotova
- Department of Paediatrics, Medical University Varna, Varna, Bulgaria
| | - Tsvetalina Tankova
- Department of Diabetology, Clinical Center of Endocrinology, Medical University Sofia, Sofia, Bulgaria
| | | | - Yannis Manios
- Department of Nutrition and Dietetics, School of Health Science and Education Harokopio University, Athens, Greece
| |
Collapse
|
22
|
Khalangot MD, Kovtun VA, Gurianov VG, Pysarenko YM, Kravchenko VI. Evaluation of type 2 diabetes prevention through diet modification in people with impaired glucose regulation: A population-based study. Prim Care Diabetes 2019; 13:535-541. [PMID: 31023525 DOI: 10.1016/j.pcd.2019.03.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 03/17/2019] [Accepted: 03/25/2019] [Indexed: 01/04/2023]
Abstract
PURPOSE A few interventional studies to date have specifically assessed the association between dairy products and/or sugar consumption and the risk of type 2 diabetes mellitus (T2D) incidence. The aim of this study was to assess the effectiveness of diet modification in people with impaired glucose regulation (IGR) as defined by a glucose tolerance test (GTT). METHODS A quasi-experimental study design was used for this study. A total of 318 randomly selected 18-year-old or older participants from the rural area of the Kyiv region of Ukraine who had not been registered as T2D patients before underwent GTT between June 2013 and June 2017. For those who had been diagnosed with IGR, World Health Organization (WHO)/International Diabetes Federation criteria were used. Of 318 participants screened for T2D, 123 (74% of them females) were diagnosed with IGR. They were aged 18 to 79 years old with a median (QI - QIII) age of 62 (52-68) years. They were repeatedly tested during the study and completed a questionnaire on average 2.8 (1.1) years (standard deviation [SD]), after they had received their lifestyle-based T2D prevention recommendations. In addition to basic recommendations, they were advised to consume approximately 200 g of low-fat dairy products and less than 25 g of sugar daily. Cases of screen-detected diabetes mellitus (SDDM) were diagnosed and reported as an outcome variable if a fast capillary blood glucose level reached 6.1 mmol/L and above. To define the association between implementation of recommendations and the risk of SDDM, the Cox proportional-hazards regression analysis was used. RESULTS During the study observation period, 56 (45.5%) of 123 IGR-positive participants were recognized as SDDM cases. Those individuals with IGR (n = 111) who confirmed their adherence to preventive recommendations had a significantly lower risk of identifying SDDM, age- and gender-adjusted hazard ratio (HR) 0.26 (95% CІ; 0.09-0.72). This effect appears to be related to the recommendation to reduce the daily intake of sugar to less than 25 g (n = 99), corresponding to age- and gender-adjusted HR 0.44 (95% CІ; 0.2-0.99). We cannot prove that increasing consumption of dairy products, vegetables, and fruit or increased physical activity had similar effectiveness. CONCLUSIONS After 2.8 years of follow-up, the individuals who are IGR-positive and who confirmed their adherence to lifestyle-based preventive recommendations had a significantly lower risk of identifying SDDM. This effect appears to be related to recommendations to reduce the daily intake of sugar to less than 25 g.
Collapse
Affiliation(s)
- Mykola D Khalangot
- Endocrinology Department, Shupyk National Medical Academy of Postgraduate Education, Kyiv, Ukraine; Epidemiology Department, Komisarenko Institute of Endocrinology and Metabolism, National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine.
| | - Volodymyr A Kovtun
- Epidemiology Department, Komisarenko Institute of Endocrinology and Metabolism, National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine
| | - Vitaly G Gurianov
- Medical & Biological Physics and Informatics Department, Bogomolets National Medical University, Kyiv, Ukraine
| | | | - Victor I Kravchenko
- Epidemiology Department, Komisarenko Institute of Endocrinology and Metabolism, National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine
| |
Collapse
|
23
|
Obesity Does Not Modulate the Glycometabolic Benefit of Insoluble Cereal Fibre in Subjects with Prediabetes-A Stratified Post Hoc Analysis of the Optimal Fibre Trial (OptiFiT). Nutrients 2019; 11:nu11112726. [PMID: 31717901 PMCID: PMC6893443 DOI: 10.3390/nu11112726] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 10/18/2019] [Accepted: 10/22/2019] [Indexed: 02/06/2023] Open
Abstract
Obesity does not modulate the glycometabolic benefit of insoluble cereal fibre in subjects with prediabetes—a stratified post hoc analysis of the Optimal Fibre Trial (OptiFiT). Background: OptiFiT demonstrated the beneficial effect of insoluble oat fibres on dysglycemia in prediabetes. Recent analyses of OptiFiT and other randomised controlled trials (RCTs) indicated that this effect might be specific for the subgroup of patients with impaired fasting glucose (IFG). As subjects with IFG are more often obese, there is a need to clarify if the effect modulation is actually driven by glycemic state or body mass index (BMI). Aim: We conducted a stratified post hoc analysis of OptiFiT based on the presence or absence of obesity. Methods: 180 Caucasian participants with impaired glucose tolerance (IGT) were randomised in a double-blinded fashion to either twice-a-day fibre or placebo supplementation for 2 years (n = 89 and 91, respectively). Once a year, they underwent fasting blood sampling, an oral glucose tolerance test (oGTT) and full anthropometry. At baseline, out of 136 subjects who completed the first year of intervention, 87 (62%) were classified as OBESE (BMI >30) and 49 subjects were NONOBESE. We performed a stratified per-protocol analysis of the primary glycemic and secondary metabolic effects attributable to dietary fibre supplementation after 1 year of intervention. Results: Neither the NONOBESE nor the OBESE subgroup showed significant differences between the respective fibre and placebo groups in metabolic, anthropometric or inflammatory outcomes. None of the four subgroups showed a significant improvement in either fasting glucose or glycated haemoglobin (HbA1c) after 1 year of intervention and only OBESE fibre subjects improved 2 h glucose. Within the NONOBESE stratum, there were no significant differences in the change of primary or secondary metabolic parameters between the fibre and placebo arms. We found a significant interaction effect for leukocyte count (time × supplement × obesity status). Within the OBESE stratum, leukocyte count and gamma-glutamyl transferase (GGT) levels decreased more in the fibre group compared with placebo (adjusted for change in body weight). Comparison of both fibre groups revealed that OBESE subjects had a significantly stronger benefit with respect to leukocyte count and fasting C-peptide levels than NONOBESE participants. Only the effect on leukocyte count survived correction for multiple comparisons. In contrast, under placebo conditions, NONOBESE subjects managed to decrease their body fat content significantly more than OBESE ones. Intention-to-treat (ITT) analysis resulted in similar outcomes. Conclusions: The state of obesity does not relevantly modulate the beneficial effect of cereal fibre on major glycometabolic parameters by fibre supplementation, but leukocyte levels may be affected. Hence, BMI is not a suitable parameter to stratify this cohort with respect to diabetes risk or responsiveness to cereal fibre, but obesity needs to be accounted for when assessing anti-inflammatory effects of fibre treatments. Targeted diabetes prevention should focus on the actual metabolic state rather than on mere obesity.
Collapse
|
24
|
Kabisch S, Meyer NMT, Honsek C, Gerbracht C, Dambeck U, Kemper M, Osterhoff MA, Birkenfeld AL, Arafat AM, Hjorth MF, Weickert MO, Pfeiffer AFH. Fasting Glucose State Determines Metabolic Response to Supplementation with Insoluble Cereal Fibre: A Secondary Analysis of the Optimal Fibre Trial (OptiFiT). Nutrients 2019; 11:nu11102385. [PMID: 31590438 PMCID: PMC6835423 DOI: 10.3390/nu11102385] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 09/28/2019] [Accepted: 10/01/2019] [Indexed: 02/07/2023] Open
Abstract
Background: High intake of cereal fibre is associated with reduced risk for type 2 diabetes and long-term complications. Within the first long-term randomized controlled trial specifically targeting cereal fibre, the Optimal Fibre Trial (OptiFiT), intake of insoluble oat fibre was shown to significantly reduce glycaemia. Previous studies suggested that this effect might be limited to subjects with impaired fasting glucose (IFG). Aim: We stratified the OptiFiT cohort for normal and impaired fasting glucose (NFG, IFG) and conducted a secondary analysis comparing the effects of fibre supplementation between these subgroups. Methods: 180 Caucasian participants with impaired glucose tolerance (IGT) were randomized to twice-a-day fibre or placebo supplementation for 2 years (n = 89 and 91, respectively), while assuring double-blinded intervention. Fasting blood sampling, oral glucose tolerance test and full anthropometry were assessed annually. At baseline, out of 136 subjects completing the first year of intervention, 72 (54%) showed IFG and IGT, while 64 subjects had IGT only (labelled “NFG”). Based on these two groups, we performed a stratified per-protocol analysis of glycometabolic and secondary effects during the first year of intervention. Results: The NFG group did not show significant differences between fibre and placebo group concerning anthropometric, glycometabolic, or other biochemical parameters. Within the IFG stratum, 2-h glucose, HbA1c, and gamma-glutamyl transferase levels decreased more in the fibre group, with a significant supplement x IFG interaction effect for HbA1c. Compared to NFG subjects, IFG subjects had larger benefits from fibre supplementation with respect to fasting glucose levels. Results were robust against adjustment for weight change and sex. An ITT analysis did not reveal any differences from the per-protocol analysis. Conclusions: Although stratification resulted in relatively small subgroups, we were able to pinpoint our previous findings from the entire cohort to the IFG subgroup. Cereal fibre can beneficially affect glycemic metabolism, with most pronounced or even isolated effectiveness in subjects with impaired fasting glucose.
Collapse
Affiliation(s)
- Stefan Kabisch
- Department of Clinical Nutrition, German Institute of Human Nutrition Potsdam-Rehbrücke, Arthur-Scheunert-Allee 114-116, 14558 Nuthetal, Germany.
- Deutsches Zentrum für Diabetesforschung e.V., Geschäftsstelle am Helmholtz-Zentrum München, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany.
| | - Nina M T Meyer
- Department of Clinical Nutrition, German Institute of Human Nutrition Potsdam-Rehbrücke, Arthur-Scheunert-Allee 114-116, 14558 Nuthetal, Germany.
- Deutsches Zentrum für Diabetesforschung e.V., Geschäftsstelle am Helmholtz-Zentrum München, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany.
| | - Caroline Honsek
- Department of Clinical Nutrition, German Institute of Human Nutrition Potsdam-Rehbrücke, Arthur-Scheunert-Allee 114-116, 14558 Nuthetal, Germany.
| | - Christiana Gerbracht
- Department of Clinical Nutrition, German Institute of Human Nutrition Potsdam-Rehbrücke, Arthur-Scheunert-Allee 114-116, 14558 Nuthetal, Germany.
| | - Ulrike Dambeck
- Department of Clinical Nutrition, German Institute of Human Nutrition Potsdam-Rehbrücke, Arthur-Scheunert-Allee 114-116, 14558 Nuthetal, Germany.
| | - Margrit Kemper
- Department of Clinical Nutrition, German Institute of Human Nutrition Potsdam-Rehbrücke, Arthur-Scheunert-Allee 114-116, 14558 Nuthetal, Germany.
- Deutsches Zentrum für Diabetesforschung e.V., Geschäftsstelle am Helmholtz-Zentrum München, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany.
| | - Martin A Osterhoff
- Department of Clinical Nutrition, German Institute of Human Nutrition Potsdam-Rehbrücke, Arthur-Scheunert-Allee 114-116, 14558 Nuthetal, Germany.
- Department of Endocrinology, Diabetes and Nutrition, Campus Benjamin Franklin, Charité University Medicine, Hindenburgdamm 30, 12203 Berlin, Germany.
| | - Andreas L Birkenfeld
- Deutsches Zentrum für Diabetesforschung e.V., Geschäftsstelle am Helmholtz-Zentrum München, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany.
- Section of Metabolic Vascular Medicine, Medical Clinic III and Paul Langerhans Institute Dresden of the Helmholtz Center Munich at University Hospital and Faculty of Medicine, TU Dresden, Fetscherstraße 74, 01307 Dresden, Germany.
- Section of Diabetes and Nutritional Sciences, Rayne Institute, Denmark Hill Campus, King's College London, SE5 9NT London, UK.
| | - Ayman M Arafat
- Department of Clinical Nutrition, German Institute of Human Nutrition Potsdam-Rehbrücke, Arthur-Scheunert-Allee 114-116, 14558 Nuthetal, Germany.
- Department of Endocrinology, Diabetes and Nutrition, Campus Benjamin Franklin, Charité University Medicine, Hindenburgdamm 30, 12203 Berlin, Germany.
| | - Mads F Hjorth
- University of Copenhagen, Faculty of Science, Department of Nutrition, Exercise, and Sports, 2200 Copenhagen, Denmark.
| | - Martin O Weickert
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism; The ARDEN NET Centre, ENETS CoE; University Hospitals Coventry and Warwickshire NHS Trust, CV2 2DX Coventry, UK.
- Centre of Applied Biological & Exercise Sciences (ABES), Faculty of Health & Life Sciences, Coventry University, CV1 5FB Coventry, UK.
- Translational & Experimental Medicine, Division of Biomedical Sciences, Warwick Medical School, University of Warwick, CV4 7AL Coventry, UK.
| | - Andreas F H Pfeiffer
- Department of Clinical Nutrition, German Institute of Human Nutrition Potsdam-Rehbrücke, Arthur-Scheunert-Allee 114-116, 14558 Nuthetal, Germany.
- Deutsches Zentrum für Diabetesforschung e.V., Geschäftsstelle am Helmholtz-Zentrum München, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany.
- Department of Endocrinology, Diabetes and Nutrition, Campus Benjamin Franklin, Charité University Medicine, Hindenburgdamm 30, 12203 Berlin, Germany.
| |
Collapse
|
25
|
Rosenzweig JL, Bakris GL, Berglund LF, Hivert MF, Horton ES, Kalyani RR, Murad MH, Vergès BL. Primary Prevention of ASCVD and T2DM in Patients at Metabolic Risk: An Endocrine Society* Clinical Practice Guideline. J Clin Endocrinol Metab 2019; 104:3939-3985. [PMID: 31365087 DOI: 10.1210/jc.2019-01338] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 06/13/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To develop clinical practice guidelines for the primary prevention of atherosclerotic cardiovascular disease (ASCVD) and type 2 diabetes mellitus (T2DM) in individuals at metabolic risk for developing these conditions. CONCLUSIONS Health care providers should incorporate regular screening and identification of individuals at metabolic risk (at higher risk for ASCVD and T2DM) with measurement of blood pressure, waist circumference, fasting lipid profile, and blood glucose. Individuals identified at metabolic risk should undergo 10-year global risk assessment for ASCVD or coronary heart disease to determine targets of therapy for reduction of apolipoprotein B-containing lipoproteins. Hypertension should be treated to targets outlined in this guideline. Individuals with prediabetes should be tested at least annually for progression to diabetes and referred to intensive diet and physical activity behavioral counseling programs. For the primary prevention of ASCVD and T2DM, the Writing Committee recommends lifestyle management be the first priority. Behavioral programs should include a heart-healthy dietary pattern and sodium restriction, as well as an active lifestyle with daily walking, limited sedentary time, and a structured program of physical activity, if appropriate. Individuals with excess weight should aim for loss of ≥5% of initial body weight in the first year. Behavior changes should be supported by a comprehensive program led by trained interventionists and reinforced by primary care providers. Pharmacological and medical therapy can be used in addition to lifestyle modification when recommended goals are not achieved.
Collapse
Affiliation(s)
| | | | | | - Marie-France Hivert
- Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, Massachusetts
| | | | - Rita R Kalyani
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - M Hassan Murad
- Evidence-Based Practice Center, Mayo Clinic, Rochester, Minnesota
| | - Bruno L Vergès
- Centre Hospitalier Universitaire Dijon Bourgogne, Dijon, France
| |
Collapse
|
26
|
Böhme P, Luc A, Gillet P, Thilly N. Effectiveness of a type 2 diabetes prevention program combining FINDRISC scoring and telephone-based coaching in the French population of bakery/pastry employees. Eur J Clin Nutr 2019; 74:409-418. [PMID: 31316174 PMCID: PMC7062631 DOI: 10.1038/s41430-019-0472-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 06/26/2019] [Accepted: 07/03/2019] [Indexed: 11/28/2022]
Abstract
Background/objectives Preventive actions targeting the risk of type 2 diabetes mellitus (T2D) and deployed from the workplace are scarce. This study aimed to measure this T2D risk in a large sample of the bakery/pastry employees in France and to assess the effectiveness of a telephone coaching program in participants with the highest risk. Subjects/methods A screening survey using the FINDRISC score was conducted by phone among the employees. Those with a moderate risk (score ≥ 12 and <15; body mass index ≥ 25 kg/m2) or high/very high risk (score ≥ 15) were invited to participate in a 6-month coaching program including 6 monthly interviews together with a final evaluation interview three months later. The effects and impact were evaluated using 8 questions on dietary knowledge/behavior as well as the GPAQ (physical activity) and SF-12 (quality of life) questionnaires. Results There were 19,951 employees eligible for screening (age: 38.0 ± 13.5 years, men 49.6%, mean FINDRISC score 5.9 ± 4.4). A high/very high score was found in 4% of individuals. Overall, 1,348 (among 2,018) eligible employees agreed to participate in the coaching program, 630 of whom participated in all interviews. Of the latter, dietary knowledge/behavior (+1.60) and quality of life (+1.83) improved (P < 0.0001), with a favorable trend for physical activity (+0.06, P = 0.0756). Dietary knowledge/behavior continued to improve in the 581 completers (+0.17, P = 0.0001). Conclusions This two-step prevention program associating T2D risk estimation and a 6-month telephone coaching was deployed in the French craft bakery/pastry sector with significant adhesion. Such program appears beneficial for enhancing knowledge and mobilizing skills associated with T2D prevention.
Collapse
Affiliation(s)
- Philip Böhme
- CHRU de Nancy, Service d'Endocrinologie, Diabétologie, Nutrition, F-54511, Vandœuvre-Lès-Nancy, France. .,Université de Lorraine, EA 4360 APEMAC, F-54000, Nancy, France.
| | - Amandine Luc
- CHRU Nancy, Plateforme d'Aide à la Recherche Clinique, F-54511, Vandœuvre-Lès-Nancy, France
| | - Pascal Gillet
- MEDIALANE, Plateforme de télésanté, F-54320, Maxéville, France
| | - Nathalie Thilly
- Université de Lorraine, EA 4360 APEMAC, F-54000, Nancy, France.,CHRU Nancy, Plateforme d'Aide à la Recherche Clinique, F-54511, Vandœuvre-Lès-Nancy, France
| |
Collapse
|
27
|
Al-Murani F, Aweko J, Nordin I, Delobelle P, Kasujja F, Östenson CG, Peterson SS, Daivadanam M, Alvesson HM. Community and stakeholders' engagement in the prevention and management of Type 2 diabetes: a qualitative study in socioeconomically disadvantaged suburbs in region Stockholm. Glob Health Action 2019; 12:1609313. [PMID: 31116096 PMCID: PMC6537701 DOI: 10.1080/16549716.2019.1609313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Background: Community-based approaches have been identified as an effective strategy to address the growing burden of noncommunicable diseases (NCDs) worldwide. However, little is known about community as a concept among people living in socioeconomically disadvantaged settings and stakeholders' interactions and engagement in NCDs prevention and management. Objective: The aim of this study was to understand; (1) the meaning of community among people living in socioeconomically disadvantaged suburbs in Region Stockholm and (2) how communities interact and engage with stakeholders at local and regional levels for the prevention and management of type 2 diabetes (T2D). Methods: This qualitative study was conducted in three municipalities in Region Stockholm with a high proportion of migrants. Multiple data collection methods were used, including observations of community activities; interviews with community members, representatives of public authorities and NGOs; and group interviews with healthcare providers. Data were analyzed using content analysis. Results: Community was perceived as living in close proximity with shared beliefs, values and resources. Although they recognized its social and cultural diversity, community members focused more on the commonalities of living in their neighborhood and less on their differences in country of birth and languages spoken. Several mismatches between awareness of community needs and the available skills and resources among stakeholders for T2D prevention were identified. Stakeholders expressed awareness of T2D risk and interest in addressing it in a culturally appropriate manner. Conclusion: Interaction between the communities and stakeholders was limited, as was engagement in T2D prevention and management. This highlights barriers in the collaboration between community, healthcare institutions and other stakeholders which consequently affect the implementation of preventive interventions. Innovative ways to link the community to the healthcare sector and other local government institutions are needed to build the capacity of health systems for T2D prevention in socioeconomically disadvantaged communities.
Collapse
Affiliation(s)
- F Al-Murani
- a Department of Public Health Sciences , Karolinska Institutet , Stockholm , Sweden
| | - J Aweko
- a Department of Public Health Sciences , Karolinska Institutet , Stockholm , Sweden
| | - I Nordin
- b Department of Food Studies, Nutrition, and Dietetics , Uppsala University , Uppsala , Sweden
| | - P Delobelle
- c School of Public Health , University of the Western Cape , Bellville , South Africa.,d Chronic Disease Initiative for Africa , University of Cape Town , Rondebosch , South Africa
| | - Fx Kasujja
- e Department of Biostatistics and Epidemiology , Makerere University College of Health Sciences, School of Public Health , Kampala , Uganda
| | - C-G Östenson
- f Department of Molecular Medicine and Surgery, Diabetes and Endocrinology Unit , Karolinska Institutet , Stockholm , Sweden
| | - S S Peterson
- g Department of Women's and Children's Health , International Maternal and Child Health, Uppsala University , Uppsala , Sweden
| | - M Daivadanam
- a Department of Public Health Sciences , Karolinska Institutet , Stockholm , Sweden.,b Department of Food Studies, Nutrition, and Dietetics , Uppsala University , Uppsala , Sweden
| | - H M Alvesson
- a Department of Public Health Sciences , Karolinska Institutet , Stockholm , Sweden
| |
Collapse
|
28
|
Cuschieri S, Grech S. Closing the gap - Is type 2 diabetes awareness enough to prevent the growing epidemic? Diabetes Metab Syndr 2019; 13:1739-1744. [PMID: 31235087 DOI: 10.1016/j.dsx.2019.03.044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 03/29/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND Diabetes mellitus is a public health burden requiring a multi-sectorial approach including adequate population awareness to tackle this epidemic. The study was aimed to determine the level of diabetes awareness among a high-risk dysglycaemic population in relation to socio-demographic, lifestyle and family history of diabetes as well as to body mass index (BMI) and blood pressure measurements. Furthermore, the authors strived to explore any relationships between diabetes awareness and an oral glucose tolerance test dysglycaemia diagnosis. METHOD Participants obtaining impaired fasting blood glucose in a representative health examination survey were invited to undergo an oral glucose tolerance test (OGTT). During the OGTT session, participants were invited to take part in a diabetes awareness questionnaire as well as have their weight, height and blood pressure measured. Association between awareness scores and different parameters (age, gender, education, residential district, smoking, alcohol habit, family history, BMI and blood pressure) were explored. RESULTS Being a female, ageing, non-smoker and having a family history of diabetes had a positive association with adequate diabetes awareness. Even though generally good awareness was present, the majority of the participants were obese, with an elevated blood pressure and obtained a dysglycaemic status post OGTT. CONCLUSION Diabetes awareness solely does not appear to engage individuals in preventive initiatives. Behavioural changes are required but these are only established after the motivational action gap has been overcome. Empowering community diabetes mellitus screening programs targeting the environment, social gradients and cultural norms while engaging in preventive interventions are recommended.
Collapse
Affiliation(s)
- Sarah Cuschieri
- Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta.
| | - Stephan Grech
- Royal National Orthopeadics Hospital, Stanmore, London, UK.
| |
Collapse
|
29
|
Mediators of Lifestyle Behaviour Changes in Obese Pregnant Women. Secondary Analyses from the DALI Lifestyle Randomised Controlled Trial. Nutrients 2019; 11:nu11020311. [PMID: 30717227 PMCID: PMC6412227 DOI: 10.3390/nu11020311] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 01/24/2019] [Accepted: 01/28/2019] [Indexed: 11/17/2022] Open
Abstract
A better understanding of what drives behaviour change in obese pregnant overweight women is needed to improve the effectiveness of lifestyle interventions in this group at risk for gestational diabetes (GDM). Therefore, we assessed which factors mediated behaviour change in the Vitamin D and Lifestyle Intervention for GDM Prevention (DALI) Lifestyle Study. A total of 436 women, with pre-pregnancy body mass index ≥29 kg/m², ≤19 + 6 weeks of gestation and without GDM, were randomised for counselling based on motivational interviewing (MI) on healthy eating and physical activity, healthy eating alone, physical activity alone, or to a usual care group. Lifestyle was measured at baseline, and at 24⁻28 and 35⁻37 weeks of gestation. Outcome expectancy, risk perception, task self-efficacy and social support were measured at those same time points and considered as possible mediators of intervention effects on lifestyle. All three interventions resulted in increased positive outcome expectancy for GDM reduction, perceived risk to the baby and increased task self-efficacy. The latter mediated intervention effects on physical activity and reduced sugared drink consumption. In conclusion, our MI intervention was successful in increasing task self-efficacy, which was related to improved health behaviours.
Collapse
|
30
|
Ibrahim M, Tuomilehto J, Aschner P, Beseler L, Cahn A, Eckel RH, Fischl AH, Guthrie G, Hill JO, Kumwenda M, Leslie RD, Olson DE, Pozzilli P, Weber SL, Umpierrez GE. Global status of diabetes prevention and prospects for action: A consensus statement. Diabetes Metab Res Rev 2018; 34:e3021. [PMID: 29757486 DOI: 10.1002/dmrr.3021] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 04/20/2018] [Accepted: 04/24/2018] [Indexed: 12/15/2022]
Abstract
Primary prevention of type 2 diabetes (T2D) should be achievable through the implementation of early and sustainable measures. Several randomized control studies that found success in preventing the progression to T2D in high-risk populations have identified early and intensive intervention based on an individualized prevention model as the key factor for participant benefit. The global prevalence of both overweight and obesity has now been widely recognized as the major epidemic of the 21st century. Obesity is a major risk factor for the progression from normal glucose tolerance to prediabetes and then to T2D. However, not all obese individuals will develop prediabetes or progress to diabetes. Intensive, multicomponent behavioural interventions for overweight and obese adults can lead to weight loss. Diabetes medications, including metformin, GLP-1 agonists, glitazones, and acarbose, can be considered for selected high-risk patients with prediabetes when lifestyle-based programmes are proven unsuccessful. Nutrition education is the cornerstone of a healthy lifestyle. Also, physical activity is an integral part of the prediabetes management plan and one of the main pillars in the prevention of diabetes. Mobile phones, used extensively worldwide, can facilitate communication between health professionals and the general population, and have been shown to be helpful in the prevention of T2D. Universal screening is needed. Noninvasive risk scores should be used in all countries, but they should be locally validated in all ethnic populations focusing on cultural differences around the world. Lifestyle interventions reduce the progression to prediabetes and diabetes. Nevertheless, many questions still need to be answered.
Collapse
Affiliation(s)
| | - Jaakko Tuomilehto
- Dasman Diabetes Institute, Kuwait, Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland, and Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Pablo Aschner
- Javeriana University School of Medicine, San Ignacio University Hospital, Bogota, Colombia
| | - Lucille Beseler
- Family Nutrition Center of South Florida, Coconut Creek, FL, USA
| | - Avivit Cahn
- Hadassah Hebrew University Hospital, The Diabetes Unit & Endocrinology and Metabolism Unit, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Robert H Eckel
- University of Colorado Denver Anschutz Medical Campus, University of Colorado Hospital, Denver, CO, USA
| | - Amy Hess Fischl
- University of Chicago Kovler Diabetes Center, Chicago, IL, USA
| | - George Guthrie
- Florida Hospital Graduate Medical Education, Orlando, FL, USA
| | - James O Hill
- Colorado Nutrition Obesity Research Center (NORC), University of Colorado School of Medicine, Aurora, CO, USA
| | | | - R David Leslie
- Blizard Institute, Queen Mary, University of London, London, UK
| | - Darin E Olson
- Division of Endocrinology, Metabolism and Lipids, Emory University School of Medicine, Atlanta, GA, USA
| | - Paolo Pozzilli
- Unit of Endocrinology and Diabetes, University Campus Bio-Medico, Rome, Italy
- Centre of Immunobiology, Barts and the London School of Medicine, Queen Mary, University of London, London, UK
| | - Sandra L Weber
- Greenville Health System, University of South Carolina School of Medicine-Greenville, Greenville, SC, USA
| | | |
Collapse
|
31
|
Honsek C, Kabisch S, Kemper M, Gerbracht C, Arafat AM, Birkenfeld AL, Dambeck U, Osterhoff MA, Weickert MO, Pfeiffer AFH. Fibre supplementation for the prevention of type 2 diabetes and improvement of glucose metabolism: the randomised controlled Optimal Fibre Trial (OptiFiT). Diabetologia 2018; 61:1295-1305. [PMID: 29492637 DOI: 10.1007/s00125-018-4582-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 01/17/2018] [Indexed: 10/17/2022]
Abstract
AIMS/HYPOTHESIS Insoluble cereal fibres have been shown in large prospective cohort studies to be highly effective in preventing type 2 diabetes, but there is a lack of interventional data. Our 2 year randomised double-blind prospective intervention study compared the effect of an insoluble oat fibre extract with that of placebo on glucose metabolism and incidence of diabetes. METHODS A total of 180 participants with impaired glucose tolerance underwent a modified version of the 1 year lifestyle training programme PREvention of DIAbetes Self-management (PREDIAS) and were randomised to receive a fibre supplement (n = 89; 7.5 g of insoluble fibre per serving) or placebo (n = 91; 0.8 g of insoluble fibre per serving) twice daily for 2 years. Eligible participants were men and women, were at least 18 years old and did not report corticosteroid or other intensive anti-inflammatory treatment, fibre intolerance or any of the following disorders: overt diabetes, chronic or malignant disease, or severe cardiopulmonary, endocrine, psychiatric, gastrointestinal, autoimmune or eating disorder. Participants were recruited at two clinical wards in Berlin and Nuthetal. The allocation was blinded to participants and study caregivers (physicians, dietitians, study nurses). Randomisation was conducted by non-clinical staff, providing neutrally numbered supplement tins. Both supplements were similar in their visual, olfactory and gustatory appearance. Intention-to-treat analysis was applied to all individuals. RESULTS After 1 year, 2 h OGTT levels decreased significantly in both groups but without a significant difference between the groups (fibre -0.78 ± 1.88 mmol/l [p ≤ 0.001] vs placebo -0.46 ± 1.80 mmol/l [p = 0.020]; total difference 0.32 ± 0.29 mmol/l; not significant). The 2 year incidence of diabetes was 9/89 (fibre group) compared with 16/91 (placebo group; difference not significant). As secondary outcomes, the change in HbA1c level was significantly different between the two groups (-0.2 ± 4.6 mmol/mol [-0.0 ± 0.0%; not significant] vs +1.2 ± 5.2 mmol/mol [+0.1 ± 0.0%; not significant]; total difference 1.4 ± 0.7 mmol/mol [0.1 + 0.0%]); p = 0.018); insulin sensitivity and hepatic insulin clearance increased in both groups. After 2 years, improved insulin sensitivity was still present in both groups, although the effect size had diminished. Separate analysis of the sexes revealed a significantly greater reduction in 2 h glucose levels for women in the fibre group (-0.88 ± 1.59 mmol/l [p ≤ 0.001] vs -0.22 ± 1.52 mmol/l [p = 0.311]; total difference 0.67 ± 0.31 mmol/l; p = 0.015). Levels of fasting glucose, adipokines and inflammatory markers remained unchanged in the two groups. Significantly increased fibre intake was restricted to the fibre group, despite dietary counselling for both groups. No severe side effects occurred. CONCLUSIONS/INTERPRETATION We cannot currently provide strong evidence for a beneficial effect of insoluble cereal fibre on glycaemic metabolism, although further studies may support minor effects of fibre supplementation in reducing glucose levels, insulin resistance and the incidence of type 2 diabetes. TRIAL REGISTRATION clinicaltrials.gov NCT01681173 Funding: German Diabetes Foundation (grant no. 232/11/08).
Collapse
Affiliation(s)
- Caroline Honsek
- Department of Clinical Nutrition, German Institute of Human Nutrition Potsdam-Rehbrücke, Arthur-Scheunert-Allee 114-116, 14558, Nuthetal, Germany
| | - Stefan Kabisch
- Department of Clinical Nutrition, German Institute of Human Nutrition Potsdam-Rehbrücke, Arthur-Scheunert-Allee 114-116, 14558, Nuthetal, Germany.
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany.
| | - Margrit Kemper
- Department of Clinical Nutrition, German Institute of Human Nutrition Potsdam-Rehbrücke, Arthur-Scheunert-Allee 114-116, 14558, Nuthetal, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Christiana Gerbracht
- Department of Clinical Nutrition, German Institute of Human Nutrition Potsdam-Rehbrücke, Arthur-Scheunert-Allee 114-116, 14558, Nuthetal, Germany
| | - Ayman M Arafat
- Department of Clinical Nutrition, German Institute of Human Nutrition Potsdam-Rehbrücke, Arthur-Scheunert-Allee 114-116, 14558, Nuthetal, Germany
- Department of Endocrinology, Diabetes and Nutrition, Campus Benjamin Franklin, Charité University Medicine, Berlin, Germany
| | - Andreas L Birkenfeld
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Section of Metabolic Vascular Medicine, Medical Clinic III and Paul Langerhans Institute Dresden of the Helmholtz Center Munich at University Hospital and Faculty of Medicine, Dresden, Germany
- Studienzentrum für Metabolisch-Vaskuläre Medizin, Gesellschaft für Wissens- und Technologietransfer TU Dresden (GWT-TUD), Dresden, Germany
| | - Ulrike Dambeck
- Department of Clinical Nutrition, German Institute of Human Nutrition Potsdam-Rehbrücke, Arthur-Scheunert-Allee 114-116, 14558, Nuthetal, Germany
| | - Martin A Osterhoff
- Department of Clinical Nutrition, German Institute of Human Nutrition Potsdam-Rehbrücke, Arthur-Scheunert-Allee 114-116, 14558, Nuthetal, Germany
- Department of Endocrinology, Diabetes and Nutrition, Campus Benjamin Franklin, Charité University Medicine, Berlin, Germany
| | - Martin O Weickert
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, The ARDEN NET Centre, European Neuroendocrine Tumor Society Center of Excellence (ENETS CoE), University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, UK.
- Centre of Applied Biological and Exercise Sciences (ABES), Faculty of Health and Life Sciences, Coventry University, Coventry, UK.
- Translational and Experimental Medicine, Division of Biomedical Sciences, Warwick Medical School, University of Warwick, Coventry, UK.
| | - Andreas F H Pfeiffer
- Department of Clinical Nutrition, German Institute of Human Nutrition Potsdam-Rehbrücke, Arthur-Scheunert-Allee 114-116, 14558, Nuthetal, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Department of Endocrinology, Diabetes and Nutrition, Campus Benjamin Franklin, Charité University Medicine, Berlin, Germany
| |
Collapse
|
32
|
Costa-Pinel B, Mestre-Miravet S, Barrio-Torrell F, Cabré-Vila JJ, Cos-Claramunt X, Aguilar-Sanz S, Solé-Brichs C, Castell-Abat C, Arija-Val V, Lindström J. Implementation of the DP-TRANSFERS project in Catalonia: A translational method to improve diabetes screening and prevention in primary care. PLoS One 2018; 13:e0194005. [PMID: 29543842 PMCID: PMC5854335 DOI: 10.1371/journal.pone.0194005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 02/22/2018] [Indexed: 01/06/2023] Open
Abstract
Background The DE-PLAN-CAT project (Diabetes in Europe–Prevention using lifestyle, physical activity and nutritional intervention–Catalonia) has shown that an intensive lifestyle intervention is feasible in the primary care setting and substantially reduces the incidence of diabetes among high-risk Mediterranean participants. The DP-TRANSFERS project (Diabetes Prevention–Transferring findings from European research to society) is a large-scale national programme aimed at implementing this intervention in primary care centres whenever feasible. Methods A multidisciplinary committee first evaluated the programme in health professionals and then participants without diabetes aged 45–75 years identified as being at risk of developing diabetes: FINDRISC (Finnish Diabetes Risk Score)>11 and/or pre-diabetes diagnosis. Implementation was supported by a 4-channel transfer approach (institutional relationships, facilitator workshops, collaborative groupware, programme website) and built upon a 3-step (screening, intervention, follow-up) real-life strategy. The 2-year lifestyle intervention included a 9-hour basic module (6 sessions) and a subsequent 15-hour continuity module (10 sessions) delivered by trained primary healthcare professionals. A 3-level (centre, professionals and participants) descriptive analysis was conducted using cluster sampling to assess results and barriers identified one year after implementation. Results The programme was started in June-2016 and evaluated in July-2017. In all, 103 centres covering all the primary care services for 1.4 million inhabitants (27.9% of all centres in Catalonia) and 506 professionals agreed to develop the programme. At the end of the first year, 83 centres (80.6%) remained active and 305 professionals (60.3%) maintained regular web-based activities. Implementation was not feasible in 20 centres (19.4%), and 5 main barriers were prioritized: lack of healthcare manager commitment; discontinuity of the initial effort; substantial increase in staff workload; shift in professional status and lack of acceptance. Overall, 1819 people were screened and 1458 (80.1%) followed the lifestyle intervention, with 1190 (81.6% or 65.4% of those screened) participating in the basic module and 912 in the continuity module (62.5% or 50.1%, respectively). Conclusions A large-scale lifestyle intervention in primary care can be properly implemented within a reasonably short time using existing public healthcare resources. Regrettably, one fifth of the centres and more than one third of the professionals showed substantial resistance to performing these additional activities.
Collapse
Affiliation(s)
- Bernardo Costa-Pinel
- Jordi Gol Primary Care Research Institute, Catalan Health Institute, Primary Health Care Division, Reus-Barcelona, Catalonia, Spain
- * E-mail:
| | - Santiago Mestre-Miravet
- Jordi Gol Primary Care Research Institute, Catalan Health Institute, Primary Health Care Division, Reus-Barcelona, Catalonia, Spain
| | - Francisco Barrio-Torrell
- Jordi Gol Primary Care Research Institute, Catalan Health Institute, Primary Health Care Division, Reus-Barcelona, Catalonia, Spain
| | - Joan-Josep Cabré-Vila
- Jordi Gol Primary Care Research Institute, Catalan Health Institute, Primary Health Care Division, Reus-Barcelona, Catalonia, Spain
| | - Xavier Cos-Claramunt
- Jordi Gol Primary Care Research Institute, Catalan Health Institute, Primary Health Care Division, Reus-Barcelona, Catalonia, Spain
| | - Sofía Aguilar-Sanz
- Jordi Gol Primary Care Research Institute, Catalan Health Institute, Primary Health Care Division, Reus-Barcelona, Catalonia, Spain
| | - Claustre Solé-Brichs
- Jordi Gol Primary Care Research Institute, Catalan Health Institute, Primary Health Care Division, Reus-Barcelona, Catalonia, Spain
| | - Conxa Castell-Abat
- Public Health Division. Department of Health, Generalitat de Catalunya. Barcelona, Catalonia, Spain
| | - Victoria Arija-Val
- Jordi Gol Primary Care Research Institute, Catalan Health Institute, Primary Health Care Division, Reus-Barcelona, Catalonia, Spain
- Faculty of Medicine and Health Sciences, Nutrition and Mental Health Research Group (NUTRISAM), Universitat Rovira i Virgili. Institut d’Investigació Sanitaria Pere Virgili. Reus, Catalonia, Spain
| | - Jaana Lindström
- Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland
| | | |
Collapse
|
33
|
Gilis-Januszewska A, Lindström J, Barengo NC, Tuomilehto J, Schwarz PEH, Wójtowicz E, Piwońska-Solska B, Szybiński Z, Windak A, Hubalewska-Dydejczyk A. Predictors of completing a primary health care diabetes prevention intervention programme in people at high risk of type 2 diabetes: Experiences of the DE-PLAN project. Medicine (Baltimore) 2018; 97:e9790. [PMID: 29384876 PMCID: PMC5805448 DOI: 10.1097/md.0000000000009790] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 12/23/2017] [Accepted: 01/14/2018] [Indexed: 11/25/2022] Open
Abstract
It has been shown that real-life implementation studies for the prevention of type 2 diabetes (DM2) performed in different settings and populations can be effective. However, not enough information is available on factors influencing the reach of DM2 prevention programmes. This study examines the predictors of completing an intervention programme targeted at people at high risk of DM2 in Krakow, Poland as part of the DE-PLAN project.A total of 262 middle-aged people, everyday patients of 9 general practitioners' (GP) practices, at high risk of DM2 (Finnish Diabetes Risk Score (FINDRISK) >14) agreed to participate in the lifestyle intervention to prevent DM2. Intervention consisted of 11 lifestyle counseling sessions, organized physical activity sessions followed by motivational phone calls and letters. Measurements were performed at baseline and 1 year after the initiation of the intervention.Seventy percent of the study participants enrolled completed the core curriculum (n = 184), 22% were men. When compared to noncompleters, completers had a healthier baseline diabetes risk profile (P <.05). People who completed the intervention were less frequently employed versus noncompleters (P = .037), less often had hypertension (P = .043), and more frequently consumed vegetables and fruit daily (P = .055).In multiple logistic regression model, employment reduced the likelihood of completing the intervention 2 times (odds ratio [OR] 0.45, 95% confidence interval [CI] 0.25-0.81). Higher glucose 2 hours after glucose load and hypertension were the independent factors decreasing the chance to participate in the intervention (OR 0.79, 95% 0.69-0.92 and OR 0.52, 95% CI 0.27-0.99, respectively). Daily consumption of vegetables and fruits increased the likelihood of completing the intervention (OR 1.86, 95% 1.01-3.41).In conclusion, people with healthier behavior and risk profile are more predisposed to complete diabetes prevention interventions. Male, those who work and those with a worse health profile, are less likely to participate and complete interventions. Targeted strategies are needed in real-life diabetes prevention interventions to improve male participation and to reach those who are working as well as people with a higher risk profile.
Collapse
Affiliation(s)
| | - Jaana Lindström
- Chronic Disease Prevention Unit, National Institute for Health and Welfare (THL), Helsinki, Finland
| | - Noël C Barengo
- Department of Medical and Population Health Science, Herbert Wertheim College of Medicine, Florida International University, Miami, USA
| | - Jaakko Tuomilehto
- Dasman Diabetes Institute, Dasman, Kuwait
- Centre for Vascular Prevention, Danube-University Krems, Krems, Austria
- Department of Chronic Disease Prevention, National Institute for Health and Welfare
- Department of Public Health, University of Helsinki, Helsinki, Finland
- Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Peter EH Schwarz
- Department for Prevention & Care of Diabetes, Medical Clinic Unit III, University Clinic, Carl Gustav Carus at Technical University Dresden
- Paul Langerhans Institute Dresden of the Helmholtz Center Munich at University Hospital and Faculty of Medicine, Technical University Dresden, Dresden
- German Center for Diabetes Research, Neuherberg, Germany
| | | | | | | | - Adam Windak
- Department of Family Medicine, Chair of Medicine and Gerontology, Jagiellonian University, Medical College, Krakow, Poland
| | | |
Collapse
|
34
|
Riemenschneider H, Saha S, van den Broucke S, Maindal HT, Doyle G, Levin-Zamir D, Muller I, Ganahl K, Sørensen K, Chang P, Schillinger D, Schwarz PEH, Müller G. State of Diabetes Self-Management Education in the European Union Member States and Non-EU Countries: The Diabetes Literacy Project. J Diabetes Res 2018; 2018:1467171. [PMID: 29850598 PMCID: PMC5932431 DOI: 10.1155/2018/1467171] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 02/21/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Diabetes self-management education (DSME) is considered essential for improving the prevention and care of diabetes through empowering patients to increase agency in their own health and care processes. However, existing evidence regarding DSME in the EU Member States (EU MS) is insufficient to develop an EU-wide strategy. OBJECTIVES This study presents the state of DSME in the 28 EU MS and contrasts it with 3 non-EU countries with comparable Human Development Index score: Israel, Taiwan, and the USA (ITU). Because type 2 diabetes mellitus (T2DM) disproportionately affects minority and low-income groups, we paid particular attention to health literacy aspects of DSME for vulnerable populations. METHODS Data from multiple stakeholders involved in diabetes care were collected from Feb 2014 to Jan 2015 using an online Diabetes Literacy Survey (DLS). Of the 379 respondents (249 from EU MS and 130 from ITU), most were people with diabetes (33% in the EU MS, 15% in ITU) and care providers (47% and 72%). These data were supplemented by an expert survey (ES) administered to 30 key informants. RESULTS Access to DSME varies greatly in the EU MS: an average of 29% (range 21% to 50%) of respondents report DSME programs are tailored for people with limited literacy, educational attainment, and language skills versus 63% in ITU. More than half of adult T2DM patients and children/adolescents participate in DSME in EU MS; in ITU, participation of T1DM patients and older people is lower. Prioritization of DSME (6.1 ± 2.8 out of 10) and the level of satisfaction with the current state of DSME (5.0 ± 2.4 out of 10) in the EU MS were comparable with ITU. CONCLUSION Variation in availability and organization of DSME in the EU MS presents a clear rationale for developing an EU-wide diabetes strategy to improve treatment and care for people with diabetes.
Collapse
Affiliation(s)
- Henna Riemenschneider
- Medical Clinic 3, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Sarama Saha
- Medical Clinic 3, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Stephan van den Broucke
- Institut de Recherche en Sciences Psychologiques, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | | | - Gerardine Doyle
- College of Business, University College Dublin, Dublin, Ireland
| | | | - Ingrid Muller
- Department of Psychology, University of Southampton, Southampton, UK
| | - Kristin Ganahl
- Gesundheit Österreich GmbH (Austrian Public Health Institute), Vienna, Austria
| | - Kristine Sørensen
- Department of International Health, Maastricht University, Maastricht, Netherlands
| | - Peter Chang
- Ministry of Health & Welfare, National Taipei Hospital, New Taipei City, Taiwan
| | - Dean Schillinger
- Center for Vulnerable Populations, Division of General Internal Medicine, University of California, San Francisco, CA, USA
| | - Peter E. H. Schwarz
- Medical Clinic 3, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Gabriele Müller
- Center for Evidence-based Healthcare, Medical Faculty, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| |
Collapse
|
35
|
Gagliardino JJ, Elgart JF, Bourgeois M, Etchegoyen G, Fantuzzi G, Ré M, Ricart JP, García S, Giampieri C, González L, Suárez-Crivaro F, Kronsbein P, Angelini JM, Martínez C, Martínez J, Ricart A, Spinedi E. Diabetes primary prevention program: New insights from data analysis of recruitment period. Diabetes Metab Res Rev 2018; 34. [PMID: 28843031 DOI: 10.1002/dmrr.2943] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Revised: 08/06/2017] [Accepted: 08/16/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND Primary Prevention of Diabetes Program in Buenos Aires Province evaluates the effectiveness of adopting healthy lifestyle to prevent type 2 diabetes (T2D) in people at high risk of developing it. We aimed to present preliminary data analysis of FINDRISC and laboratory measurements taken during recruitment of people for the Primary Prevention of Diabetes Program in Buenos Aires Province in the cities of La Plata, Berisso, and Ensenada, Argentina. METHODS People were recruited through population approach (house-to-house survey by FINDRISC in randomized areas) and opportunistic approach (FINDRISC completed by participants during consultations for nonrelated prediabetes/diabetes symptoms in public and private primary care centres of cities involved). In people with FINDRISC score ≥ 13 points, we evaluated blood concentrations of HbA1c , creatinine, lipids, and an oral glucose tolerance test (OGTT). RESULTS Approximately 3415 individuals completed the FINDRISC populational survey and 344 the opportunistic survey; 43% of the 2 groups scored over 13 points; 2.8 and 75.4% of them, respectively, took the prescribed OGTT. Approximately 53.7% of the OGTT showed normal values and 5.2% unknown T2D. The remaining cases showed 69.5% impaired fasting glucose, 13.6% impaired glucose tolerance, and 16.9% both impairments. HbA1c values showed significant differences compared with normal glucose tolerance (4.96 ± 0.43%), prediabetes (5.28 ± 0.51%), and T2D (5.60 ± 0.51%). Participants with prediabetes and T2D showed a predominant increase in low-density lipoprotein-cholesterol values. In prediabetes, >50% showed insulin resistance. CONCLUSIONS People with prediabetes/T2D had dyslipidemia associated with insulin resistance, which promotes the development of T2D and cardiovascular disease. Thus, it merits its appropriate treatment.
Collapse
Affiliation(s)
- Juan J Gagliardino
- Faculty of Medical Sciences (UNLP), CENEXA Center for Experimental and Applied Endocrinology (UNLP-CONICET La Plata), La Plata, Argentina
| | - Jorge F Elgart
- Faculty of Medical Sciences (UNLP), CENEXA Center for Experimental and Applied Endocrinology (UNLP-CONICET La Plata), La Plata, Argentina
| | - Marcelo Bourgeois
- Chair of Epidemiology INUS Center, Faculty of Medical Sciences (UNLP), La Plata, Argentina
| | - Graciela Etchegoyen
- Chair of Epidemiology INUS Center, Faculty of Medical Sciences (UNLP), La Plata, Argentina
| | - Gabriel Fantuzzi
- Faculty of Medical Sciences (UNLP), CENEXA Center for Experimental and Applied Endocrinology (UNLP-CONICET La Plata), La Plata, Argentina
| | - Matías Ré
- Faculty of Medical Sciences (UNLP), CENEXA Center for Experimental and Applied Endocrinology (UNLP-CONICET La Plata), La Plata, Argentina
| | - Juan P Ricart
- Faculty of Medical Sciences (UNLP), CENEXA Center for Experimental and Applied Endocrinology (UNLP-CONICET La Plata), La Plata, Argentina
| | - Silvia García
- Faculty of Medical Sciences (UNLP), CENEXA Center for Experimental and Applied Endocrinology (UNLP-CONICET La Plata), La Plata, Argentina
| | - Cecilia Giampieri
- Faculty of Medical Sciences (UNLP), CENEXA Center for Experimental and Applied Endocrinology (UNLP-CONICET La Plata), La Plata, Argentina
| | - Lorena González
- Faculty of Medical Sciences (UNLP), CENEXA Center for Experimental and Applied Endocrinology (UNLP-CONICET La Plata), La Plata, Argentina
| | - Florencia Suárez-Crivaro
- Laboratory, Secretariat of Health and Social Medicine, Municipality of La Plata, La Plata, Argentina
| | - Peter Kronsbein
- Faculty of Nutrition, Food and Hospitality Sciences, Niederrhein University of Applied Sciences, Mönchengladbach, Germany
| | - Julieta M Angelini
- Faculty of Medical Sciences, National University of La Plata (UNLP), La Plata, Argentina
| | - Camilo Martínez
- Faculty of Medical Sciences, National University of La Plata (UNLP), La Plata, Argentina
| | - Jorge Martínez
- Faculty of Medical Sciences, National University of La Plata (UNLP), La Plata, Argentina
| | - Alberto Ricart
- Faculty of Humanities and Cs of Education (UNLP), IdIHCS Institute of Research in Humanities and Social Sciences (UNLP-CONICET La Plata), La Plata, Argentina
| | - Eduardo Spinedi
- Faculty of Medical Sciences (UNLP), CENEXA Center for Experimental and Applied Endocrinology (UNLP-CONICET La Plata), La Plata, Argentina
| |
Collapse
|
36
|
Di Battista EM, Bracken RM, Stephens JW, Rice S, Thomas M, Williams SP, Mellalieu SD, Morgan K, Cottrell C, Davies V, Newbury‐Davies L, Street L, Judd F, Evans C, James J, Jones C, Williams C, Smith S, Thornton J, Williams S, Williams R, Williams M. Workplace delivery of a dietitian‐led cardiovascular disease and type 2 diabetes prevention programme: A qualitative study of participants’ experiences in the context of Basic Needs Theory. NUTR BULL 2017. [DOI: 10.1111/nbu.12292] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- E. M. Di Battista
- Aneurin Bevan University Health Board Caerleon UK
- University of South Wales Pontypridd UK
| | | | | | - S. Rice
- Hywel Dda Health Board Llanelli UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Individualising Chronic Care Management by Analysing Patients' Needs - A Mixed Method Approach. Int J Integr Care 2017; 17:2. [PMID: 29588635 PMCID: PMC5854149 DOI: 10.5334/ijic.3067] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Modern health systems are increasingly faced with the challenge to provide effective, affordable and accessible health care for people with chronic conditions. As evidence on the specific unmet needs and their impact on health outcomes is limited, practical research is needed to tailor chronic care to individual needs of patients with diabetes. Qualitative approaches to describe professional and informal caregiving will support understanding the complexity of chronic care. Results are intended to provide practical recommendations to be used for systematic implementation of sustainable chronic care models. Method A mixed method study was conducted. A standardised survey (n = 92) of experts in chronic care using mail responses to open-ended questions was conducted to analyse existing chronic care programs focusing on effective, problematic and missing components. An expert workshop (n = 22) of professionals and scientists of a European funded research project MANAGE CARE was used to define a limited number of unmet needs and priorities of elderly patients with type 2 diabetes mellitus and comorbidities. This list was validated and ranked using a multilingual online survey (n = 650). Participants of the online survey included patients, health care professionals and other stakeholders from 56 countries. Results The survey indicated that current care models need to be improved in terms of financial support, case management and the consideration of social care. The expert workshop identified 150 patient needs which were summarised in 13 needs dimensions. The online survey of these pre-defined dimensions revealed that financial issues, education of both patients and professionals, availability of services as well as health promotion are the most important unmet needs for both patients and professionals. Conclusion The study uncovered competing demands which are not limited to medical conditions. The findings emphasise that future care models need to focus stronger on individual patient needs and promote their active involvement in co-design and implementation. Future research is needed to develop new chronic care models providing evidence-based and practical implications for the regional care setting.
Collapse
|
38
|
Rodríguez-Ramírez G, Simental-Mendía LE, Carrera-Gracia MDLA, Quintanar-Escorza MA. Vitamin E Deficiency and Oxidative Status are Associated with Prediabetes in Apparently Healthy Subjects. Arch Med Res 2017; 48:257-262. [PMID: 28923327 DOI: 10.1016/j.arcmed.2017.03.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 03/27/2017] [Indexed: 01/16/2023]
Abstract
BACKGROUND Previous studies have indicated that vitamin E deficiency and oxidative stress affect the beta cell function. Hence, the aim of this study was to determine the association between vitamin E deficiency and oxidative status with prediabetes in apparently healthy subjects. METHODS Apparently healthy men and women aged 18-65 years were enrolled in a case-control study. Individuals with new diagnosis of prediabetes were considered as cases and compared with a control group of individuals with normal glucose tolerance. Smoking, alcohol intake, pregnancy, diabetes, kidney disease, liver disease, cardiovascular disease, malignancy, glucocorticoid treatment and consumption of lipid-lowering drugs, antioxidants and vitamin supplements were exclusion criteria. Vitamin E deficiency was defined by serum levels of α-tocopherol <11.6 μmol/L, oxidative status was assessed by total antioxidant capacity and lipid peroxidation, and prediabetes was considered by the presence of impaired fasting glucose and/or impaired glucose tolerance. RESULTS A total of 148 subjects were allocated into the case (n = 74) and control (n = 74) groups. The frequency of vitamin E deficiency was higher in the case group (41.8%) compared with the control group (35.1%), p = 0.03. The logistic regression analysis adjusted by age, waist circumference and body mass index, revealed a significant association between vitamin E deficiency (OR 3.23; 95% CI: 1.34-7.79, p = 0.009), lipoperoxidation (OR 2.82; CI 95%: 1.42-5.59, p = 0.003) and total antioxidant capacity (OR 0.93; CI 95%: 0.90-0.96, p <0.001) with prediabetes. CONCLUSIONS Results of the present study suggest that both vitamin E deficiency and oxidative status are associated with prediabetes in apparently healthy subjects.
Collapse
Affiliation(s)
| | - Luis E Simental-Mendía
- Unidad de Investigación Biomédica del Instituto Mexicano del Seguro Social en Durango, Durango, Dgo., México.
| | | | | |
Collapse
|
39
|
Laaksonen J, Taipale T, Seppälä I, Raitoharju E, Mononen N, Lyytikäinen LP, Waldenberger M, Illig T, Hutri-Kähönen N, Rönnemaa T, Juonala M, Viikari J, Kähönen M, Raitakari O, Lehtimäki T. Blood pathway analyses reveal differences between prediabetic subjects with or without dyslipidaemia. The Cardiovascular Risk in Young Finns Study. Diabetes Metab Res Rev 2017; 33. [PMID: 28609607 DOI: 10.1002/dmrr.2914] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 04/21/2017] [Accepted: 05/22/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND Prediabetes often occurs together with dyslipidaemia, which is paradoxically treated with statins predisposing to type 2 diabetes mellitus. We examined peripheral blood pathway profiles in prediabetic subjects with (PRD ) and without dyslipidaemia (PR0 ) and compared these to nonprediabetic controls without dyslipidaemia (C0 ). METHODS The participants were from the Cardiovascular Risk in Young Finns Study, including 1240 subjects aged 34 to 49 years. Genome-wide expression data of peripheral blood and gene set enrichment analysis were used to investigate the differentially expressed genes and enriched pathways between different subtypes of prediabetes. RESULTS Pathways for cholesterol synthesis, interleukin-12-mediated signalling events, and downstream signalling in naïve CD8+ T-cells were upregulated in the PR0 group in comparison with controls (C0 ). The upregulation of these pathways was independent of waist circumference, blood pressure, smoking status, and insulin. Adjustment for CRP left the CD8+ T-cell signalling and interleukin-12-mediated signalling event pathway upregulated. The cholesterol synthesis pathway was also upregulated when all prediabetic subjects (PR0 and PRD ) were compared with the nonprediabetic control group. No pathways were upregulated or downregulated when the PRD group was compared with the C0 group. Five genes in the PR0 group and 1 in the PRD group were significantly differentially expressed in comparison with the C0 group. CONCLUSIONS Blood cell gene expression profiles differ significantly between prediabetic subjects with and without dyslipidaemia. Whether this classification may be used in detection of prediabetic individuals at a high risk of cardiovascular complications remains to be examined.
Collapse
Affiliation(s)
- Jaakko Laaksonen
- Department of Clinical Chemistry, Fimlab Laboratories and Finnish Cardiovascular Research Center - Tampere, Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Tuukka Taipale
- Department of Clinical Chemistry, Fimlab Laboratories and Finnish Cardiovascular Research Center - Tampere, Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Ilkka Seppälä
- Department of Clinical Chemistry, Fimlab Laboratories and Finnish Cardiovascular Research Center - Tampere, Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Emma Raitoharju
- Department of Clinical Chemistry, Fimlab Laboratories and Finnish Cardiovascular Research Center - Tampere, Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Nina Mononen
- Department of Clinical Chemistry, Fimlab Laboratories and Finnish Cardiovascular Research Center - Tampere, Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Leo-Pekka Lyytikäinen
- Department of Clinical Chemistry, Fimlab Laboratories and Finnish Cardiovascular Research Center - Tampere, Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Melanie Waldenberger
- Research Unit of Molecular Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, München, Germany
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, München, Germany
| | - Thomas Illig
- Research Unit of Molecular Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, München, Germany
- Hannover Unified Biobank, Hannover Medical School, Hannover, Germany
- Institute for Human Genetics, Hannover Medical School, Hannover, Germany
| | - Nina Hutri-Kähönen
- Department of Paediatrics, Tampere University Hospital and Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Tapani Rönnemaa
- Department of Medicine, University of Turku, Turku, Finland
- Division of Medicine, Turku University Hospital, Turku, Finland
| | - Markus Juonala
- Department of Medicine, University of Turku, Turku, Finland
- Division of Medicine, Turku University Hospital, Turku, Finland
| | - Jorma Viikari
- Department of Medicine, University of Turku, Turku, Finland
- Division of Medicine, Turku University Hospital, Turku, Finland
| | - Mika Kähönen
- Department of Clinical Physiology, Tampere University Hospital and Finnish Cardiovascular Research Center - Tampere, Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Olli Raitakari
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, University of Turku, Turku, Finland
- Research Centre for Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
| | - Terho Lehtimäki
- Department of Clinical Chemistry, Fimlab Laboratories and Finnish Cardiovascular Research Center - Tampere, Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| |
Collapse
|
40
|
Medical Nutrition Therapy and Weight Loss Questions for the Evidence Analysis Library Prevention of Type 2 Diabetes Project: Systematic Reviews. J Acad Nutr Diet 2017; 117:1578-1611. [DOI: 10.1016/j.jand.2017.06.361] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 06/20/2017] [Indexed: 01/03/2023]
|
41
|
Rashad NM, El-Shal AS, Amin AI, Soliman MH. Effects of probiotics supplementation on macrophage migration inhibitory factor and clinical laboratory feature of polycystic ovary syndrome. J Funct Foods 2017. [DOI: 10.1016/j.jff.2017.06.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
|
42
|
Wijesuriya M, Fountoulakis N, Guess N, Banneheka S, Vasantharajah L, Gulliford M, Viberti G, Gnudi L, Karalliedde J. A pragmatic lifestyle modification programme reduces the incidence of predictors of cardio-metabolic disease and dysglycaemia in a young healthy urban South Asian population: a randomised controlled trial. BMC Med 2017; 15:146. [PMID: 28851373 PMCID: PMC5576225 DOI: 10.1186/s12916-017-0905-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 06/29/2017] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND There is an increasing incidence of type 2 diabetes mellitus (T2DM) in young urban South-Asians. We tested the effect of a pragmatic trimonthly lifestyle modification (LSM) programme (P-LSM) versus a less-intensive 12-monthly control LSM (C-LSM) intervention on a primary composite endpoint of predictors of cardio-metabolic disease (new onset T2DM, hypertension, impaired glucose tolerance (IGT), impaired fasting glycaemia (IFG) and markers of cardio-renal disease) in participants aged 5-40 years with risk factors for T2DM. METHODS This was a randomised controlled trial performed at the National Diabetes Centre, Sri-Lanka. We individually randomised 4672 participants at risk of T2DM, of whom 3539 (mean age 22.5 (range 6-40 years, 48% males) received either trimonthly (P-LSM n = 1726) or 12-monthly (C-LSM n = 1813) peer educator advice aimed at reducing weight, improving diet, reducing psychological stress and increasing physical activity. RESULTS During a median follow-up of 3 years, the cumulative incidence of the primary endpoint was n = 479 in P-LSM (74 per 1000 person years) vs. 561 in C-LSM (96 per 1000 person years), with an incident rate ratio (IRR) of 0.89 (95% CI 0.83-0.96, P = 0.02). In post hoc analyses, new onset dysglycaemia (T2DM, IFG and IGT), was the major contributor to the composite and was significantly reduced by P-LSM (IRR 0.9, 95% CI 0.83-0.97, P = 0.01). A significant impact of P-LSM on the incidence of the composite endpoint was noted in 1725 participants (P-LSM n = 850, C-LSM n = 875) aged below 18; P-LSM n = 140 (48 per 1000 person years) versus C-LSM n = 174 (55.4 per 1000 person years), with an IRR of 0.83 (95% CI 0.73-0.94, P = 0.004). CONCLUSIONS In a young at-risk South-Asian population, a pragmatic LSM programme significantly reduces the incidence of predictors of cardio-metabolic disease. Our results highlight the importance of early intervention in young at-risk subjects. TRIAL REGISTRATION World Health Organization international clinical trial registry platform ( SLCTR/2008/003 ). Registration Date: March 28, 2008. Retrospectively registered.
Collapse
Affiliation(s)
| | - Nikolaos Fountoulakis
- Cardiovascular Division, Faculty of Life Science & Medicine, King's College London, London, UK
| | - Nicola Guess
- Diabetes and Nutritional Sciences Division, Faculty of Life Science & Medicine, King's College London, London, UK
| | | | | | - Martin Gulliford
- Department of Primary Care and Public Health Sciences, King's College, London, UK
| | - Giancarlo Viberti
- Cardiovascular Division, Faculty of Life Science & Medicine, King's College London, London, UK
| | - Luigi Gnudi
- Cardiovascular Division, Faculty of Life Science & Medicine, King's College London, London, UK
| | - Janaka Karalliedde
- Cardiovascular Division, Faculty of Life Science & Medicine, King's College London, London, UK.
| |
Collapse
|
43
|
Kokic V, Kokic S, Krnic M, Petric M, Liberati AM, Simac P, Milenkovic T, Capkun V, Rahelic D, Blaslov K. Prediabetes awareness among Southeastern European physicians. J Diabetes Investig 2017; 9:544-548. [PMID: 28853223 PMCID: PMC5934258 DOI: 10.1111/jdi.12740] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 08/04/2017] [Accepted: 08/20/2017] [Indexed: 01/03/2023] Open
Abstract
AIMS/INTRODUCTION Prediabetes (PD) represents a transitional state where the glucose levels are higher than normal, but not enough for diabetes mellitus diagnosis. As there is a growing number of the population with PD, its early detection and treatment could prevent the development of diabetes mellitus and its complications. We aimed to assess the overall knowledge of PD among medical professionals of different varieties. MATERIALS AND METHODS A questionnaire-based study addressing PD and type 2 diabetes mellitus knowledge among Southeastern European general practitioners, postgraduates, physicians and superior specialists was carried out. RESULTS A total of 397 physicians completed the questionnaire. The total rate of correct answers from diabetologists, non-diabetologist internists, residents and general practitioners was 69, 56.1, 54 and 53%, respectively. Questions related to the PD definition achieved a total of 46.6% correct answers. Correct responses considering the numerical definition of impaired fasting glucose and impaired glucose tolerance were 46.3 and 46.8%, respectively. Younger physicians had better knowledge of numerical values regarding PD and type 2 diabetes mellitus criteria (P < 0.001). CONCLUSIONS The present results show that overall knowledge of PD is poor among Southeastern European physicians, which necessitates adequate educational programs on PD in this region.
Collapse
Affiliation(s)
- Visnja Kokic
- School of Medicine, University of Split, Split, Croatia
- Department of Endocrinology, Diabetes and Metabolic Disease, Clinical Hospital Center Split, Split, Croatia
| | - Slaven Kokic
- School of Medicine, University of Split, Split, Croatia
| | - Mladen Krnic
- School of Medicine, University of Split, Split, Croatia
- Department of Endocrinology, Diabetes and Metabolic Disease, Clinical Hospital Center Split, Split, Croatia
| | - Marin Petric
- School of Medicine, University of Split, Split, Croatia
- Department of Rheumatology and Clinical Immunology, Clinical Hospital Center Split, Split, Croatia
| | - Ana Marija Liberati
- Department of Endocrinology, Diabetes and Metabolic Disease, Clinical Hospital "Sveti Duh", Zagreb, Croatia
| | - Petra Simac
- School of Medicine, University of Split, Split, Croatia
- Department of Rheumatology and Clinical Immunology, Clinical Hospital Center Split, Split, Croatia
| | - Tatjana Milenkovic
- University St. Cyril and Methodius - University Clinic of Endocrinology, Skopje, Macedonia
| | - Vesna Capkun
- School of Medicine, University of Split, Split, Croatia
| | - Dario Rahelic
- Department of Endocrinology, Diabetes and Clinical Pharmacology, Clinical Hospital "Dubrava", Zagreb, Croatia
| | | |
Collapse
|
44
|
Beliefs about hypertension among Nigerian immigrants to the United Kingdom: A qualitative study. PLoS One 2017; 12:e0181909. [PMID: 28750080 PMCID: PMC5531475 DOI: 10.1371/journal.pone.0181909] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 06/24/2017] [Indexed: 01/13/2023] Open
Abstract
Objective The aim of the study was to elicit beliefs about hypertension among Nigerian immigrants in the United Kingdom. Background The distributions of cardiovascular risk factors and diseases are not shared equally across ethnic and economic groups in the United Kingdom. Its burden is more clustered among minority ethnic populations and migrant groups including black African Nigerian migrants. Similar patterns have been reported across Europe, Australia, Canada, Nordic countries and the United States of America. There are about 300 distinct ethnic groups in Nigeria and reliable information about their beliefs about hypertension is not available. Given that the United Kingdom has a large community of Nigerian immigrants from these different ethno-cultural backgrounds, understanding their unique beliefs about hypertension may help promote appropriate care for this population in the United Kingdom and Nigeria. Setting A single Pentecostal church community in West London Participants Twenty-seven Nigerian migrant members of the church entered and completed the study Methods and outcome measure A qualitative interview study was conducted. The interviews were analysed using thematic framework analysis. The outcome measures were emerging themes from the thematic framework analysis. Results Participants expressed beliefs in four major areas related to hypertension: (1) The Meaning of the term hypertension, (2) Perceptions of causation, (3) Effects of hypertension, and (4) Perceptions of treatment. The study revealed a diversity of beliefs about hypertension which incorporated both orthodox and culturally framed ideas. Conclusions This study identified important beliefs among Nigerian migrants about hypertension that can contribute to our understanding of the management of hypertension in this group and suggests the need for further research to determine whether these beliefs may be representative of this group.
Collapse
|
45
|
Damschroder LJ, Reardon CM, AuYoung M, Moin T, Datta SK, Sparks JB, Maciejewski ML, Steinle NI, Weinreb JE, Hughes M, Pinault LF, Xiang XM, Billington C, Richardson CR. Implementation findings from a hybrid III implementation-effectiveness trial of the Diabetes Prevention Program (DPP) in the Veterans Health Administration (VHA). Implement Sci 2017; 12:94. [PMID: 28747191 PMCID: PMC5530572 DOI: 10.1186/s13012-017-0619-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 07/04/2017] [Indexed: 11/10/2022] Open
Abstract
Background The Diabetes Prevention Program (DPP) is an effective lifestyle intervention to reduce incidence of type 2 diabetes. However, there are gaps in knowledge about how to implement DPP. The aim of this study was to evaluate implementation of DPP via assessment of a clinical demonstration in the Veterans Health Administration (VHA). Methods A 12-month pragmatic clinical trial compared weight outcomes between the Veterans Affairs Diabetes Prevention Program (VA-DPP) and the usual care MOVE!® weight management program (MOVE!). Eligible participants had a body mass index (BMI) ≥30 kg/m2 (or BMI ≥ 25 kg/m2 with one obesity-related condition), prediabetes (glycosylated hemoglobin (HbA1c) 5.7–6.5% or fasting plasma glucose (FPG) 100–125 mg/dL), lived within 60 min of their VA site, and had not participated in a weight management program within the last year. Established evaluation and implementation frameworks were used to guide the implementation evaluation. Implementation barriers and facilitators, delivery fidelity, participant satisfaction, and implementation costs were assessed. Using micro-costing methods, costs for assessment of eligibility and scheduling and maintaining adherence per participant, as well as cost of delivery per session, were also assessed. Results Several barriers and facilitators to Reach, Adoption, Implementation, Effectiveness and Maintenance were identified; barriers related to Reach were the largest challenge encountered by site teams. Fidelity was higher for VA-DPP delivery compared to MOVE! for five of seven domains assessed. Participant satisfaction was high in both programs, but higher in VA-DPP for most items. Based on micro-costing methods, cost of assessment for eligibility was $68/individual assessed, cost of scheduling and maintaining adherence was $328/participant, and cost of delivery was $101/session. Conclusions Multi-faceted strategies are needed to reach targeted participants and successfully implement DPP. Costs for assessing patients for eligibility need to be carefully considered while still maximizing reach to the targeted population.
Collapse
Affiliation(s)
- Laura J Damschroder
- Ann Arbor VA HSR&D/Center for Clinical Management Research, P.O. Box 130170, Ann Arbor, MI, 48113-0170, USA. .,VA Diabetes QUERI, Ann Arbor, MI, USA.
| | - Caitlin M Reardon
- Ann Arbor VA HSR&D/Center for Clinical Management Research, P.O. Box 130170, Ann Arbor, MI, 48113-0170, USA
| | - Mona AuYoung
- Ann Arbor VA HSR&D/Center for Clinical Management Research, P.O. Box 130170, Ann Arbor, MI, 48113-0170, USA.,Scripps Translational Science Institute/The Scripps Research Institute, 10550 North Torrey Pines Road, Mail Drop: TRY-30, La Jolla, CA, 92037, USA
| | - Tannaz Moin
- VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd 3, Los Angeles, CA, 90073, USA.,David Geffen School of Medicine, University of California, Los Angeles, CA, USA.,Greater Los Angeles VA Health Services Research and Development (HSR&D) Center for Healthcare Innovation, Implementation and Policy, Los Angeles, CA, USA
| | - Santanu K Datta
- Durham VA Medical Center HSR&D, 411 W Chapel Hill St, Suite 600, Durham, NC, 27701, USA.,Duke University School of Medicine, Durham, NC, USA
| | - Jordan B Sparks
- Ann Arbor VA HSR&D/Center for Clinical Management Research, P.O. Box 130170, Ann Arbor, MI, 48113-0170, USA
| | - Matthew L Maciejewski
- Durham VA Medical Center HSR&D, 411 W Chapel Hill St, Suite 600, Durham, NC, 27701, USA.,Duke University School of Medicine, Durham, NC, USA
| | - Nanette I Steinle
- VA Maryland Healthcare System, 10 North Greene St, Baltimore, MD, 21201, USA.,University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jane E Weinreb
- VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd 3, Los Angeles, CA, 90073, USA.,David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Maria Hughes
- Ann Arbor VA HSR&D/Center for Clinical Management Research, P.O. Box 130170, Ann Arbor, MI, 48113-0170, USA
| | - Lillian F Pinault
- VA Maryland Healthcare System, 10 North Greene St, Baltimore, MD, 21201, USA.,University of Maryland School of Medicine, Baltimore, MD, USA
| | - Xinran M Xiang
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA.,Louisiana State University Pediatric Neurology Program, 1542 Tulane Ave Rm 763, New Orleans, LA, 70112, USA
| | - Charles Billington
- Minneapolis VA Healthcare System, 1 Veterans Drive, Minneapolis, MN, 55417, USA.,University of Minnesota Medical Center, Minneapolis, MN, USA
| | - Caroline R Richardson
- Ann Arbor VA HSR&D/Center for Clinical Management Research, P.O. Box 130170, Ann Arbor, MI, 48113-0170, USA.,VA Diabetes QUERI, Ann Arbor, MI, USA.,Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA.,University of Michigan Department of Family Medicine, 1018 Fuller St, Ann Arbor, MI, 48104, USA
| |
Collapse
|
46
|
Changes in dietary intake following a culturally adapted lifestyle intervention among Iraqi immigrants to Sweden at high risk of type 2 diabetes: a randomised trial. Public Health Nutr 2017; 20:2827-2838. [DOI: 10.1017/s136898001700146x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
AbstractObjectiveTo investigate the effectiveness of a culturally adapted lifestyle intervention for changing dietary intake, particularly energy, fat and fibre intakes, in the intervention group (IG) compared with the control group (CG).DesignRandomised controlled trial.SettingIG (n 50) and CG (n 46). The IG was offered seven group sessions, including one cooking class, over a period of 4 months. The participants filled out 4 d food diaries at the start, mid and end of the study.SubjectsIraqi-born residents of Malmö, Sweden, at increased risk for developing diabetes.ResultsAt baseline, participants’ fat intake was high (40 % of total energy intake (E%)). The predefined study goals of obtaining <30 E% from fat and ≥15 g fibre/4184 kJ (1000 kcal) were met by very few individuals. In the IG v. the CG, the proportion of individuals obtaining <40 E% from fat (48·4 v. 34·6 %, P=0·65), <10 E% from saturated fat (32·3 v. 11·5 %, P=0·14) and ≥10 g fibre/4184 kJ (45·2 v. 26·9 %, P=0·46) appeared to be higher at the last visit, although the differences were statistically non-significant. A trend towards decreased mean daily intakes of total energy (P=0·03), carbohydrate (P=0·06), sucrose (P=0·02) and fat (P=0·02) was observed within the IG. Differences in changes over time between the groups did not reach statistical significance.ConclusionsAlthough no significant differences were observed in the two groups, our data indicate that this culturally adapted programme has the potential to modify dietary intake in Middle Eastern immigrants. The high fat intake in this group should be addressed.
Collapse
|
47
|
Suwannaphant K, Laohasiriwong W, Puttanapong N, Saengsuwan J, Phajan T. Association between Socioeconomic Status and Diabetes Mellitus: The National Socioeconomics Survey, 2010 and 2012. J Clin Diagn Res 2017; 11:LC18-LC22. [PMID: 28892937 DOI: 10.7860/jcdr/2017/28221.10286] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 06/09/2017] [Indexed: 12/16/2022]
Abstract
INTRODUCTION The prevalence of Diabetes Mellitus (DM) is increasing, globally. However, studies on the association between Socioeconomic Status (SES) factors and DM have mostly been conducted in specific areas with rather small sample sizes or not with nationally representative samples. Their results have also been inconclusive regarding whether SES has any influence on DM or not. AIM To determine the association between SES and DM in Thailand. MATERIALS AND METHODS This study utilized the data from the National socioeconomics survey, a cross-sectional study conducted by the National Statistical Office (NSO) in 2010 and 2012. A total of 17,045 and 16,903 participants respectively who met the inclusion criteria were included in this study. The information was collected by face-to-face interview with structured questionnaires. Multilevel mixed-effects logistic regression analysis was performed to determine the potential socioeconomic factors associated with DM. RESULTS The prevalence of DM was 3.70% (95% CI: 3.36 to 4.05) and 8.11% (95%CI: 6.25 to 9.74) in 2010 and 2012 respectively and the prevalence of DM in 2012 was 1.36 times (95% CI: 1.25 to 1.48) when compared with 2010. The multilevel mixed-effects logistic regression observed that odds of having DM were significantly higher among those who aged 55-64 years old in 2010 and 65 years old or greater in 2012 (ORadj = 18.13; 95%CI: 9.11 to 36.08, ORadj 31.69; 95%CI: 20.78 to 48.33, respectively), females (ORadj = 2.09; 95%CI: 1.66 to 2.62, ORadj = 1.77; 95%CI: 1.54 to 2.05, respectively), and had lower education attainment (ORadj = 5.87; 95%CI: 4.70 to 7.33, ORadj= 1.22; 95%CI: 1.04 to 1.45, respectively) were also found to be associated with DM . CONCLUSION The study indicated that SES has been associated with DM. Those with female gender, old age and low educational attainment were vulnerable to DM.
Collapse
Affiliation(s)
| | - Wongsa Laohasiriwong
- Associate Professor, Department of Public Health, Enhancing Quality of Life for Working, Khon Kaen, Thailand
| | - Nattapong Puttanapong
- Assistant Professor, Department of Economics, Thammasat University, Bangkok, Thailand
| | | | - Teerasak Phajan
- Instructor, Department of Public Health, Sirindorn College of Public Health, Khon Kaen, Thailand
| |
Collapse
|
48
|
Prevalence, Awareness, Treatment, and Control of Hypertension among Chinese First-Generation Migrants and Italians in Prato, Italy: The CHIP Study. Int J Hypertens 2017; 2017:6402085. [PMID: 28487768 PMCID: PMC5406722 DOI: 10.1155/2017/6402085] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 03/11/2017] [Accepted: 03/19/2017] [Indexed: 01/19/2023] Open
Abstract
Data on health needs of Chinese living in the South of Europe are lacking. To compare prevalence, awareness, treatment, control, and risk factors for hypertension between Chinese migrants and Italian adults, a sample of 1200 first-generation Chinese migrants and 291 native Italians aged 35–59 years living in Prato (Italy) was recruited in a community-based participatory cross-sectional survey. Primary outcome measure was hypertension, diagnosed for blood pressure values ≥ 140/90 mmHg or current use of antihypertensive medications. Associations with exposures (including age, gender, body mass index, waist, education level, total cholesterol, and triglycerides) were examined using logistic regression. When compared with Italians, Chinese had higher hypertension prevalence (27.2% versus 21.3%, p < 0.01), with comparable levels of awareness (57.4% and 48.4%) but lower treatment rates (70.6% and 90.0%, resp.). In both ethnic groups age and parental history of hypertension were predictors of awareness and treatment, body mass index being predictor of hypertension diagnosis. In Chinese participants, where the optimum cut-off point for body mass index was ≥23.9 kg/m2, the sensibility and specificity prediction for hypertension were 61.7% and 59.8%, respectively (area under the ROC curve = 0.629). Implementation of specific, culturally adapted health programs for the Chinese community is now needed.
Collapse
|
49
|
Gilis-Januszewska A, Lindström J, Tuomilehto J, Piwońska-Solska B, Topór-Mądry R, Szybiński Z, Peltonen M, Schwarz PEH, Windak A, Hubalewska-Dydejczyk A. Sustained diabetes risk reduction after real life and primary health care setting implementation of the diabetes in Europe prevention using lifestyle, physical activity and nutritional intervention (DE-PLAN) project. BMC Public Health 2017; 17:198. [PMID: 28202029 PMCID: PMC5312576 DOI: 10.1186/s12889-017-4104-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 02/03/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Real life implementation studies performed in different settings and populations proved that lifestyle interventions in prevention of type 2 diabetes can be effective. However, little is known about long term results of these translational studies. Therefore, the purpose of this study was to examine the maintenance of diabetes type 2 risk factor reduction achieved 1 year after intervention and during 3 year follow-up in primary health care setting in Poland. METHODS Study participants (n = 262), middle aged, slightly obese, with increased type 2 diabetes risk ((age 55.5 (SD = 11.3), BMI 32 (SD = 4.8), Finnish Diabetes Risk Score FINDRISC 18.4 (SD = 2.9)) but no diabetes at baseline, were invited for 1 individual and 10 group lifestyle counselling sessions as well as received 6 motivational phone calls and 2 letters followed by organized physical activity sessions combined with counselling to increase physical activity. Measurements were performed at baseline and then repeated 1 and 3 years after the initiation of the intervention. RESULTS One hundred five participants completed all 3 examinations (baseline age 56.6 (SD = 10.7)), BMI 31.1 (SD = 4.9)), FINDRISC 18.57 (SD = 3.09)). Males comprised 13% of the group, 10% of the patients presented impaired fasting glucose (IFG) and 14% impaired glucose tolerance (IGT). Mean weight of participants decreased by 2.27 kg (SD = 5.25) after 1 year (p = <0.001). After 3 years a weight gain by 1.13 kg (SD = 4.6) (p = 0.04) was observed. In comparison with baseline however, the mean total weight loss at the end of the study was maintained by 1.14 kg (SD = 5.8) (ns). Diabetes risk (FINDRISC) declined after one year by 2.8 (SD = 3.6) (p = 0.001) and the decrease by 2.26 (SD = 4.27) was maintained after 3 years (p = 0.001). Body mass reduction by >5% was achieved after 1 and 3 years by 27 and 19% of the participants, respectively. Repeated measures analysis revealed significant changes observed from baseline to year 1 and year 3 in: weight (p = 0.048), BMI (p = 0.001), total cholesterol (p = 0.013), TG (p = 0.061), fasting glucose level (p = 0.037) and FINDRISC (p = 0.001) parameters. The conversion rate to diabetes was 2% after 1 year and 7% after 3 years. CONCLUSIONS Type 2 diabetes prevention in real life primary health care setting through lifestyle intervention delivered by trained nurses leads to modest weight reduction, favorable cardiovascular risk factors changes and decrease of diabetes risk. These beneficial outcomes can be maintained at a 3-year follow-up. TRIAL REGISTRATION ISRCTN, ID ISRCTN96692060 , registered 03.08.2016 retrospectively.
Collapse
Affiliation(s)
- Aleksandra Gilis-Januszewska
- Chair and Department of Endocrinology, Jagiellonian University, Medical College, Kopernika 17, 31-501, Kraków, Poland.
| | - Jaana Lindström
- Chronic Disease Prevention Unit, National Institute for Health and Welfare (THL), Helsinki, Finland
| | - Jaakko Tuomilehto
- Centre for Vascular Prevention, Danube-University Krems, Krems, Austria.,Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland.,Department of Public Health, University of Helsinki, Helsinki, Finland.,Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia.,Dasman Diabetes Institute, Dasman, Kuwait
| | - Beata Piwońska-Solska
- Chair and Department of Endocrinology, Jagiellonian University, Medical College, Kopernika 17, 31-501, Kraków, Poland
| | - Roman Topór-Mądry
- Department of Epidemiology and Population Studies, Jagiellonian University Medical College, Krakow, Poland
| | - Zbigniew Szybiński
- Chair and Department of Endocrinology, Jagiellonian University, Medical College, Kopernika 17, 31-501, Kraków, Poland
| | - Markku Peltonen
- Chronic Disease Prevention Unit, National Institute for Health and Welfare (THL), Helsinki, Finland
| | - Peter E H Schwarz
- Department for Prevention & Care of Diabetes, Medical Clinic Unit III, University Clinic Carl Gustav Carus at Technical University DreSDen, DreSDen, Germany
| | - Adam Windak
- Department of Family Medicine, Chair of Medicine and Gerontology, Jagiellonian University Medical College, Krakow, Poland
| | - Alicja Hubalewska-Dydejczyk
- Chair and Department of Endocrinology, Jagiellonian University, Medical College, Kopernika 17, 31-501, Kraków, Poland
| |
Collapse
|
50
|
Bowes A, Begley J, Kerr D. Lifestyle change reduces cardiometabolic risk factors and glucagon-like peptide-1 levels in obese first-degree relatives of people with diabetes. J Hum Nutr Diet 2017; 30:490-498. [DOI: 10.1111/jhn.12440] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- A. Bowes
- Bournemouth Diabetes and Endocrine Centre; Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust; Bournemouth UK
- Intermediate Dietetics Department; Dorset Healthcare University NHS Foundation Trust; Diabetes Centre; Poole UK
| | - J. Begley
- Bournemouth Diabetes and Endocrine Centre; Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust; Bournemouth UK
| | - D. Kerr
- Research and Innovation; William Sansum Diabetes Center; Santa Barbara CA USA
| |
Collapse
|