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McMullen B, Duncanson K, Collins C, MacDonald-Wicks L. A systematic review of the mechanisms influencing engagement in diabetes prevention programmes for people with pre-diabetes. Diabet Med 2024; 41:e15323. [PMID: 38829966 DOI: 10.1111/dme.15323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 03/02/2024] [Accepted: 03/20/2024] [Indexed: 06/05/2024]
Abstract
AIMS To identify barriers and enablers that influence engagement in and acceptability of diabetes prevention programmes for people with pre-diabetes. The results will provide insights for developing strategies and recommendations to improve design and delivery of diabetes prevention programmes with enhanced engagement and acceptability for people with pre-diabetes. METHODS This review used a critical realist approach to examine context and mechanisms of diabetes prevention programmes. Medline, Embase, PsycInfo, Cinahl, Web of Science, Scopus and Pre-Medline were searched for English language studies published between 2000 and 2023. A quality assessment was conducted using Joanna Briggs Institute critical appraisal tools. RESULTS A total of 90 papers met inclusion criteria. The included studies used a variety of quantitative and qualitative methodologies. Data extracted focused on barriers and enablers to engagement in and acceptability of diabetes prevention programmes, with seven key mechanisms identified. These included financial, environmental, personal, healthcare, social and cultural, demographic and programme mechanisms. Findings highlighted diverse factors that influenced engagement in preventive programmes and the importance of considering these factors when planning, developing and implementing future diabetes prevention programmes. CONCLUSIONS Mechanisms identified in this review can inform design and development of diabetes prevention programmes for people with pre-diabetes and provide guidance for healthcare professionals and policymakers. This will facilitate increased participation and engagement in preventive programmes, potentially reducing progression and/or incidence of pre-diabetes to type 2 diabetes and improving health outcomes.
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Affiliation(s)
- Britney McMullen
- Mid North Coast Local Health District, University of Newcastle, Coffs Harbour, Australia
| | - Kerith Duncanson
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
| | - Clare Collins
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
- Food and Nutrition Research Program, Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Lesley MacDonald-Wicks
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
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Bennasar-Veny M, Malih N, Galmes-Panades AM, Hernandez-Bermudez IC, Garcia-Coll N, Ricci-Cabello I, Yañez AM. Effect of physical activity and different exercise modalities on glycemic control in people with prediabetes: a systematic review and meta-analysis of randomized controlled trials. Front Endocrinol (Lausanne) 2023; 14:1233312. [PMID: 37842295 PMCID: PMC10569497 DOI: 10.3389/fendo.2023.1233312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/14/2023] [Indexed: 10/17/2023] Open
Abstract
Background Numerous studies have shown the beneficial effects of exercise on glycemic control in people with prediabetes. However, the most effective exercise modality for improving glycemic control remains unclear. We aimed to assess which exercise training modality is most effective in improving glycemic control in a population with prediabetes. Methods We conducted searches in Pubmed/MEDLINE, EMBASE, SPORTDiscus, Web of Science, PEDro, BVS, and the Cochrane Library from inception to June 2022. Included studies reported fasting plasma glucose (FPG), glycated hemoglobin (HbA1c), and 2-hour postprandial (2hPP) levels and implemented an exercise program lasting at least 12 weeks in adults with prediabetes. We performed a direct meta-analysis using a random-effects model and a network meta-analysis. Cochran's Q statistic and the inconsistency I2 test were used to assess the heterogenicity between studies. Results Twenty trials were included, with 15 trials (comprising 775 participants with prediabetes) combined in the meta-analysis, and 13 in the network meta-analysis. The meta-analysis results did not show a statistically significant reduction in fasting plasma glucose (FPG) after aerobic training (AT) intervention compared to a control group (mean (95%CI) difference = -5.18 (-13.48; 3.12) mg/dL, Z=1.22, p=0.22). However, a difference of -7.25 (-13.79; -0.71) mg/dL, p=0.03, in FPG after interval training (IT) intervention was detected compared to a control group. After resistance training (RT) intervention, FPG was significantly lower -6.71 (-12.65,-0.77) mg/dL, Z=2.21, p=0.03, and HbA1c by -0.13 (-0.55, 0.29), p=0.54, compared to the control group. The impact of RT compared to no intervention on 2hPP was not statistically significant (p=0.26). The network meta-analysis did not show statistical significance. Most of the studies presented an unclear risk of bias, and a low and very low-quality of evidence. According to the GRADE criteria, the strength of the body of evidence was low. Conclusion Resistance training and IT had demonstrated benefits on glycemic indices, especially on FPG, in a population with prediabetes. Further studies with larger sample sizes and a more robust methodology that compare different types of exercise modalities, frequencies, and durations, are needed to establish a beneficial exercise intervention. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=370688, identifier CRD42022370688.
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Affiliation(s)
- Miquel Bennasar-Veny
- Global Health and Lifestyles Research Group, Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Institute of Health Carlos III, Madrid, Spain
- Department of Nursing and Physiotherapy, University of the Balearic Islands (UIB), Palma, Spain
| | - Narges Malih
- Research Group on Global Health, University of the Balearic Islands (UIB), Palma, Spain
| | - Aina M. Galmes-Panades
- Global Health and Lifestyles Research Group, Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
- Research Group on Global Health, University of the Balearic Islands (UIB), Palma, Spain
- CIBER of Physiopathology of Obesity and Nutrition (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- Physical Activity and Sport Sciences Research Group (GICAFE), Institute for Educational Research and Innovation (IRIE), University of the Balearic Islands, Palma, Spain
| | | | - Natalia Garcia-Coll
- Research Group on Global Health, University of the Balearic Islands (UIB), Palma, Spain
| | - Ignacio Ricci-Cabello
- CIBER de Epidemiología y Salud Pública (CIBERESP), Institute of Health Carlos III, Madrid, Spain
- Research Group in Primary Care and Promotion—Balearic Islands Community (GRAPP-caIB), Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
- Primary Care Research Unit of Mallorca (IB-Salut), Balearic Health Service, Palma de Mallorca, Spain
| | - Aina M. Yañez
- Global Health and Lifestyles Research Group, Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
- Department of Nursing and Physiotherapy, University of the Balearic Islands (UIB), Palma, Spain
- Research Group on Global Health, University of the Balearic Islands (UIB), Palma, Spain
- Research Network on Chronicity, Primary Care, and Health Promotion (RICAPPS), Institute of Health Carlos III, Madrid, Spain
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Guo M, Wang Z, Wang S, Wang J, Jiang Q. Investigation of risk factors associated with impaired glucose regulation: Using the momentum equation to assess the impact of risk factors on community residents. Front Endocrinol (Lausanne) 2023; 14:1145847. [PMID: 36998481 PMCID: PMC10043464 DOI: 10.3389/fendo.2023.1145847] [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: 01/16/2023] [Accepted: 02/14/2023] [Indexed: 03/16/2023] Open
Abstract
OBJECTIVE To identify risk factors for impaired glucose regulation (IGR) and assess their impact on community residents, this study used a questionnaire to conduct cross-sectional surveys and analysis. METHODS Overall, 774 residents of an urban community in northern China (Jian city) participated in this study. Trained investigators conducted surveys using questionnaires. Based on their medical history, respondents were divided into three glucose status groups as follows: normal (NGT), IGR, and diabetes mellitus (DM). Statistical analysis of survey data was performed using SPSS v. 22.0. RESULTS Age, hypertension, family history of diabetes (FHD), dyslipidemia, obesity, and cardiovascular and cerebral disease (CVD) were positively correlated with IGR in men and women. IGR was negatively correlated with a sedentary lifestyle in men and positively correlated with being overweight in women. The number of type 2 diabetes mellitus (T2D) risk factors per subject was positively correlated with age in the NGT group. Glucose status deteriorated with increasing age and the number of risk factors. FHD was the strongest risk factor in both men and women. CONCLUSIONS Prevention of IGR includes weight control, physical activity, and prevention of hypertension and dyslipidemia, especially in subjects with FHD.
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Affiliation(s)
- Mengqian Guo
- Department of Traditional Chinese Medicine, Jinan Central Hospital, Jinan, Shandong, China
| | - Zhen Wang
- Department of Ophthalmology, Jinan Central Hospital, Jinan, Shandong, China
| | - Shumei Wang
- Department of Traditional Chinese Medicine, Jinan Central Hospital, Jinan, Shandong, China
| | - Jinju Wang
- Department of Traditional Chinese Medicine, Jinan Central Hospital, Jinan, Shandong, China
| | - Qiang Jiang
- Department of Endocrinology, Jinan Central Hospital, Jinan, Shandong, China
- *Correspondence: Qiang Jiang,
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Efficacy of Different Modalities and Frequencies of Physical Exercise on Glucose Control in People with Prediabetes (GLYCEX Randomised Trial). Metabolites 2022; 12:metabo12121286. [PMID: 36557324 PMCID: PMC9785307 DOI: 10.3390/metabo12121286] [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: 11/25/2022] [Revised: 12/13/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022] Open
Abstract
To assess the efficacy of different modalities and frequencies of physical exercise on glycaemic control in adults with prediabetes. A two-phase, parallel, randomised, controlled clinical trial will be carried out, in 210 participants. In phase 1, 120 participants will be randomized into four arms: (1) aerobic exercise, (2) aerobic exercise combined with resistance, (3) high-intensity intervallic exercise and (4) control group. In phase 2, 90 new participants will be randomized into three arms, using the exercise modality that showed the best glycaemic control in phase 1 in the following manner: (1) frequency of 5 days/week, (2) frequency of 3 days/week and (3) frequency of 2 days/week. The control group (n = 30) will be included in phase 1 to evaluate the effect of any type of intervention versus no intervention. Data collection will be performed at baseline and after 15 weeks of follow up. Sociodemographic data, medication, comorbidity, blood biochemical parameters, blood pressure, anthropometric measurements, body composition, physical activity, sedentary lifestyle, diet, smoking, alcohol consumption, quality of life and sleep questionnaires will be collected. Physical activity, sedentary behaviour and sleep will be further determined with an accelerometer, and continuous glycaemia will be determined with a glycaemic monitor, both during seven days, at two time points. The main dependent variable will be the reduction in the mean amplitude of glycaemic excursions. The impact of these interventions on health will also be evaluated through gene expression analysis in peripheral blood cells. The results of this study will contribute to a better understanding of the mechanisms behind the glucose response to physical exercise in a population with prediabetes as well as improve physical exercise prescriptions for diabetes prevention. Increasing glycaemic control in people with prediabetes through physical exercise offers an opportunity to prevent diabetes and reduce associated comorbidities and health costs.
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Impact of Work and Recreational Physical Activity on Prediabetes Condition among U.S. Adults: NHANES 2015-2016. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041378. [PMID: 33546150 PMCID: PMC7913268 DOI: 10.3390/ijerph18041378] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 01/15/2021] [Accepted: 01/20/2021] [Indexed: 12/15/2022]
Abstract
More minutes of physical activity (PA) accumulated during a day are associated with a lower risk of diabetes mellitus type 2. However, it is less known if distinct dimensions of PA can produce a different protective effect in the prevention of prediabetes. The aim of this study was to analyze the impact of work and recreational PA on prediabetes among U.S. adults during the period 2015–2016 using the National Health and Nutrition Examination Survey (NHANES) database. Individuals (n = 4481) with hemoglobin A1c (HbA1c) test values of 5.7% to 6.4% were included. A logistic regression multivariate-adjusted analysis was conducted to estimate the association between the odds ratios (ORs) and 95% confidence intervals (CIs) of prediabetes, with work and recreational PA. The prevalence of prediabetes among U.S. adults was lower in physically active individuals both at work (~24%) and recreational (~21%) physical activities compared to individuals who were not physically active (27 to 30%). Individuals lacking practice of recreational PA had a high risk of prediabetes (OR = 1.26, 95% CI: 1.080 to 1.466). PA may be a protective factor for prediabetes conditions depending on gender, age, ethnic group, waist circumference, and thyroid disease.
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Community-Based Culturally Preferred Physical Activity Intervention Targeting Populations at High Risk for Type 2 Diabetes: Results and Implications. Can J Diabetes 2016; 40:561-569. [PMID: 27496778 DOI: 10.1016/j.jcjd.2016.05.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 05/09/2016] [Accepted: 05/12/2016] [Indexed: 12/25/2022]
Abstract
OBJECTIVES In Canada, an ageing population, obesity rates and high risk among certain ethnocultural populations are driving diabetes prevalence. Given the burden associated with type 2 diabetes and its link to modifiable risk factors, this study aimed to implement culturally preferred physical activities at the community level, targeting individuals at high risk for type 2 diabetes. Glycated hemoglobin (A1C) levels were used to detect potential improvements in glycemic control. METHODS Participants were screened for diabetes risk using a questionnaire and capillary point-of-care A1C blood testing. Participants were offered community-based physical activity classes 2 to 3 times per week for 6 months. A subset of participants (n=84) provided additional measurements. RESULTS In total, 718 subjects were reached during recruitment. Substantial participant dropout took place, and 487 participants were exposed to the intervention. Among those who participated in the physical activity and provided follow up, mean A1C levels were reduced by 0.17 (p=0.002) after 3 months (n=84) and by 0.06 (p=0.35; n=49) after 6 months. The homeostatic model assessment (HOMA-beta) showed a significant improvement of 23.6% after 3 months (n=20; p=0.03) and 45.2% after 6 months (n=12; p=0.02). Resting systolic blood pressure and diastolic blood pressure plus combined hand-grip strength improved after 6 months (n=12). CONCLUSIONS Implementation of this community-based, culturally preferred physical activity program presented several challenges and was associated with significant participant dropout. After considering participant dropout, the relatively small group who participated and provided follow-up measures showed improvements various physiologic measures. Despite efforts to enhance accessibility, it appears that several barriers to physical activity participation remain and need to be explored to enhance the success of future programs.
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Myers MF, Fernandes SL, Arduser L, Hopper JL, Koehly LM. Talking About Type 2 Diabetes: Family Communication From the Perspective of At-Risk Relatives. DIABETES EDUCATOR 2015; 41:716-28. [PMID: 26323720 DOI: 10.1177/0145721715604367] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE The purpose of this study was to describe type 2 diabetes (T2DM) communication and risk reduction recommendations from the perspective of family members at risk for T2DM based on family history. METHODS Semistructured qualitative interviews were conducted with 33 individuals with a first-degree relative with T2DM. Participants were recruited from the community and a previous pharmacogenetics study. Deductive and inductive codes were applied to the transcripts. RESULTS Conversations with family members with and without T2DM focused on symptoms and disease management of the family member with T2DM. With at-risk relatives, conversations also focused on prevention. Lack of perceived relevance to family members without T2DM was a barrier to communication. Recommendations to facilitate communication included education of an at-risk family member to increase awareness of risk, followed by sharing of learned information with others. CONCLUSION Efforts are needed to increase awareness and improve communication about T2DM risk factors, familial risk, and risk reduction behaviors within families with a family history of T2DM. Family members with and without T2DM should be encouraged to communicate with their relatives about T2DM and the risk to family members. Identification of family members who can facilitate communication, education, and modeling of healthy behaviors may increase awareness and motivate at-risk individuals to engage in risk-reducing behaviors.
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Affiliation(s)
- Melanie F Myers
- Cincinnati Children's Hospital Medical Center, Department of Pediatrics, Cincinnati, OH, USA (Dr Myers, Ms Fernandes, Ms Hopper)
- University of Cincinnati, College of Medicine, Cincinnati, OH, USA (Dr Myers, Ms Fernandes, Ms Hopper)
| | - Sara L Fernandes
- Cincinnati Children's Hospital Medical Center, Department of Pediatrics, Cincinnati, OH, USA (Dr Myers, Ms Fernandes, Ms Hopper)
- University of Cincinnati, College of Medicine, Cincinnati, OH, USA (Dr Myers, Ms Fernandes, Ms Hopper)
- LabCorp Integrated Genetics, Monrovia, CA, USA (Ms Fernandes)
| | - Lora Arduser
- University of Cincinnati, College of Arts and Sciences, Cincinnati, OH, USA (Dr Arduser)
| | - Jennifer L Hopper
- Cincinnati Children's Hospital Medical Center, Department of Pediatrics, Cincinnati, OH, USA (Dr Myers, Ms Fernandes, Ms Hopper)
- University of Cincinnati, College of Medicine, Cincinnati, OH, USA (Dr Myers, Ms Fernandes, Ms Hopper)
| | - Laura M Koehly
- National Human Genome Research Institute, Social and Behavioral Research Branch, Bethesda, MD, USA (Dr Koehly)
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Arena R, Guazzi M, Lianov L, Whitsel L, Berra K, Lavie CJ, Kaminsky L, Williams M, Hivert MF, Franklin NC, Myers J, Dengel D, Lloyd-Jones DM, Pinto FJ, Cosentino F, Halle M, Gielen S, Dendale P, Niebauer J, Pelliccia A, Giannuzzi P, Corra U, Piepoli MF, Guthrie G, Shurney D. Healthy Lifestyle Interventions to Combat Noncommunicable Disease—A Novel Nonhierarchical Connectivity Model for Key Stakeholders: A Policy Statement From the American Heart Association, European Society of Cardiology, European Association for Cardiovascular Prevention and Rehabilitation, and American College of Preventive Medicine. Mayo Clin Proc 2015; 90:1082-103. [PMID: 26143646 DOI: 10.1016/j.mayocp.2015.05.001] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 04/19/2015] [Accepted: 05/01/2015] [Indexed: 01/14/2023]
Abstract
Noncommunicable diseases (NCDs) have become the primary health concern for most countries around the world. Currently, more than 36 million people worldwide die from NCDs each year, accounting for 63% of annual global deaths; most are preventable. The global financial burden of NCDs is staggering, with an estimated 2010 global cost of $6.3 trillion (US dollars) that is projected to increase to $13 trillion by 2030. A number of NCDs share one or more common predisposing risk factors, all related to lifestyle to some degree: (1) cigarette smoking, (2) hypertension, (3) hyperglycemia, (4) dyslipidemia, (5) obesity, (6) physical inactivity, and (7) poor nutrition. In large part, prevention, control, or even reversal of the aforementioned modifiable risk factors are realized through leading a healthy lifestyle (HL). The challenge is how to initiate the global change, not toward increasing documentation of the scope of the problem but toward true action-creating, implementing, and sustaining HL initiatives that will result in positive, measurable changes in the previously defined poor health metrics. To achieve this task, a paradigm shift in how we approach NCD prevention and treatment is required. The goal of this American Heart Association/European Society of Cardiology/European Association for Cardiovascular Prevention and Rehabilitation/American College of Preventive Medicine policy statement is to define key stakeholders and highlight their connectivity with respect to HL initiatives. This policy encourages integrated action by all stakeholders to create the needed paradigm shift and achieve broad adoption of HL behaviors on a global scale.
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Arena R, Guazzi M, Lianov L, Whitsel L, Berra K, Lavie CJ, Kaminsky L, Williams M, Hivert MF, Cherie Franklin N, Myers J, Dengel D, Lloyd-Jones DM, Pinto FJ, Cosentino F, Halle M, Gielen S, Dendale P, Niebauer J, Pelliccia A, Giannuzzi P, Corra U, Piepoli MF, Guthrie G, Shurney D, Arena R, Berra K, Dengel D, Franklin NC, Hivert MF, Kaminsky L, Lavie CJ, Lloyd-Jones DM, Myers J, Whitsel L, Williams M, Corra U, Cosentino F, Dendale P, Giannuzzi P, Gielen S, Guazzi M, Halle M, Niebauer J, Pelliccia A, Piepoli MF, Pinto FJ, Guthrie G, Lianov L, Shurney D. Healthy lifestyle interventions to combat noncommunicable disease-a novel nonhierarchical connectivity model for key stakeholders: a policy statement from the American Heart Association, European Society of Cardiology, European Association for Cardiovascular Prevention and Rehabilitation, and American College of Preventive Medicine. Eur Heart J 2015; 36:2097-2109. [PMID: 26138925 DOI: 10.1093/eurheartj/ehv207] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Noncommunicable diseases (NCDs) have become the primary health concern for most countries around the world. Currently, more than 36 million people worldwide die from NCDs each year, accounting for 63% of annual global deaths; most are preventable. The global financial burden of NCDs is staggering, with an estimated 2010 global cost of $6.3 trillion (US dollars) that is projected to increase to $13 trillion by 2030. A number of NCDs share one or more common predisposing risk factors, all related to lifestyle to some degree: (1) cigarette smoking, (2) hypertension, (3) hyperglycemia, (4) dyslipidemia, (5) obesity, (6) physical inactivity, and (7) poor nutrition. In large part, prevention, control, or even reversal of the aforementioned modifiable risk factors are realized through leading a healthy lifestyle (HL). The challenge is how to initiate the global change, not toward increasing documentation of the scope of the problem but toward true action-creating, implementing, and sustaining HL initiatives that will result in positive, measurable changes in the previously defined poor health metrics. To achieve this task, a paradigm shift in how we approach NCD prevention and treatment is required. The goal of this American Heart Association/European Society of Cardiology/European Association for Cardiovascular Prevention and Rehabilitation/American College of Preventive Medicine policy statement is to define key stakeholders and highlight their connectivity with respect to HL initiatives. This policy encourages integrated action by all stakeholders to create the needed paradigm shift and achieve broad adoption of HL behaviors on a global scale.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Carl J Lavie
- University of Queensland School of Medicine, New Orleans, LA
| | | | - Jonathan Myers
- VA Palo Alto Health Care System, Palo Alto, CA, and Stanford University, Stanford, CA
| | | | | | | | - Ugo Corra
- Università degli Studi di Milano, Milan, Italy
| | | | | | | | | | | | | | | | | | | | | | | | - George Guthrie
- Center for Family Medicine at Florida Hospital, Winter Park, FL
| | - Liana Lianov
- American College of Lifestyle Medicine, Chesterfield, MO
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Rowan CP, Miadovnik LA, Riddell MC, Rotondi MA, Gledhill N, Jamnik VK. Identifying persons at risk for developing type 2 diabetes in a concentrated population of high risk ethnicities in Canada using a risk assessment questionnaire and point-of-care capillary blood HbA1c measurement. BMC Public Health 2014; 14:929. [PMID: 25196023 PMCID: PMC4168061 DOI: 10.1186/1471-2458-14-929] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 09/02/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Amidst the growing health care burden created by diabetes, this study aimed to assess the utility of a prediabetes/type 2 diabetes risk questionnaire in high risk ethnic communities in Toronto Canada. METHODS Participants (n = 691) provided questionnaire responses and capillary blood tests collected via fingerstick and results were analysed for HbA1c using the Bio-Rad in2it point-of-care device. The Bland-Altman method was used to compare point-of-care HbA1c analysis (Bio-Rad, boronate affinity chromatography) to that using high performance liquid chromatography. ANOVA and linear regression were performed to investigate the relationship between questionnaire and blood data. RESULTS Mean (± SD) HbA1c was 5.99% ± 0.84 and the Bland-Altman analysis revealed no significant biases HbA1c (bias = 0.039, 95% limits of agreement = -1.14 to 1.22). ANOVA showed that with increasing risk classification based on questionnaire answers (with the exception of "moderate"-to-"high"), there was a significant increase in mean HbA1c (Welch Statistic 30.449, p < 0.001). Linear regression revealed that the number of high risk parents, age category, BMI, physical activity participation and previous diagnosis of high blood sugar were significant contributors (p < 0.05) to the variance in HbA1c. CONCLUSIONS Though not a substitute for established diagnostic protocols, the use of a risk questionnaire can be an accurate, low cost, educational and time efficient method for assessment of type 2 diabetes risk. The early detection of prediabetes and type 2 diabetes is vital to increased awareness and opportunity for intervention with the goal of preventing or delaying the progression of type 2 diabetes and the known associated complications.
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Affiliation(s)
- Chip P Rowan
- />358 Norman Bethune College, York University, 4700 Keele St., Toronto, Ontario M3J 1P3 Canada
| | - Lisa A Miadovnik
- />358 Norman Bethune College, York University, 4700 Keele St., Toronto, Ontario M3J 1P3 Canada
| | - Michael C Riddell
- />347 Norman Bethune College, York University, 4700 Keele St., Toronto, Ontario M3J 1P3 Canada
| | - Michael A Rotondi
- />364 Norman Bethune College, York University, 4700 Keele St., Toronto, Ontario M3J 1P3 Canada
| | - Norman Gledhill
- />356 Norman Bethune College, York University, 4700 Keele St., Toronto, Ontario M3J 1P3 Canada
| | - Veronica K Jamnik
- />355 Norman Bethune College, York University, 4700 Keele St., Toronto, Ontario M3J 1P3 Canada
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Chen P, Chai J, Cheng J, Li K, Xie S, Liang H, Shen X, Feng R, Wang D. A smart web aid for preventing diabetes in rural China: preliminary findings and lessons. J Med Internet Res 2014; 16:e98. [PMID: 24691410 PMCID: PMC4004141 DOI: 10.2196/jmir.3228] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Revised: 02/05/2014] [Accepted: 03/13/2014] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Increasing cases of diabetes, a general lack of routinely operational prevention, and a long history of separating disease prevention and treatment call for immediate engagement of frontier clinicians. This applies especially to village doctors who work in rural China where the majority of the nation's vast population lives. OBJECTIVE This study aims to develop and test an online Smart Web Aid for Preventing Type 2 Diabetes (SWAP-DM2) capable of addressing major barriers to applying proven interventions and integrating diabetes prevention into routine medical care. METHODS Development of SWAP-DM2 used evolutionary prototyping. The design of the initial system was followed by refinement cycles featuring dynamic interaction between development of practical and effective standardized operation procedures (SOPs) for diabetes prevention and Web-based assistance for implementing the SOPs. The resulting SOPs incorporated proven diabetes prevention practices in a synergetic way. SWAP-DM2 provided support to village doctors ranging from simple educational webpages and record maintenance to relatively sophisticated risk scoring and personalized counseling. Evaluation of SWAP-DM2 used data collected at baseline and 6-month follow-up assessment: (1) audio recordings of service encounters; (2) structured exit surveys of patients' knowledge, self-efficacy, and satisfaction; (3) measurement of fasting glucose, body mass index, and blood pressure; and (4) qualitative interviews with doctors and patients. Data analysis included (1) descriptive statistics of patients who received SWAP-DM2-assisted prevention and those newly diagnosed with prediabetes and diabetes; (2) comparison of the variables assessed between baseline and follow-up assessment; and (3) narratives of qualitative data. RESULTS The 17 participating village doctors identified 2219 patients with elevated diabetes risk. Of these, 84.85% (1885/2219) consented to a fasting glucose test with 1022 new prediabetes and 113 new diabetes diagnoses made within 6 months. The prediabetic patients showed substantial improvement from baseline to 6-month follow-up in vegetable intake (17.0%, 43/253 vs 88.7%, 205/231), calorie intake (1.6%, 4/253 vs 71.4%, 165/231), leisure-time exercises (6.3%, 16/253 vs 21.2%, 49/231), body weight (mean 62.12 kg, SD 9.85 vs mean 58.33 kg, SD 9.18), and body mass index (mean 24.80 kg/m(2), SD 3.21 vs mean 23.36 kg/m(2), SD 2.95). The prediabetic patients showed improvement in self-efficacy for modifying diet (mean 5.31, SD 2.81 vs mean 8.53, SD 2.25), increasing physical activities (mean 4.52, SD 3.35 vs mean 8.06, SD 2.38), engaging relatives (mean 3.93, SD 3.54 vs mean 6.93, SD 2.67), and knowledge about diabetes and risks of an imbalanced diet and inadequate physical activity. Most participating doctors and patients viewed SWAP-DM2 as useful and effective. CONCLUSIONS SWAP-DM2 is helpful to village doctors, acceptable to patients, and effective in modifying immediate determinants of diabetes at least in the short term, and may provide a useful solution to the general lack of participation in diabetes prevention by frontier clinicians in rural China. TRIAL REGISTRATION International Standard Randomized Controlled Trial Number (ISRCTN): 66772711; http://www.controlled-trials.com/ISRCTN66772711.
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Affiliation(s)
- Penglai Chen
- School of Health Services Management, Anhui Medical University, Hefei, China
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