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Riise HKR, Graue M, Igland J, Birkeland KI, Kolltveit BCH. Prevalence of increased risk of type 2 diabetes in general practice: a cross-sectional study in Norway. BMC PRIMARY CARE 2023; 24:151. [PMID: 37468831 PMCID: PMC10357693 DOI: 10.1186/s12875-023-02100-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 07/03/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND Type 2 diabetes (T2D) is a global public health problem, but the onset can be delayed or prevented with adequate intervention in individuals with increased risk. Therefore, a major challenge in general practice is to identify individuals at risk of diabetes. However, limited knowledge is available about the prevalence of high diabetes risk individuals in a primary care population. In a cohort of consecutive patients in general practice we examined the prevalence of known diabetes and estimated risk of diabetes using The Finnish Diabetes Risk Score (FINDRISC) calculator, by sociodemographic and clinical characteristics. METHODS This study was a cross-sectional study conducted in four general practices in Western and Eastern Norway. A total of 1682 individuals, 20-80 years of age, were assessed for eligibility from May to December 2019. We excluded patients who actively declined participation (n = 112), were lost because of various organization challenges (n = 103) and patients who did not fulfil the inclusions criteria (n = 63). Diabetes prevalence and prevalence of individuals at risk of T2D with 95% confidence intervals (CI) were estimated for the total sample, by age group and for men and women separately. We tested for differences between groups using t-test for continuous variables and chi-square test (Pearson Chi-Square) for categorical variables. RESULTS Of 1404 individuals, 132 reported known diabetes, yielding a prevalence of 9.9% (95% CI 8.4-11.6). Among participants without a known diagnosis of diabetes, the following estimates of elevated risk assessment scores were found: FINDRISC score ≥ 11 32.8% (95% CI 30.3-35.4) and FINDRISC ≥ 15 10.0% (95% CI 8.6-11.9). Comparable results were found between the sexes. CONCLUSIONS Detection of unknown diabetes and individuals with increased risk, is of high public health relevance for early implementation of preventive measures aimed to reduce the risk of diabetes and its complications through lifestyle modification. A simple, non-expensive questionnaire, such as FINDRISC, may be valuable as an initial screening method in general practice to identify those in need for preventive measures.
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Affiliation(s)
- Hilde Kristin Refvik Riise
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, P.O. Box 7030, N-5020, Bergen, Norway.
| | - Marit Graue
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, P.O. Box 7030, N-5020, Bergen, Norway
| | - Jannicke Igland
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, P.O. Box 7030, N-5020, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Kåre I Birkeland
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Beate-Christin Hope Kolltveit
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, P.O. Box 7030, N-5020, Bergen, Norway
- Vossevangen Medical Center, Voss, Norway
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Screening for identifying individuals at risk of developing type 2 diabetes using the Canadian diabetes risk (CANRISK) questionnaire. J Public Health (Oxf) 2021. [DOI: 10.1007/s10389-021-01606-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Valdez LA, Morrill KE, Griffith DM, Lindberg NM, Hooker SP, Garcia DO. Mexican Origin Hispanic Men's Perspectives of Physical Activity-Related Health Behaviors. Am J Mens Health 2020; 13:1557988319834112. [PMID: 30819068 PMCID: PMC6775557 DOI: 10.1177/1557988319834112] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Approximately 83% of Hispanic men of Mexican origin are overweight or obese, which are both associated with increased risk of chronic disease and all-cause mortality. Consequently, men of Mexican origin have some of the highest prevalence rates of obesity-related comorbidities. Physical activity (PA) may be an important strategy for Hispanic men of Mexican origin in reducing incidence and risk factors of lifestyle diseases. The current study engaged Spanish-speaking, Hispanic men of Mexican origin aged 24–64 years with overweight/obesity to examine perspectives of health behaviors related to PA. A total of 14 in-depth semistructured individual interviews were completed between September and November of 2015 and data analyzed using an iterative deductive–inductive thematic assessment strategy. The men suggested that their PA was hindered by (a) work-related energy and time constraints, (b) socioeconomic status (SES) and the need to prioritize work, (c) adaptations to majority population lifestyle norms, and (d) perceived lack of suitable access to PA-promoting spaces. The men provided valuable insight for strategies to improve PA interventions such as (a) accurately accounting for current PA levels of participants, including occupational and transportation PA, (b) considerations of family dynamics that influence PA-based behavior change, and (c) considerations of economic and geographical constraints that can be remediated. To improve effectiveness, future PA-related intervention research with Hispanic men of Mexican origin should consider methods that (a) account for transportation and occupational PA to better tailor PA to individual needs, (b) consider sociocultural and socioeconomic influences, (c) account for social support and accountability, and (d) consider economic and geographical constraints.
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Affiliation(s)
- Luis A Valdez
- 1 School of Public Health and Health Sciences, Department of Health Promotion and Policy, University of Massachusetts, Amherst, MA, USA
| | - Kristin E Morrill
- 2 College of Agriculture & Life Sciences, Department of Nutritional Sciences, University of Arizona, Tucson, AZ, USA
| | - Derek M Griffith
- 3 Center for Research on Men's Health, Center for Medicine, Health and Society, Vanderbilt University, Nashville, TN, USA
| | | | - Steven P Hooker
- 5 College of Health and Human Services, San Diego State University, CA, USA
| | - David O Garcia
- 6 Mel and Enid Zuckerman College of Public Health, Department of Health Promotion Sciences, University of Arizona, Tucson, AZ, USA
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Milovanovic S, Silenzi A, Kheiraoui F, Ventriglia G, Boccia S, Poscia A. Detecting persons at risk for diabetes mellitus type 2 using FINDRISC: results from a community pharmacy-based study. Eur J Public Health 2018; 28:1127-1132. [PMID: 29408980 DOI: 10.1093/eurpub/cky009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background This cross-sectional study has been developed within the framework of the Italian project 'We love your heart' ('Ci sta a cuore il tuo cuore') and reports the results of the initial type 2 diabetes mellitus (T2DM) risk assessment carried out in a big network of community pharmacies in Italy and Spain. Methods In total 4002 pharmacists from 854pharmacies were specifically trained to collect data and perform the evaluation of the probability of developing T2DM among pharmacy customers. The risk of developing T2DM within 10 years was evaluated using the FINDRISC. Results Overall, 7234 (22.1%) subjects were at low risk to develop the disease, whereas 43.3% were at slightly elevated risk (scores 7-11), 19.3% were at moderate (scores 12-14), 13.9% were at high (scores 15-20), and 1.4% were at very high risk (scores > 20). Spanish participants showed higher levels of risk than Italian (16.7 vs. 14.7%) taking the cut-off FINDRISC ≥ 15. Conclusion This study shows that considerable percentage of persons is likely to develop diabetes in the next 10 years. Analyses of the risk factors indicate that men were more susceptible to develop this disease, as well as the Spanish participants respect to Italian.
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Affiliation(s)
- Sonja Milovanovic
- Section of Hygiene, Institute of Public Health, Faculty of Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Silenzi
- Section of Hygiene, Institute of Public Health, Faculty of Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Flavia Kheiraoui
- Section of Hygiene, Institute of Public Health, Faculty of Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giuseppe Ventriglia
- Italian Society of General Practitioner and Primary Care (SIMG), Florence, Italy
| | - Stefania Boccia
- Section of Hygiene, Institute of Public Health, Faculty of Medicine, Università Cattolica del Sacro Cuore, Rome, Italy.,Fondazione Policlinico 'A. Gemelli', Rome, Italy
| | - Andrea Poscia
- Section of Hygiene, Institute of Public Health, Faculty of Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
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Jølle A, Midthjell K, Holmen J, Tuomilehto J, Carlsen SM, Shaw J, Åsvold BO. Impact of sex and age on the performance of FINDRISC: the HUNT Study in Norway. BMJ Open Diabetes Res Care 2016; 4:e000217. [PMID: 27403326 PMCID: PMC4932345 DOI: 10.1136/bmjdrc-2016-000217] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 04/14/2016] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE The Finnish Diabetes Risk Score (FINDRISC) is recommended as a screening tool for diabetes risk. However, there is a lack of well-powered studies examining the performance of FINDRISC by sex and age. We aim to estimate, by sex and age, the prevalence of elevated FINDRISC and positive predictive value (PPV) of FINDRISC for identifying impaired glucose metabolism (IGM) in a general Norwegian population. RESEARCH DESIGN AND METHODS We estimated the prevalence of elevated FINDRISC (≥15) among 47 694 adults in the third survey of the Nord-Trøndelag Health Study (HUNT3, 2006-08). Among 2559 participants who participated in oral glucose tolerance testing, we estimated the PPV of elevated FINDRISC for identifying unknown prevalent diabetes and other forms of IGM. RESULTS The prevalence of elevated FINDRISC was 12.1% in women, 9.6% in men, and increased from 1.5% at age 20-39 to 25.1% at age 70-79 years. The PPVs of elevated FINDRISC were 9.8% for diabetes, 16.9% for impaired glucose tolerance, 8.2% for impaired fasting glucose, and 34.9% for any form of IGM. The PPV for IGM was lower in women (31.2%) than in men (40.4%), and increased from 19.1% at age 20-39 to 55.5% at age ≥80 years. CONCLUSIONS FINDRISC identified more women than men as high-risk individuals for diabetes. FINDRISC had a high PPV for detecting prevalent IGM, and the PPV was higher in men than in women and in the older individuals. Our data indicate that the impact of sex and age on diabetes risk is not fully captured by FINDRISC, and that refinements to it might improve diabetes prediction.
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Affiliation(s)
- Anne Jølle
- Faculty of Medicine, Department of Public Health and General Practice , HUNT Research Centre, NTNU, Norwegian University of Science and Technology , Levanger , Norway
| | - Kristian Midthjell
- Faculty of Medicine, Department of Public Health and General Practice , HUNT Research Centre, NTNU, Norwegian University of Science and Technology , Levanger , Norway
| | - Jostein Holmen
- Faculty of Medicine, Department of Public Health and General Practice , HUNT Research Centre, NTNU, Norwegian University of Science and Technology , Levanger , Norway
| | - Jaakko Tuomilehto
- Dasman Diabetes Insitute, Dasman, Kuwait; Department for Clinical Neurosciences and Preventive Medicine, Danube University Krems, Krems an der Donau, Austria; Chronic Disease Prevention Unit, National 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
| | - Sven M Carlsen
- Department of Endocrinology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Unit for Applied Clinical Research, Institute for Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Jonathan Shaw
- Baker IDI, Heart and Diabetes Institute , Melbourne , Australia
| | - Bjørn O Åsvold
- Faculty of Medicine, Department of Public Health and General Practice, HUNT Research Centre, NTNU, Norwegian University of Science and Technology, Levanger, Norway; Department of Endocrinology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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O'Dea A, Tierney M, McGuire BE, Newell J, Glynn LG, Gibson I, Noctor E, Danyliv A, Connolly SB, Dunne FP. Can the Onset of Type 2 Diabetes Be Delayed by a Group-Based Lifestyle Intervention in Women with Prediabetes following Gestational Diabetes Mellitus (GDM)? Findings from a Randomized Control Mixed Methods Trial. J Diabetes Res 2015; 2015:798460. [PMID: 26347894 PMCID: PMC4546980 DOI: 10.1155/2015/798460] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Accepted: 07/07/2015] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To evaluate a 12-week group-based lifestyle intervention programme for women with prediabetes following gestational diabetes (GDM). DESIGN A two-group, mixed methods randomized controlled trial in which 50 women with a history of GDM and abnormal glucose tolerance postpartum were randomly assigned to intervention (n = 24) or wait control (n = 26) and postintervention qualitative interviews with participants. MAIN OUTCOME MEASURES Modifiable biochemical, anthropometric, behavioural, and psychosocial risk factors associated with the development of type 2 diabetes. The primary outcome variable was the change in fasting plasma glucose (FPG) from study entry to one-year follow-up. RESULTS At one-year follow-up, the intervention group showed significant improvements over the wait control group on stress, diet self-efficacy, and quality of life. There was no evidence of an effect of the intervention on measures of biochemistry or anthropometry; the effect on one health behaviour, diet adherence, was close to significance. CONCLUSIONS Prevention programmes must tackle the barriers to participation faced by this population; home-based interventions should be investigated. Strategies for promoting long-term health self-management need to be developed and tested.
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Affiliation(s)
- Angela O'Dea
- School of Medicine, Clinical Sciences Institute, National University of Ireland Galway, Galway, Ireland
| | - Marie Tierney
- School of Medicine, Clinical Sciences Institute, National University of Ireland Galway, Galway, Ireland
| | - Brian E. McGuire
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - John Newell
- HRB Clinical Research Facility, National University of Ireland Galway, Galway, Ireland
| | - Liam G. Glynn
- Discipline of General Practice, School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Irene Gibson
- Croí–The West of Ireland Cardiac Foundation, Croí Heart and Stroke Centre, Moyola Lane, Newcastle, Galway, Ireland
| | - Eoin Noctor
- School of Medicine, Clinical Sciences Institute, National University of Ireland Galway, Galway, Ireland
| | - Andrii Danyliv
- J.E. Cairnes School of Business & Economics, National University of Ireland Galway, Cairnes Building, Galway, Ireland
| | - Susan B. Connolly
- Cardiovascular Medicine, International Centre for Circulatory Health, Imperial College London, London W2 1LA, UK
| | - Fidelma P. Dunne
- School of Medicine, Clinical Sciences Institute, National University of Ireland Galway, Galway, Ireland
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7
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Relationship between screening plasma glucose concentrations and cancer- and all-cause mortality: the Jichi Medical School (JMS) cohort study. J Public Health (Oxf) 2014. [DOI: 10.1007/s10389-014-0643-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
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8
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Marmugi A, Lasserre F, Beuzelin D, Ducheix S, Huc L, Polizzi A, Chetivaux M, Pineau T, Martin P, Guillou H, Mselli-Lakhal L. Adverse effects of long-term exposure to bisphenol A during adulthood leading to hyperglycaemia and hypercholesterolemia in mice. Toxicology 2014; 325:133-43. [DOI: 10.1016/j.tox.2014.08.006] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Revised: 08/05/2014] [Accepted: 08/21/2014] [Indexed: 12/20/2022]
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9
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Vähäsarja K, Salmela S, Villberg J, Rintala P, Vanhala M, Saaristo T, Peltonen M, Keinänen-Kiukaanniemi S, Korpi-Hyövälti E, Moilanen L, Niskanen L, Oksa H, Poskiparta ME. Perceived sufficiency of physical activity levels among adults at high risk of type 2 diabetes: the FIN-D2D study. Int J Behav Med 2014; 21:99-108. [PMID: 23224617 DOI: 10.1007/s12529-012-9285-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Any increase from a low level of physical activity reduces the risk of type 2 diabetes. However, lack of awareness of one's physical activity level insufficiency may act as an obstacle to increased physical activity. PURPOSE This study assessed the determinants of perceived physical activity levels (PALs) among adults at high risk of diabetes and the associations with self-reported physical activity. METHODS In total, 10,149 adults participated in the FIN-D2D lifestyle intervention at baseline. Opportunistic screening was used in identifying high-risk individuals. Physical activity and perceived PAL sufficiency were assessed and compared. Key risk factors for diabetes and psychosocial and demographic characteristics were analyzed as determinants using logistic regression. RESULTS PAL sufficiency was rated realistically by 73 % of men and 75 % of women. Perception of sufficient PAL was more likely among individuals with a smaller waist circumference, a higher level of perceived fitness, and no exercise intention. In men, a higher age, and in women, a lower education, and a lower occupational status, also increased the likelihood of perceiving PAL as sufficient. Out of all the participants, 65 % of men and 66 % of women were inactive. Among the inactive participants, 20 (men) and 16 % (women) overestimated their PAL sufficiency. In both genders, such overestimation was predicted by dyslipidemia, a lower waist circumference, a higher level of perceived fitness, and no exercise intention; also (among men) by a higher age and a family history of diabetes, and (among women) by a lower occupational status, and a lower BMI. CONCLUSIONS In diabetes prevention, it is important to recognize the groups that perceive their PAL as sufficient since they may not see increased PAL as a tool for decreasing their risk of diabetes.
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Affiliation(s)
- Kati Vähäsarja
- Research Centre for Health Promotion, Department of Health Sciences, University of Jyväskylä, 40014, Jyväskylä, Finland,
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10
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Rautio N, Jokelainen J, Korpi-Hyövälti E, Oksa H, Saaristo T, Peltonen M, Moilanen L, Vanhala M, Uusitupa M, Tuomilehto J, Keinänen-Kiukaanniemi S. Lifestyle intervention in prevention of type 2 diabetes in women with a history of gestational diabetes mellitus: one-year results of the FIN-D2D project. J Womens Health (Larchmt) 2014; 23:506-12. [PMID: 24787505 DOI: 10.1089/jwh.2013.4520] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Lifestyle interventions are effective in preventing type 2 diabetes (T2D). Women with history of gestational diabetes mellitus (GDM) may have barriers to lifestyle changes, and the previous results of lifestyle interventions are contradictory reporting either favorable outcomes or no significant beneficial effects. Our aim was to compare cardio-metabolic risk profile and responses to a 1-year lifestyle intervention program in women with and without history of GDM. METHODS The Implementation Project of the Program for Prevention of Type 2 Diabetes (FIN-D2D) was conducted in Finland in five hospital districts. Altogether 1,661 women aged ≤45 years participated in the program. One-year follow-up was available for 393 women who did not have screen-detected T2D at baseline, and 265 of them had at least one intervention visit [115 (43.4%) women with history of GDM and 150 (56.6%) without history of GDM]. RESULTS At baseline, women with GDM had similar baseline glucose tolerance but better anthropometric characteristics, blood pressure, and lipid profile than women without GDM after adjustment for age. Beneficial changes in cardiovascular risk profile existed among women with and without GDM during follow-up and the effect of lifestyle intervention was similar between the groups, except that low-density lipoprotein cholesterol improved only in women with GDM. Altogether, 4.0% of those with GDM and 5.0% of those without GDM developed T2D (p=0.959 adjustment for age). CONCLUSIONS The effect of a 1-year lifestyle intervention in primary healthcare setting was similar regardless of history of GDM, both women with and without GDM benefitted from participation in the lifestyle intervention.
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Affiliation(s)
- Nina Rautio
- 1 Pirkanmaa Hospital District , Tampere, Finland
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11
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Infanti JJ, Dunne FP, O’Dea A, Gillespie P, Gibson I, Glynn LG, Noctor E, Newell J, McGuire BE. An evaluation of Croí MyAction community lifestyle modification programme compared to standard care to reduce progression to diabetes/pre-diabetes in women with prior gestational diabetes mellitus (GDM): study protocol for a randomised controlled trial. Trials 2013; 14:121. [PMID: 23782471 PMCID: PMC3747856 DOI: 10.1186/1745-6215-14-121] [Citation(s) in RCA: 13] [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: 12/18/2012] [Accepted: 04/18/2013] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Universal screening using the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria has identified a prevalence of gestational diabetes mellitus (GDM) of 12.4% in women living in Ireland. Women with prior GDM are at increased risk of developing type 2 diabetes later in life. A number of risk factors linked to the development of type 2 diabetes are potentially modifiable through lifestyle and behaviour changes, and medical management. No previous Irish studies have adequately investigated the efficacy of lifestyle intervention programmes in reducing these risk factors in women with prior GDM. Through a two-group, parallel randomised controlled trial (RCT), this study aims to assess the clinical impact, cost-effectiveness and psychological experience of the Croí MyAction intensive lifestyle modification programme for women with prior GDM. METHODS/DESIGN A total of 54 women with a history of GDM and persistent post-partum glucose dysfunction (impaired glucose tolerance (IGT) or impaired fasting glucose (IFG)), are randomly assigned to a control arm (n=27) or to the Croí MyAction intervention group (n=27). The control arm receives usual health care advice--written information on diet and lifestyle changes for reducing diabetes risks and visits with general practitioners as required. The intervention group receives usual health care as per the control group in addition to attending a 12-week intensive lifestyle modification programme known as Croí MyAction. Croí MyAction involves 2.5 hour sessions once per week (for 12 weeks) comprising a group exercise programme, group health promotion or education seminars, and one-to-one meetings with a multidisciplinary health care team to personalise risk factor reductions. Randomisation and allocation to the intervention arms is carried out by an independent researcher, ensuring that the allocation sequence is concealed from study researchers until the interventions are assigned. The primary analysis is based on glucose dysfunction, comparing a mean reduction in fasting plasma glucose (FPG) levels on a 75 gram oral glucose tolerance test (OGTT) in the two groups at a one-year, post-intervention follow-up. The trial is funded by the Irish Health Research Board (HRB). Ethics approval was obtained on 27 March 2012 from the Clinical Research Ethics Committee, Galway University Hospitals, Health Service Executive of Ireland (Ref: C.A.691). TRIAL REGISTRATION Current Controlled Trials ISRCTN41202110.
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MESH Headings
- Biomarkers/blood
- Blood Glucose/metabolism
- Clinical Protocols
- Community Health Services
- Cost-Benefit Analysis
- Diabetes Mellitus, Type 2/blood
- Diabetes Mellitus, Type 2/diagnosis
- Diabetes Mellitus, Type 2/economics
- Diabetes Mellitus, Type 2/prevention & control
- Diabetes Mellitus, Type 2/psychology
- Diabetes, Gestational/blood
- Diabetes, Gestational/diagnosis
- Diabetes, Gestational/economics
- Diabetes, Gestational/psychology
- Diabetes, Gestational/therapy
- Disease Progression
- Female
- Glucose Tolerance Test
- Health Care Costs
- Humans
- Ireland
- Life Style
- Patient Care Team
- Prediabetic State/blood
- Prediabetic State/diagnosis
- Prediabetic State/economics
- Prediabetic State/prevention & control
- Prediabetic State/psychology
- Pregnancy
- Preventive Health Services/economics
- Preventive Health Services/methods
- Research Design
- Risk Assessment
- Risk Factors
- Risk Reduction Behavior
- Time Factors
- Treatment Outcome
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Affiliation(s)
- Jennifer J Infanti
- School of Medicine, Clinical Sciences Institute, National University of Ireland Galway, Galway, Ireland
| | - Fidelma P Dunne
- School of Medicine, Clinical Sciences Institute, National University of Ireland Galway, Galway, Ireland
| | - Angela O’Dea
- School of Medicine, Clinical Sciences Institute, National University of Ireland Galway, Galway, Ireland
| | - Paddy Gillespie
- J.E. Cairnes School of Business & Economics, Cairnes Building, National University of Ireland Galway, Galway, Ireland
| | - Irene Gibson
- Croí–The West of Ireland Cardiac Foundation, Croí House, Moyola Lane, Newcastle, Galway, Ireland
| | - Liam G Glynn
- Discipline of General Practice, School of Medicine, National University of Ireland Galway, 1 Distillery Road, Galway, Ireland
| | - Eoin Noctor
- School of Medicine, Clinical Sciences Institute, National University of Ireland Galway, Galway, Ireland
| | - John Newell
- HRB Clinical Research Facility Galway, National University of Ireland Galway, University Road, Galway, Ireland
| | - Brian E McGuire
- School of Psychology, National University of Ireland Galway, University Road, Galway, Ireland
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12
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Infanti JJ, Dunne FP, O’Dea A, Gillespie P, Gibson I, Glynn LG, Noctor E, Newell J, McGuire BE. An evaluation of Croí MyAction community lifestyle modification programme compared to standard care to reduce progression to diabetes/pre-diabetes in women with prior gestational diabetes mellitus (GDM): study protocol for a randomised controlled trial. Trials 2013. [DOI: 10.1186/1468-6708-14-121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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13
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Rautio N, Jokelainen J, Oksa H, Saaristo T, Peltonen M, Niskanen L, Saltevo J, Korpi-Hyövälti E, Uusitupa M, Tuomilehto J, Keinänen-Kiukaanniemi S. Participation, socioeconomic status and group or individual counselling intervention in individuals at high risk for type 2 diabetes: one-year follow-up study of the FIN-D2D-project. Prim Care Diabetes 2012; 6:277-283. [PMID: 22868007 DOI: 10.1016/j.pcd.2012.07.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Revised: 12/27/2011] [Accepted: 07/11/2012] [Indexed: 10/28/2022]
Abstract
AIMS To describe socioeconomic characteristics of participants and their effect on uptake and completion of the implementation project (FIN-D2D) for the National Type 2 Diabetes Prevention Programme. Furthermore, to assess the effectiveness of individual vs. group intervention during one-year follow-up. METHODS At baseline, 2820 men and 5764 women aged <65 years participated in the non-randomized implementation project in primary health care setting; one-year follow-up was available for 1067 men and 2122 women. Socioeconomic status included education and occupation. Interventions were individual and/or group-based. The changes in cardiovascular risk factors and glucose tolerance were used as measures of the effectiveness of intervention. RESULTS 68.4% of the men and 69.8% of the women participated in some of the intervention modalities offered. Low education and not working were related to active participation in the intervention in men. 88.2% of men and 76.1% of women selected the individual instead of group intervention. The effectiveness of individual vs. group interventions did not differ, except for minor changes in systolic blood pressure in women and glucose tolerance in men. CONCLUSIONS Socioeconomic status modulated participation in interventions. Both types of intervention worked equally well, but participation in group intervention was low.
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Affiliation(s)
- Nina Rautio
- Pirkanmaa Hospital District, Tampere, Finland.
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Rautio N, Jokelainen J, Saaristo T, Oksa H, Keinänen-Kiukaanniemi S, Peltonen M, Vanhala M, Korpi-Hyövälti E, Moilanen L, Saltevo J, Niskanen L, Tuomilehto J, Uusitupa M. Predictors of success of a lifestyle intervention in relation to weight loss and improvement in glucose tolerance among individuals at high risk for type 2 diabetes: the FIN-D2D project. J Prim Care Community Health 2012; 4:59-66. [PMID: 23799691 DOI: 10.1177/2150131912444130] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
AIM The authors assessed the predictors of success of a lifestyle intervention (weight loss ≥ 5% and improved glucose tolerance) in individuals at high risk for type 2 diabetes in a 1-year follow-up in a primary health care setting. METHODS High-risk individuals for type 2 diabetes were identified by opportunistic screening in the implementation of the Finnish National Diabetes Prevention Program (FIN-D2D). All together, 3880 individuals participated in the 1-year follow-up. Sociodemographic characteristics, health status and behavior, family history of diabetes, clinical factors, and health care provider were considered possible predictors of lifestyle intervention success. RESULTS In sum, 19.3% of individuals lost at least 5% of weight, and 32.6% with abnormal glucose tolerance at baseline showed improvement in glucose tolerance. Abnormal glucose tolerance was the strongest predictor of weight loss and improvement in glucose tolerance. High attendance at lifestyle intervention visits, being outside of labor force, and high body mass index at baseline were also related to weight loss, and high education was related to improvement in glucose tolerance. CONCLUSIONS In "real-life settings," glucose tolerance status, number of intervention visits, employment status, education, and body mass index explained the success of lifestyle intervention. These factors may help in targeting interventions, although they may not be generalized to other cultural settings.
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Salmela SM, Vähäsarja K, Villberg J, Vanhala M, Saaristo T, Lindström J, Oksa H, Korpi-Hyövälti E, Niskanen L, Keinänen-Kiukaanniemi S, Poskiparta M. The reporting of previous lifestyle counseling by persons at high risk of Type 2 diabetes. PATIENT EDUCATION AND COUNSELING 2012; 87:178-185. [PMID: 21943790 DOI: 10.1016/j.pec.2011.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2011] [Revised: 08/01/2011] [Accepted: 08/26/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To assess (i) whether the reporting of counseling previously received is associated with high-risk individuals' agreement to participate in lifestyle intervention, (ii) whether the reporting of previous counseling differed within such a high-risk group, and (iii) the associations between lifestyles and previous lifestyle counseling. METHODS Cross-sectional data were drawn from 10149 adults at high risk of Type 2 diabetes, who were participating in a Finnish national diabetes prevention project (FIN-D2D). Bivariate analysis and multivariate logistic regression were used. RESULTS In relation to the reporting of previous counseling, no difference was found between persons who had agreed and persons who had not agreed to participate in the lifestyle intervention. Persons who were more educated or who had dyslipidemia or diabetes were more likely than the others to report previous counseling. A generally healthy lifestyle, or certain health behaviors (being a non-smoker or eating large amounts of fruit and vegetables) may make the reporting of previous counseling more likely. CONCLUSION The results raise questions about the amount and quality of the previously received lifestyle counseling. PRACTICE IMPLICATIONS There is a need for sustainable lifestyle counseling structures, within vigorously implemented diabetes prevention projects, if long-lasting lifestyle changes are to be achieved.
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Affiliation(s)
- Sanna M Salmela
- Research Centre for Health Promotion, Faculty of Sport and Health Sciences, Department of Health Sciences, University of Jyväskylä, Finland.
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Salmela SM, Vähäsarja KA, Villberg JJ, Vanhala MJ, Saaristo TE, Lindström J, Oksa HH, Korpi-Hyövälti EAL, Moilanen L, Keinänen-Kiukaanniemi S, Poskiparta ME. Perceiving need for lifestyle counseling: findings from Finnish individuals at high risk of type 2 diabetes. Diabetes Care 2012; 35:239-41. [PMID: 22190673 PMCID: PMC3263895 DOI: 10.2337/dc11-1116] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Accepted: 11/05/2011] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To investigate the proportion of individuals at high risk of type 2 diabetes who perceive the need for lifestyle counseling, factors associated with this perception, and whether the perceived need is associated with subsequent attendance in lifestyle intervention. RESEARCH DESIGN AND METHODS Baseline and intervention data were obtained from 10,149 participants in a Finnish National Diabetes Prevention Project. RESULTS In total, 36% of men and 52% of women perceived the need for counseling. Most of the risk factors did not increase the perceived need for counseling. Those agreeing to attend supervised lifestyle intervention were more likely to report a perceived need than those who agreed on a self-initiated lifestyle change or those who refused to attend lifestyle intervention. The perceived need was associated with actual attendance in the lifestyle intervention only among women. CONCLUSIONS It will be vital to find additional means to support lifestyle change.
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Affiliation(s)
- Sanna M Salmela
- Research Centre for Health Promotion, Faculty of Sport and Health Sciences, Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
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17
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Rautio N, Jokelainen J, Oksa H, Saaristo T, Peltonen M, Puolijoki H, Tuomilehto J, Vanhala M, Moilanen L, Uusitupa M, Keinänen-Kiukaanniemi S. Family history of diabetes and effectiveness of lifestyle counselling on the cardio-metabolic risk profile in individuals at high risk of Type 2 diabetes: 1-year follow-up of the FIN-D2D project. Diabet Med 2012; 29:207-11. [PMID: 21781153 DOI: 10.1111/j.1464-5491.2011.03388.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS To investigate whether a positive family history of diabetes is associated with the effectiveness of lifestyle counselling on cardio-metabolic risk factors and glucose tolerance status in a 1-year follow-up in a cohort of Finnish men and women at high risk for Type 2 diabetes. METHODS Altogether, 10,149 individuals who had high risk of Type 2 diabetes participated in the implementation programme of the national diabetes prevention programme at baseline. One-year follow-up data were available for 2798 individuals without diabetes. Family history of diabetes was based on self-report. Lifestyle interventions were individual or groups sessions on lifestyle changes. The effectiveness of lifestyle intervention was measured as changes in cardiovascular risk factors, glucose tolerance status and incidence of Type 2 diabetes. RESULTS Family history was associated with the effectiveness of lifestyle intervention in men, but not in women. During the 1-year follow-up, body weight, BMI, systolic blood pressure, total cholesterol, LDL cholesterol and score for 10-year risk for fatal cardiovascular disease (SCORE) decreased and glucose tolerance status improved more in men without a family history of diabetes than in men with a family history of diabetes. Of the participating men and women, 10% and 5% developed Type 2 diabetes, respectively. Family history was not related to the incidence of Type 2 diabetes in either gender. CONCLUSIONS Men without a family history of diabetes were more successful in responding to lifestyle counselling with regard to cardio-metabolic measurements and glucose tolerance than those with a family history of diabetes. Similar results were not seen in women. In keeping with findings from earlier studies, the prevention of Type 2 diabetes is not influenced by a family history of diabetes.
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Affiliation(s)
- N Rautio
- Pirkanmaa Hospital District, Tampere Institute of Health Sciences, University of Oulu, Finland.
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18
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Rautio N, Jokelainen J, Oksa H, Saaristo T, Peltonen M, Vanhala M, Puolijoki H, Moilanen L, Tuomilehto J, Keinänen-Kiukaanniemi S, Uusitupa M. Do statins interfere with lifestyle intervention in the prevention of diabetes in primary healthcare? One-year follow-up of the FIN-D2D project. BMJ Open 2012; 2:bmjopen-2012-001472. [PMID: 22983785 PMCID: PMC3467638 DOI: 10.1136/bmjopen-2012-001472] [Citation(s) in RCA: 8] [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] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES To examine whether the use of statins is associated with the incidence of type 2 diabetes (T2D) and changes in glucose metabolism among individuals at high risk for T2D participating in 1-year lifestyle intervention in primary healthcare setting. DESIGN Prospective follow-up study. SETTING In all, 400 primary healthcare centres and occupational healthcare clinics in Finland. PARTICIPANTS We screened altogether 10 149 individuals at increased risk for T2D; of these, 2798 non-diabetic individuals verified by a 2 h glucose tolerance test participated in the 1-year follow-up. INTERVENTIONS Lifestyle intervention (individual and/or group-based counselling). PRIMARY OUTCOME MEASURES Incidence of T2D and fasting and 2 h glucose measured at baseline and follow-up. RESULTS A total of 484 individuals (17.3%) used statins at the baseline. Of them 31 (7.5%) developed T2D during the follow-up, compared to 126 (6.5%) of statin non-users (OR 1.17, 95% CI 0.78 to 1.76, p=0.442). Interestingly, fasting glucose increased by 0.08 mmol/l in statin users, but remained unchanged in non-users, the difference being 0.074 mmol/l (95% CI 0.014 to 0.134) and remained significant even after adjustment for age, sex, baseline fasting glucose, the presence of cardiovascular disease (CVD), use of antihypertensive and/or coronary artery disease medication, weight and 1-year weight change (adjusted p=0.042). CONCLUSIONS The incidence of T2D did not differ between the statin users and non-users. The finding that fasting glucose slightly increased in statin users in spite of lifestyle interventions suggests the view that the use of statins might have unfavourable effects on glucose metabolism and that statins might hamper beneficial effects of lifestyle intervention in people at high risk of T2D.
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Affiliation(s)
- Nina Rautio
- Pirkanmaa Hospital District, Tampere, Finland
| | - Jari Jokelainen
- Institute of Health Sciences, University of Oulu, Oulu, Finland
- Unit of General Practice, Oulu University Hospital, Oulu, Finland
| | - Heikki Oksa
- Pirkanmaa Hospital District, Tampere, Finland
| | - Timo Saaristo
- Pirkanmaa Hospital District, Tampere, Finland
- Finnish Diabetes Association, Tampere, Finland
| | - Markku Peltonen
- Diabetes Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Mauno Vanhala
- Unit of Family Practice, Central Finland Health Care District, Jyväskylä, Finland
| | - Hannu Puolijoki
- Department of Internal Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Leena Moilanen
- Department of Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Jaakko Tuomilehto
- Diabetes Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland
- Center for Vascular Prevention, Danube-University Krems, Krems, Austria
| | - Sirkka Keinänen-Kiukaanniemi
- Institute of Health Sciences, University of Oulu, Oulu, Finland
- Unit of General Practice, Oulu University Hospital, Oulu, Finland
| | - Matti Uusitupa
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
- Research Unit, Kuopio University Hospital, Kuopio, Finland
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19
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Kujala UM, Jokelainen J, Oksa H, Saaristo T, Rautio N, Moilanen L, Korpi-Hyövälti E, Saltevo J, Vanhala M, Niskanen L, Peltonen M, Tuomilehto J, Uusitupa M, Keinänen-Kiukaannemi S. Increase in physical activity and cardiometabolic risk profile change during lifestyle intervention in primary healthcare: 1-year follow-up study among individuals at high risk for type 2 diabetes. BMJ Open 2011; 1:e000292. [PMID: 22184585 PMCID: PMC3244658 DOI: 10.1136/bmjopen-2011-000292] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Accepted: 10/31/2011] [Indexed: 11/21/2022] Open
Abstract
Objectives To investigate the association between increase in physical activity and changes in cardiometabolic risk factors during a lifestyle intervention programme in routine clinical settings. Design Prospective follow-up. Setting 400 primary healthcare centres and occupational healthcare outpatient clinics in Finland. Participants Individuals at high risk for type 2 diabetes identified in the implementation project of the national diabetes prevention programme (FIN-D2D) and participating in baseline and 1-year follow-up visits. Final study group comprised the 1871 non-diabetic participants who responded at follow-up visit to a question on stability versus increase of physical activity. Interventions Lifestyle intervention. Primary outcome measures Cardiometabolic risk factors (body composition, blood pressure and those measured from fasting venous blood samples) measured at baseline and follow-up visits. Results Of the participants, 310 (16.6% of all responders) reported at follow-up having clearly increased their physical activity during the past year, while 1380 (73.8%) had been unable to increase their physical activity. Those who increased their activity decreased their weight by 3.6 kg (95% CI 2.9 to 4.3, age and sex adjusted, p<0.001) and waist circumference by 3.6 cm (95% CI 2.9 to 4.3, p<0.001) more than those who did not increase their activity. Similarly, those who increased their physical activity had greater reductions in total cholesterol (group difference in reduction 0.17 mmol/l, 95% CI 0.06 to 0.28, p=0.002), low-density lipoprotein cholesterol (0.16 mmol/l, 95% CI 0.06 to 0.26, p=0.001), low-density lipoprotein/high-density lipoprotein ratio (0.17, 95% CI 0.08 to 0.25, p<0.001) as well as fasting glucose (0.09 mmol/l, 95% CI 0.03 to 0.15, p=0.004) and 2 h glucose levels (0.36 mmol/l, 95% CI 0.17 to 0.55, p=0.023) than those who did not increase their physical activity. Conclusion Increasing physical activity seems to be an important feature of cardiometabolic risk reduction among individuals at high risk for type 2 diabetes participating in preventive interventions in routine clinical settings.
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Affiliation(s)
- Urho M Kujala
- Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Jari Jokelainen
- Institute of Health Sciences, Faculty of Medicine, University of Oulu, Oulu, Finland
- Unit of General Practice, Oulu University Hospital, Oulu, Finland
| | - Heikki Oksa
- Pirkanmaa Hospital District, Tampere, Finland
| | - Timo Saaristo
- Pirkanmaa Hospital District, Tampere, Finland
- Finnish Diabetes Association, Tampere, Finland
| | - Nina Rautio
- Pirkanmaa Hospital District, Tampere, Finland
| | - Leena Moilanen
- Department of Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Eeva Korpi-Hyövälti
- Department of Internal Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Juha Saltevo
- Department of Internal Medicine, Central Finland Hospital District, Jyväskylä, Finland
| | - Mauno Vanhala
- Unit of Family Practice, Central Finland Hospital District, Jyväskylä, Finland
- Kuopio University Hospital, Kuopio, Finland
- University of Eastern Finland, Kuopio, Finland
| | - Leo Niskanen
- Department of Internal Medicine, Central Finland Hospital District, Jyväskylä, Finland
- Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Markku Peltonen
- National Institute for Health and Welfare, Helsinki, Finland
| | - Jaakko Tuomilehto
- Department of Public Health, Hjelt Institute, University of Helsinki, Helsinki, Finland
| | - Matti Uusitupa
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
- Research Unit, Kuopio University Hospital, Finland
| | - Sirkka Keinänen-Kiukaannemi
- Institute of Health Sciences, Faculty of Medicine, University of Oulu, Oulu, Finland
- Unit of General Practice, Oulu University Hospital, Oulu, Finland
- Unit of General Practice, Oulu University Hospital District, Oulu, Finland
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20
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Tuomilehto J. Advances in diabetes information. Prim Care Diabetes 2011; 5:71-72. [PMID: 21679888 DOI: 10.1016/j.pcd.2011.05.002] [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] [Received: 05/11/2011] [Accepted: 05/11/2011] [Indexed: 11/26/2022]
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Rautio N, Jokelainen J, Oksa H, Saaristo T, Peltonen M, Niskanen L, Puolijoki H, Vanhala M, Uusitupa M, Keinänen-Kiukaanniemi S. Socioeconomic position and effectiveness of lifestyle intervention in prevention of type 2 diabetes: one-year follow-up of the FIN-D2D project. Scand J Public Health 2011; 39:561-70. [PMID: 21622677 DOI: 10.1177/1403494811408482] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIMS Lifestyle intervention is effective in prevention of type 2 diabetes (T2D) in high-risk individuals. However, health behaviour and health outcomes are modified by socioeconomic position through various mechanisms. It is therefore possible that success in lifestyle intervention may be determined by factors such as level of education or occupation. In this study we assessed the impact of the level of education and occupation on the baseline anthropometric and clinical characteristics and their changes during a one-year follow-up in a cohort of Finnish men and women at high risk for T2D aged 20-64 years. METHODS As part of a Finnish national diabetes prevention programme 2003-2007 (FIN-D2D), high-risk individuals were identified using opportunistic screening for lifestyle intervention in primary health care. 1,067 men and 2,122 women had one-year follow-up data. Education and occupation were used as factors of socioeconomic position. Measures of anthropometric and clinical characteristics included weight, body mass index (BMI), waist circumference, systolic and diastolic blood pressure, total, HDL and LDL cholesterol, triglycerides, FINDRISC scores and glucose tolerance status. RESULTS The effect of intervention was similar in all socioeconomic groups, but the level of education was related to glucose tolerance status in both genders. In addition, socioeconomic differences existed in blood pressure, weight, BMI, waist circumference and HDL cholesterol. CONCLUSIONS Socioeconomic position did not seem to have any impact on the effectiveness of lifestyle intervention in individuals at high risk for T2D, which is encouraging from the point of view of reducing health inequalities.
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Uusitupa M, Tuomilehto J, Puska P. Are we really active in the prevention of obesity and type 2 diabetes at the community level? Nutr Metab Cardiovasc Dis 2011; 21:380-389. [PMID: 21470836 DOI: 10.1016/j.numecd.2010.12.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Revised: 12/16/2010] [Accepted: 12/20/2010] [Indexed: 11/28/2022]
Abstract
The prevalence of type 2 diabetes is increasing rapidly worldwide. Much of this increase in type 2 diabetes epidemic is related to the increase in obesity. There is now firm evidence from randomised trials that type 2 diabetes is preventable by lifestyle modification influencing diet, physical activity and obesity. This prevention effect is sustainable for many years after cessation of active intervention. The slow progression in the development and implementation of population-based strategies in the prevention of obesity and its most common and serious co-morbidity, type 2 diabetes, is of great concern. We summarise published implementation programmes and describe briefly the activities carried out in Finland. In the Finnish implementation programme for the prevention of type 2 diabetes (FIN-D2D), it was found that it is possible to prevent type 2 diabetes "in real life" in the primary health-care settings. We point out that innovative strategic guidelines and their proper implementation are needed to prevent the diabetes epidemic. Among the different tools, also taxation and other regulation to promote healthy food selection and good interaction with the media should be considered.
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Affiliation(s)
- M Uusitupa
- University of Eastern Finland, Institute of Public Health and Clinical Nutrition and Research Unit, Kuopio University Hospital, P.O. Box 1627, SF-70211 Kuopio, Finland.
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