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Neuwahl SJ, Sharma AJ, Zhang P, Hoerger TJ. Postdelivery Intervention to Prevent Type 2 Diabetes and the Cost-Effectiveness of Screening Criteria for Gestational Diabetes. Prev Chronic Dis 2022; 19:E89. [PMID: 36580414 PMCID: PMC9809391 DOI: 10.5888/pcd19.220055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE AND OBJECTIVES The objective of our study was to model the costs and benefits of 2 screening criteria for people with gestational diabetes. Because people with a history of gestational diabetes are at increased risk for type 2 diabetes, we modeled the effects of a postdelivery intervention based on the Diabetes Prevention Program, which is offered to all people with a history of gestational diabetes defined by either set of criteria. INTERVENTION APPROACH We used a probabilistic decision tree model to compare the cost-effectiveness of the International Association of Diabetes in Pregnancy Study Group's (IADPSG's) screening criteria and the Carpenter-Coustan screening criteria for gestational diabetes through delivery and a follow-up period during which people might develop type 2 diabetes after pregnancy. EVALUATION METHODS The model included perinatal outcomes for the infant and mother and a 10-year postdelivery period to model maternal progression to type 2 diabetes. The model assumed the health care system perspective. People with gestational diabetes received treatment for gestational diabetes during pregnancy, and we assumed that 10% would participate in a Diabetes Prevention Program-based postdelivery intervention to reduce the risk of type 2 diabetes. We estimated the cost-effectiveness of each screening strategy in quality-adjusted life-years (QALYs) in 2022 dollars. RESULTS At 10% participation in a Diabetes Prevention Program-based postdelivery intervention, the Carpenter-Coustan criteria were cost-effective, compared with no screening ($66,085 per QALY). The IADPSG screening criteria were slightly less cost-effective, compared with no screening ($97,878 per QALY) or Carpenter-Coustan screening criteria ($122,279 per QALY). With participation rates of 23% or higher, the IADPSG screening criteria were highly cost-effective ($48,588 per QALY), compared with Carpenter-Coustan screening criteria. IMPLICATIONS FOR PUBLIC HEALTH Diagnosing a larger proportion of pregnant people using the IADPSG screening criteria, compared with using Carpenter-Coustan screening criteria, is not cost-effective at low levels of participation. However, with moderate levels of participation (23%) in a Diabetes Prevention Program-based postdelivery intervention, the expanded IADPSG screening criteria are cost-effective and reach up to 4 times as many people as Carpenter-Coustan screening.
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Affiliation(s)
| | - Andrea J. Sharma
- Centers for Disease Control and Prevention, Atlanta, Georgia,US Public Health Service Commissioned Corps, Atlanta, Georgia
| | - Ping Zhang
- Centers for Disease Control and Prevention, Atlanta, Georgia
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Kivelä J, Wikström K, Virtanen E, Georgoulis M, Cardon G, Civeira F, Iotova V, Karuranga E, Ko W, Liatis S, Makrilakis K, Manios Y, Mateo-Gallego R, Nanasi A, Rurik I, Tankova T, Tsochev K, Van Stappen V, Lindström J. Obtaining evidence base for the development of Feel4Diabetes intervention to prevent type 2 diabetes - a narrative literature review. BMC Endocr Disord 2020; 20:140. [PMID: 32164690 PMCID: PMC7066732 DOI: 10.1186/s12902-019-0468-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 12/04/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Feel4Diabetes was a school and community based intervention aiming to promote healthy lifestyle and tackle obesity for the prevention of type 2 diabetes among families in 6 European countries. We conducted this literature review in order to guide the development of evidence-based implementation of the Feel4Diabetes intervention. We focused on type 2 diabetes prevention strategies, including all the phases from risk identification to implementation and maintenance. Special focus was given to prevention among vulnerable groups and people under 45 years. METHODS Scientific and grey literature published between January 2000 and January 2015 was searched for relevant studies using electronic databases. To present the literature review findings in a systematic way, we used the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. A complementary literature search from February 2015 to December 2018 was also conducted. RESULTS The initial review included 27 studies with a follow-up ≥12 months and 9 studies with a follow-up ≥6 months and with a participant mean age < 45 years. We found out that interventions should be targeted at people at risk to improve recruiting and intervention effectiveness. Screening questionnaires (primarily Finnish Diabetes Risk Score FINDRISC) and blood glucose measurement can both be used for screening; the method does not appear to affect intervention effectiveness. Screening and recruitment is time-consuming, especially when targeting lower socioeconomic status and age under 45 years. The intervention intensity is more important for effectiveness than the mode of delivery. Moderate changes in several lifestyle habits lead to good intervention results. A minimum of 3-year follow-up seemed to be required to show a reduction in diabetes risk in high-risk individuals. In participants < 45 years, the achieved results in outcomes were less pronounced. The complementary review included 12 studies, with similar results regarding intervention targets and delivery modes, as well as clinical significance. CONCLUSION This narrative review highlighted several important aspects that subsequently guided the development of the Feel4Diabetes high-risk intervention. Research on diabetes prevention interventions targeted at younger adults or vulnerable population groups is still relatively scarce. Feel4Diabetes is a good example of a project aiming to fill this research gap. TRIAL REGISTRATION clinicaltrials.gov NCT02393872, registered 20th March 2015.
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Affiliation(s)
- Jemina Kivelä
- Department of Public Health Solutions, National Institute for Health and Welfare, PO BOX 27, 00300 Helsinki, Finland
- Department of Obstetrics and Gynecology, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Katja Wikström
- Department of Public Health Solutions, National Institute for Health and Welfare, PO BOX 27, 00300 Helsinki, Finland
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Eeva Virtanen
- Department of Public Health Solutions, National Institute for Health and Welfare, PO BOX 27, 00300 Helsinki, Finland
| | - Michael Georgoulis
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
| | - Greet Cardon
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - Fernando Civeira
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, University of Zaragoza, Zaragoza, Spain
| | - Violeta Iotova
- Department of Paediatrics, Medical University Varna, Varna, Bulgaria
| | | | - Winne Ko
- International Diabetes Federation, Brussels, Belgium
| | - Stavros Liatis
- National and Kapodistrian University of Athens, Athens, Greece
| | | | - Yannis Manios
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
| | - Rocío Mateo-Gallego
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, University of Zaragoza, Zaragoza, Spain
| | - Anna Nanasi
- Department of Family and Occupational Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Imre Rurik
- Department of Family and Occupational Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Tsvetalina Tankova
- Department of Diabetology, Clinical Center of Endocrinology, Medical University Sofia, Sofia, Bulgaria
| | - Kaloyan Tsochev
- Department of Paediatrics, Medical University Varna, Varna, Bulgaria
| | - Vicky Van Stappen
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - Jaana Lindström
- Department of Public Health Solutions, National Institute for Health and Welfare, PO BOX 27, 00300 Helsinki, Finland
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Vitolins MZ, Blackwell CS, Katula JA, Isom SP, Case LD. Long-term Weight Loss Maintenance in the Continuation of a Randomized Diabetes Prevention Translational Study: The Healthy Living Partnerships to Prevent Diabetes (HELP PD) Continuation Trial. Diabetes Care 2019; 42:1653-1660. [PMID: 31296648 PMCID: PMC6702609 DOI: 10.2337/dc19-0295] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 06/21/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE HELP PD was a clinical trial of 301 adults with prediabetes. Participants were randomized to enhanced usual care (EUC) or to a lifestyle weight loss (LWL) intervention led by community health workers that consisted of a 6-month intensive phase (phase 1) and 18 months of maintenance (phase 2). At 24 months, participants were asked to enroll in phase 3 to assess whether continued group maintenance (GM) sessions would maintain improvements realized in phases 1 and 2 compared with self-directed maintenance (SM) or EUC. RESEARCH DESIGN AND METHODS In phase 3, LWL participants were randomly assigned to GM or SM. EUC participants remained in the EUC arm and, along with participants in SM, received monthly newsletters. All participants received semiannual dietitian sessions. Anthropometrics and biomarkers were assessed every 6 months. Mixed-effects models were used to assess changes in outcomes over time. RESULTS Eighty-two of the 151 intervention participants (54%) agreed to participate in phase 3; 41 were randomized to GM and 41 to SM. Of the 150 EUC participants, 107 (71%) continued. Ninety percent of clinic visits were completed. Over 48 months of additional follow-up, outcomes remained relatively stable in the EUC participants; the GM group was able to maintain body weight, BMI, and waist circumference; and these measures all increased significantly (P < 0.001) in the SM group. CONCLUSIONS Participants in the GM arm maintained weight loss achieved in phases 1 and 2, while those in the SM arm regained weight. Because group session attendance by the participants in the GM arm was low, it is unclear what intervention components led to successful weight maintenance.
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Affiliation(s)
- Mara Z Vitolins
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Caroline S Blackwell
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Jeffrey A Katula
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC
| | - Scott P Isom
- Department of Biostatistics and Data Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - L Douglas Case
- Department of Biostatistics and Data Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC
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Liss DT, Finch EA, Cooper A, Sheth A, Tejuosho AD, Lancki N, Ackermann RT. One-year effects of a group-based lifestyle intervention in adults with type 2 diabetes: A randomized encouragement trial. Diabetes Res Clin Pract 2018; 140:36-44. [PMID: 29596950 PMCID: PMC5990453 DOI: 10.1016/j.diabres.2018.03.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 03/13/2018] [Accepted: 03/20/2018] [Indexed: 10/17/2022]
Abstract
AIMS To estimate the real-world effects of offering a group-based lifestyle intervention (GLI) to adults with diabetes. METHODS This randomized encouragement trial included adult primary care patients in metropolitan Chicago with type 2 diabetes and body mass index ≥24 kg/m2. Participants were randomized to standard care (brief dietary and lifestyle counseling) or standard care plus being encouraged, but not required, to participate in a free-of-charge GLI offered by the YMCA. The GLI was a group-based adaptation of the Look AHEAD lifestyle intervention. RESULTS Of 331 participants, 167 were randomized to standard care and 164 to the GLI encouragement arm. About one third of participants were non-Hispanic White (34.4%). In the GLI arm, 75 (45.7%) attended ≥1 GLI visits. In the primary intention-to-treat analysis, the effect of GLI encouragement was 0.95% weight loss at six months (95% confidence interval [CI], 0.13-1.77%; P = 0.02), and 1.20% weight loss at 12 months (95% CI, 0.05-2.36%; P = 0.04). At 12 months, there was a 0.30% (3.3 mmol/mol) reduction in hemoglobin A1c, but this result did not achieve statistical significance (P = 0.054). In instrumental variable analysis estimating effects among the subgroup of participants who attended any GLI visits, the effect of GLI attendance was 2.30% weight loss at six months (95% CI, 0.30-4.30%; P = 0.02), and 2.07% weight loss at 12 months (95% CI, 0.25-3.88%; P = 0.02). We detected no significant blood pressure or cholesterol effects. CONCLUSIONS Among adults with type 2 diabetes, a group-based lifestyle intervention in a community-based setting achieved modest weight loss at 6 and 12 months. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT01435603.
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Affiliation(s)
- David T Liss
- Center for Community Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States; Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.
| | - Emily A Finch
- Center for Community Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States; Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Andrew Cooper
- Center for Community Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States; Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Avani Sheth
- Department of Family and Community Medicine, Cook County Health and Hospitals System, Chicago, IL, United States
| | - Ashantí D Tejuosho
- Center for Community Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States; Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Nicola Lancki
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Ronald T Ackermann
- Center for Community Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States; Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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PREVENT-DM Comparative Effectiveness Trial of Lifestyle Intervention and Metformin. Am J Prev Med 2017; 52:788-797. [PMID: 28237635 PMCID: PMC5438762 DOI: 10.1016/j.amepre.2017.01.008] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 11/22/2016] [Accepted: 01/05/2017] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Although the Diabetes Prevention Program and other clinical trials demonstrated the efficacy of intensive lifestyle interventions (ILI) and metformin to prevent type 2 diabetes, no studies have tested their comparative effects in pragmatic settings. This study was designed to compare the real-world effectiveness of ILI, metformin, and standard care among Hispanic women (Latinas) with prediabetes. STUDY DESIGN RCT. SETTING/PARTICIPANTS Ninety-two Latinas, who had a mean hemoglobin A1c of 5.9%, BMI of 33.3 kg/m2, and waist circumference of 97.4 cm (38.3 inches), were recruited from an urban community and randomly assigned to ILI, metformin, or standard care using 1:1:1 allocation. Data were collected from 2013-2015 and analyzed in 2016. INTERVENTION The 12-month ILI was adapted from the Diabetes Prevention Program's ILI and delivered by community health workers (promotoras) over 24 sessions. Metformin participants received 850 mg twice daily. Those randomized to standard care continued their regular medical care. MAIN OUTCOME MEASURES Weight and secondary outcomes (waist circumference, blood pressure, hemoglobin A1c, fasting plasma glucose, insulin, and lipids) were assessed at baseline and 12 months. RESULTS ILI participants demonstrated significantly greater mean weight loss (-4.0 kg, 5.0%) than metformin (-0.9 kg, 1.1%) and standard care participants (+0.8 kg, 0.9%) (p<0.001). The difference in weight loss between metformin and standard care was not significant. The ILI group experienced a greater reduction in waist circumference than standard care (p=0.001), and a marginal improvement in hemoglobin A1c compared with metformin and standard care (p=0.063). CONCLUSIONS In the first comparative effectiveness trial of diabetes prevention treatments, a 12-month ILI produced significantly greater weight loss than metformin and standard care among Latinas with prediabetes. These data suggest that ILI delivered by promotoras is an effective strategy for preventing diabetes in this high-risk group, which may be superior to metformin. Future pragmatic trials involving larger samples should examine differences in diabetes incidence associated with these treatments.
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Dandanell S, Ritz C, Verdich E, Dela F, Helge JW. Repeated lifestyle interventions lead to progressive weight loss: A retrospective review chart study. Scand J Public Health 2017; 45:305-313. [DOI: 10.1177/1403494817693709] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Aims: This study aimed to investigate whether repeated lifestyle interventions lead to progressive weight loss or to weight cycling. Methods: A retrospective review chart study with follow-up on 2120 participants (mean±SD age 36±15 years; body weight 116±28 kg; fat 43±6%). All had participated in one to four 11–12 week lifestyle interventions (residential weight loss programme, mixed activities). Weight loss was promoted through a hypocaloric diet (−500 to −700 kcal/day) and daily physical activity (1–3 hours/day). Primary outcomes were weight loss and change in body composition (bioimpedance measurements) after the intervention periods and at follow-up. Results: A total of 2120, 526, 139 and 47 people participated in one to four interventions with mean±SEM times from start to follow-up of 1.3±0.1, 2.9±0.2, 4.2±0.3 and 5.2±0.4 years respectively. Overall 50, 41, 18 and 11% of the participants were lost to follow-up after one to four interventions, respectively. The cumulated weight loss at follow-up increased with the number of interventions from one to four: 12.2±0.1, 15.9±0.7, 16.1±1.2 and 18.5±2.0 kg ( p<0.001). The ratios between cumulated loss of fat and fat free mass after one to four interventions decreased with the number of interventions (2.4, 2.2, 2.1 and 1.4). Rates of weight loss during the interventions ranged from 0.70±0.06 to 1.06±0.01 kg/week and the maximum weight regain during the follow-up periods was 0.039±0.007 kg/week. Conclusions: Repeated relatively short lifestyle interventions in a selected and motivated group can be an efficient method for weight loss maintenance with only limited body weight cycling in the interim periods. However, the relationship between loss of fat and fat free mass might change in an unfavourable direction.
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Affiliation(s)
- Sune Dandanell
- Center of Healthy Aging, Department of Biomedical Sciences, XLab, University of Copenhagen, Denmark
- Department of Physiotherapy and Occupational Therapy, Metropolitan University College, Denmark
| | - Christian Ritz
- Center of Healthy Aging, Department of Biomedical Sciences, XLab, University of Copenhagen, Denmark
| | | | - Flemming Dela
- Center of Healthy Aging, Department of Biomedical Sciences, XLab, University of Copenhagen, Denmark
- Department of Geriatrics, Bispebjerg University Hospital, Denmark
| | - Jørn W. Helge
- Center of Healthy Aging, Department of Biomedical Sciences, XLab, University of Copenhagen, Denmark
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Stetson B, Minges KE, Richardson CR. New directions for diabetes prevention and management in behavioral medicine. J Behav Med 2017; 40:127-144. [PMID: 27743230 PMCID: PMC5950714 DOI: 10.1007/s10865-016-9802-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 10/05/2016] [Indexed: 12/20/2022]
Abstract
Accelerating diabetes rates have resulted in a global public health epidemic. Lifestyle change is a cornerstone of care, yet regimen demands may result in adherence difficulties. Distress, depression, and other psychosocial concerns are higher in those with diabetes. While interventions, such as the Diabetes Prevention Program appear to be effective, further research is needed to support the translation of interventions to prevent diabetes. Studies assessing optimal approaches to promoting effective decision making, coping and adherence are needed. More information is needed to evaluate the influence and potential of emerging technologies on intervention delivery and quality of life in children and adults with diabetes. Theoretically informed, interdisciplinary studies that consider ecological models are needed to develop a roadmap for policies and diabetes management recommendations. Reduction of diabetes-related health disparities is a critical area for future studies. Behavioral medicine scientists and practitioners are poised to address these and other proposed future research directions to advance diabetes prevention and management.
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Affiliation(s)
- Barbara Stetson
- Department of Psychological and Brain Sciences, University of Louisville, 317 Life Sciences Building, Louisville, KY, 40292, USA.
| | - Karl E Minges
- School of Nursing, Yale University, Orange, CT, 06447, USA
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Joiner KL, Sternberg RM, Kennedy C, Chen JL, Fukuoka Y, Janson SL. A Spanish-Language Risk Perception Survey for Developing Diabetes: Translation Process and Assessment of Psychometric Properties. J Nurs Meas 2016; 24:365-378. [PMID: 28714443 PMCID: PMC5634892 DOI: 10.1891/1061-3749.24.3.365] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Create a Spanish-language version of the Risk Perception Survey for Developing Diabetes (RPS-DD) and assess psychometric properties. RESEARCH DESIGN AND METHODS The Spanish-language version was created through translation, harmonization, and presentation to the tool's original author. It was field tested in a foreignborn Latino sample and properties evaluated in principal components analysis. RESULTS Personal Control, Optimistic Bias, and Worry multi-item Likert subscale responses did not cluster together. A clean solution was obtained after removing two Personal Control subscale items. Neither the Personal Disease Risk scale nor the Environmental Health Risk scale responses loaded onto single factors. Reliabilities ranged from .54 to .88. Test of knowledge performance varied by item. CONCLUSIONS This study contributes to evidence of validation of a Spanish-language RPS-DD in foreign-born Latinos.
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Affiliation(s)
- Kevin L Joiner
- University of California, San Francisco, School of Nursing, USA
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Noël PH, Parchman ML, Finley EP, Wang CP, Bollinger M, Espinoza SE, Hazuda HP. Primary care-public health linkages: Older primary care patients with prediabetes & type 2 diabetes encouraged to attend community-based senior centers. Prev Med Rep 2016; 4:283-8. [PMID: 27462529 PMCID: PMC4950171 DOI: 10.1016/j.pmedr.2016.06.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 06/15/2016] [Accepted: 06/27/2016] [Indexed: 11/23/2022] Open
Abstract
The Institute of Medicine (IOM) suggests that primary care-public health integration can improve health outcomes for vulnerable patients, but the extent to which formal linkages may enhance patients' use of community resources, or the factors that may influence providers to encourage their patients to use these resources, remain unclear. We conducted baseline assessments in 2014-2015 with 149 older adults with prediabetes or diabetes who had recently joined three senior centers linked to a network of primary care clinics in San Antonio, Texas. In addition to collecting sociodemographic and clinical characteristics, we asked members to identify their source of primary care and whether a health care provider had encouraged them to go to the senior center. We also asked members why they had joined the senior centers and which programs interested them the most. Members' source of primary care was not associated with being encouraged to attend the senior centers by a health care professional. Multivariable analysis indicated that participants with total annual household incomes of $20,000 or less [OR = 2.78; 95% CI = (1.05, 7.14)] and those reporting 12 years of education or less [OR = 3.57; 95% CI = (1.11, 11.11)] were significantly more likely to report being encouraged to attend the senior center by a health care provider. Providers who are aware of community-based resources to support patient self-management may be just as likely to encourage their socioeconomically vulnerable patients with prediabetes or diabetes to use them as providers who have a more formal partnership with the senior centers.
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Affiliation(s)
- Polly H. Noël
- UT Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, United States
- South Texas Veterans Health Care System, 7400 Merton Minter Blvd, San Antonio, TX 78229, United States
| | - Michael L. Parchman
- MacColl Center for Healthcare Innovation, Group Health Research Institute, Group Health Cooperative, 1730 Minor Avenue, Suite 1600, Seattle, WA 98101, United States
| | - Erin P. Finley
- UT Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, United States
- South Texas Veterans Health Care System, 7400 Merton Minter Blvd, San Antonio, TX 78229, United States
| | - Chen-Pin Wang
- UT Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, United States
- South Texas Veterans Health Care System, 7400 Merton Minter Blvd, San Antonio, TX 78229, United States
| | - Mary Bollinger
- UT Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, United States
- South Texas Veterans Health Care System, 7400 Merton Minter Blvd, San Antonio, TX 78229, United States
| | - Sara E. Espinoza
- UT Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, United States
- South Texas Veterans Health Care System, 7400 Merton Minter Blvd, San Antonio, TX 78229, United States
| | - Helen P. Hazuda
- UT Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, United States
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Hays LM, Hoen HM, Slaven JE, Finch EA, Marrero DG, Saha C, Ackermann RT. Effects of a Community-based Lifestyle Intervention on Change in Physical Activity Among Economically Disadvantaged Adults With Prediabetes. AMERICAN JOURNAL OF HEALTH EDUCATION 2016; 47:266-278. [PMID: 28717407 DOI: 10.1080/19325037.2016.1203839] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Laura M Hays
- Department of Adults, Indiana University School of Nursing, Indianapolis, IN
| | - Helena M Hoen
- Regional Research, Providence Health and Services, Portland, OR
| | - James E Slaven
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN
| | - Emily A Finch
- Department of Medicine, Northwestern Feinberg School of Medicine, Chicago, IL
| | - David G Marrero
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Chandan Saha
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN
| | - Ronald T Ackermann
- Department of Medicine, Northwestern Feinberg School of Medicine, Chicago, IL
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Liss DT, Finch EA, Gregory DL, Cooper A, Ackermann RT. Design and participant characteristics for a randomized effectiveness trial of an intensive lifestyle intervention to reduce cardiovascular risk in adults with type 2 diabetes: The I-D-HEALTH study. Contemp Clin Trials 2015; 46:114-121. [PMID: 26611433 DOI: 10.1016/j.cct.2015.11.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 11/17/2015] [Accepted: 11/19/2015] [Indexed: 01/15/2023]
Abstract
Intervening in Diabetes with Healthy Eating, Activity and Linkages To Healthcare (I-D-HEALTH) is a community-based randomized trial evaluating the effectiveness of a group-based adaption of the Look AHEAD intensive lifestyle intervention. Most potentially eligible patients were identified through electronic medical record queries or referral to a diabetes resource hub. Trial enrollees had a usual source of primary care, elevated body mass index (BMI) and type 2 diabetes. I-D-HEALTH participants were randomized to either standard care alone or standard care plus free-of-charge access to a group-based lifestyle intervention (GLI) offered by the YMCA. GLI participation was encouraged, but not required, for the latter group. The primary outcome is percent weight change over 6, 12 and 24months. Secondary outcomes include direct intervention costs and direct medical and non-medical expenditures, as well as changes in systolic blood pressure, hemoglobin A1c and cholesterol. Among 331 I-D-HEALTH participants, 167 were randomized to standard care and 164 to GLI. The mean age (±standard deviation) in each group was 57.1years (±12.2) and 57.6years (±10.5), respectively. Mean BMI was 34.9kg/m(2) (±7.3) among standard care participants and 36.2kg/m(2) (±7.8) among GLI participants. In both groups, approximately one third of participants were non-Hispanic Whites. We detected no significant differences between groups in mean systolic blood pressure, hemoglobin A1c or total cholesterol (P >0.05 for all characteristics above). The I-D-HEALTH study enrolled a diverse sample of adults with diabetes and offers a unique opportunity to evaluate the effectiveness of offering a community-based intensive lifestyle intervention.
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Affiliation(s)
- David T Liss
- Center for Community Health, Northwestern University Feinberg School of Medicine, Chicago, IL, United States; Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.
| | - Emily A Finch
- Center for Community Health, Northwestern University Feinberg School of Medicine, Chicago, IL, United States; Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Dyanna L Gregory
- Center for Community Health, Northwestern University Feinberg School of Medicine, Chicago, IL, United States; Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Andrew Cooper
- Center for Community Health, Northwestern University Feinberg School of Medicine, Chicago, IL, United States; Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Ronald T Ackermann
- Center for Community Health, Northwestern University Feinberg School of Medicine, Chicago, IL, United States; Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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Perez A, Alos VA, Scanlan A, Maia CM, Davey A, Whitaker RC, Foster GD, Ackermann RT, O'Brien MJ. The rationale, design, and baseline characteristics of PREVENT-DM: A community-based comparative effectiveness trial of lifestyle intervention and metformin among Latinas with prediabetes. Contemp Clin Trials 2015; 45:320-327. [PMID: 26597415 PMCID: PMC4674352 DOI: 10.1016/j.cct.2015.10.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 10/19/2015] [Accepted: 10/23/2015] [Indexed: 11/18/2022]
Abstract
Promotora Effectiveness Versus Metformin Trial (PREVENT-DM) is a randomized comparative effectiveness trial of a lifestyle intervention based on the Diabetes Prevention Program delivered by community health workers (or promotoras), metformin, and standard care. Eligibility criteria are Hispanic ethnicity, female sex, age ≥ 20 years, fluent Spanish-speaking status, BMI ≥ 23 kg/m(2), and prediabetes. We enrolled 92 participants and randomized them to one of the following three groups: standard care, DPP-based lifestyle intervention, or metformin. The primary outcome of the trial is the 12-month difference in weight between groups. Secondary outcomes include the following cardiometabolic markers: BMI, waist circumference, blood pressure, and fasting plasma glucose, hemoglobin A1C (HbA1c), total cholesterol, triglycerides, LDL cholesterol, HDL cholesterol, and insulin. PREVENT-DM participants are socioeconomically disadvantaged Latinas with a mean annual household income of $15,527 ± 9922 and educational attainment of 9.7 ± 3.6 years. Eighty-six percent of participants are foreign born, 20% have a prior history of gestational diabetes, and 71% have a first-degree relative with diagnosed diabetes. At baseline, PREVENT-DM participants had a mean age of 45.1 ± 12.5 years, weight of 178.8 ± 39.3 lbs, BMI of 33.3 ± 6.5 kg/m(2), HbA1c of 5.9 ± 0.2%, and waist circumference of 97.4 ± 11.1cm. Mean baseline levels of other cardiometabolic markers were normal. The PREVENT-DM study successfully recruited and randomized an understudied population of Latinas with prediabetes. This trial will be the first U.S. study to test the comparative effectiveness of metformin and lifestyle intervention versus standard care among prediabetic adults in a "real-world" setting.
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Affiliation(s)
- Alberly Perez
- Center for Obesity Research and Education, Temple University, 3223 North Broad Street, Suite 175, Philadelphia, PA 19140, USA; Puentes de Salud Health and Wellness Center, 1700 South Street, Philadelphia, PA 19146, USA
| | - Victor A Alos
- Center for Obesity Research and Education, Temple University, 3223 North Broad Street, Suite 175, Philadelphia, PA 19140, USA; Puentes de Salud Health and Wellness Center, 1700 South Street, Philadelphia, PA 19146, USA
| | - Adam Scanlan
- Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Catarina M Maia
- Center for Obesity Research and Education, Temple University, 3223 North Broad Street, Suite 175, Philadelphia, PA 19140, USA; Puentes de Salud Health and Wellness Center, 1700 South Street, Philadelphia, PA 19146, USA
| | - Adam Davey
- Department of Epidemiology and Biostatistics, College of Public Health, Temple University, 1301 Cecil B. Moore Avenue, Ritter Annex, 9th Floor, Philadelphia, PA 19122, USA
| | - Robert C Whitaker
- Center for Obesity Research and Education, Temple University, 3223 North Broad Street, Suite 175, Philadelphia, PA 19140, USA; Department of Epidemiology and Biostatistics, College of Public Health, Temple University, 1301 Cecil B. Moore Avenue, Ritter Annex, 9th Floor, Philadelphia, PA 19122, USA
| | - Gary D Foster
- Weight Watchers International, Inc., 675 Avenue of the Americas, 6th Floor, New York, NY 10010, USA
| | - Ronald T Ackermann
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Drive, 10th Floor, Chicago, IL 60611, USA; Center for Community Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Drive, 6th Floor, Chicago, IL 60611, USA
| | - Matthew J O'Brien
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Drive, 10th Floor, Chicago, IL 60611, USA; Center for Community Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Drive, 6th Floor, Chicago, IL 60611, USA.
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Ackermann RT, Liss DT, Finch EA, Schmidt KK, Hays LM, Marrero DG, Saha C. A Randomized Comparative Effectiveness Trial for Preventing Type 2 Diabetes. Am J Public Health 2015; 105:2328-34. [PMID: 26378828 DOI: 10.2105/ajph.2015.302641] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We evaluated the weight loss effectiveness of a YMCA model for the Diabetes Prevention Program (DPP) lifestyle intervention. METHODS Between July 2008 and November 2010, we individually randomized 509 overweight or obese, low-income, nondiabetic adults with elevated blood glucose in Indianapolis, Indiana, to receive standard care plus brief lifestyle counseling or be offered a group-based YMCA adaptation of the DPP (YDPP). Primary outcome was mean weight loss difference at 12 months. In our intention-to-treat analyses, we used longitudinal linear or logistic regression, multiply imputing missing observations. We used instrumental variables regression to estimate weight loss effectiveness among participants completing 9 or more intervention lessons. RESULTS In the YDPP arm, 161 (62.6%) participants attended ≥ 1 lesson and 103 (40.0%) completed 9 or more lessons. In intention-to-treat analysis, mean 12-month weight loss was 2.3 kilograms (95% confidence interval [CI] = 1.1, 3.4 kg) more for the YDPP arm than for standard care participants. In instrumental variable analyses, persons attending 9 or more lessons had a 5.3-kilogram (95% CI = 2.8, 7.9 kg) greater weight loss than did those with standard care alone. CONCLUSIONS The YMCA model for DPP delivery achieves meaningful weight loss at 12 months among low-income adults.
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Affiliation(s)
- Ronald T Ackermann
- Ronald T. Ackermann, David T. Liss, and Emily A. Finch are with the Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL. Karen K. Schmidt and David G. Marrero are with the Department of Medicine, Indiana University School of Medicine, Indianapolis. Laura M. Hays is with the Indiana University School of Nursing, Indianapolis. Chandan Saha is with the Department of Biostatistics, Indiana University School of Medicine, Indianapolis
| | - David T Liss
- Ronald T. Ackermann, David T. Liss, and Emily A. Finch are with the Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL. Karen K. Schmidt and David G. Marrero are with the Department of Medicine, Indiana University School of Medicine, Indianapolis. Laura M. Hays is with the Indiana University School of Nursing, Indianapolis. Chandan Saha is with the Department of Biostatistics, Indiana University School of Medicine, Indianapolis
| | - Emily A Finch
- Ronald T. Ackermann, David T. Liss, and Emily A. Finch are with the Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL. Karen K. Schmidt and David G. Marrero are with the Department of Medicine, Indiana University School of Medicine, Indianapolis. Laura M. Hays is with the Indiana University School of Nursing, Indianapolis. Chandan Saha is with the Department of Biostatistics, Indiana University School of Medicine, Indianapolis
| | - Karen K Schmidt
- Ronald T. Ackermann, David T. Liss, and Emily A. Finch are with the Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL. Karen K. Schmidt and David G. Marrero are with the Department of Medicine, Indiana University School of Medicine, Indianapolis. Laura M. Hays is with the Indiana University School of Nursing, Indianapolis. Chandan Saha is with the Department of Biostatistics, Indiana University School of Medicine, Indianapolis
| | - Laura M Hays
- Ronald T. Ackermann, David T. Liss, and Emily A. Finch are with the Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL. Karen K. Schmidt and David G. Marrero are with the Department of Medicine, Indiana University School of Medicine, Indianapolis. Laura M. Hays is with the Indiana University School of Nursing, Indianapolis. Chandan Saha is with the Department of Biostatistics, Indiana University School of Medicine, Indianapolis
| | - David G Marrero
- Ronald T. Ackermann, David T. Liss, and Emily A. Finch are with the Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL. Karen K. Schmidt and David G. Marrero are with the Department of Medicine, Indiana University School of Medicine, Indianapolis. Laura M. Hays is with the Indiana University School of Nursing, Indianapolis. Chandan Saha is with the Department of Biostatistics, Indiana University School of Medicine, Indianapolis
| | - Chandan Saha
- Ronald T. Ackermann, David T. Liss, and Emily A. Finch are with the Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL. Karen K. Schmidt and David G. Marrero are with the Department of Medicine, Indiana University School of Medicine, Indianapolis. Laura M. Hays is with the Indiana University School of Nursing, Indianapolis. Chandan Saha is with the Department of Biostatistics, Indiana University School of Medicine, Indianapolis
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Abstract
This article explores the high risk of diabetes and cardiovascular diseases in adults over 18 years of age and recognises, through the literature, the potential role for nurses in engagement with diabetes prevention strategies in their everyday practice. It considers the latest international projections for diabetes, a critical review of evidence of how diabetes can be prevented and how effective methods of detection of pre-diabetes can be employed with every clinical encounter with adults who perhaps previously were not considered to be 'at risk' of developing type 2 diabetes. Effective consultation approaches to raise diabetes awareness within populations and to enable tailored approaches to public health lifestyle advice are explored, to encourage each practitioner to 'think diabetes' in every clinical encounter.
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Affiliation(s)
- Anne Phillips
- Senior Lecturer in Diabetes Care, University of York
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