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Green JB, Crowley MJ, Thirunavukkarasu S, Maruthur NM, Oldenburg B. The Final Frontier in Diabetes Care: Implementing Research in Real-World Practice. Diabetes Care 2024; 47:1299-1310. [PMID: 38907682 DOI: 10.2337/dci24-0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 04/25/2024] [Indexed: 06/24/2024]
Abstract
Despite extensive evidence related to the prevention and management of type 2 diabetes (T2D) and its complications, most people at risk for and people who have diabetes do not receive recommended guideline-based care. Clinical implementation of proven care strategies is of the utmost importance because without this, even the most impressive research findings will remain of purely academic interest. In this review, we discuss the promise and challenges of implementing effective approaches to diabetes prevention and care in the real-world setting. We describe successful implementation projects in three critical areas of diabetes care-diabetes prevention, glycemic control, and prevention of diabetes-related complications-which provide a basis for further clinical translation and an impetus to improve the prevention and control of T2D in the community. Advancing the clinical translation of evidence-based care must include recognition of and assessment of existing gaps in care, identification of barriers to the delivery of optimal care, and a locally appropriate plan to address and overcome these barriers. Care models that promote team-based approaches, rather than reliance on patient-provider interactions, will enhance the delivery of contemporary comprehensive diabetes care.
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Affiliation(s)
- Jennifer B Green
- Division of Endocrinology, Department of Medicine, and Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Matthew J Crowley
- Division of Endocrinology, Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Sathish Thirunavukkarasu
- Department of Family and Preventive Medicine, Emory School of Medicine, Atlanta, GA
- Emory Global Diabetes Research Center, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Nisa M Maruthur
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Brian Oldenburg
- Department of Public Health and Implementation Science, La Trobe University, and Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
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Kapoor N, Haregu T, Singh K, Oommen AM, Audsley J, Gupta P, Jasper S, Mini GK, Thirunavukkarasu S, Oldenburg B. Strengthening research capacity of early-mid career researchers: Implementation and evaluation of the Excellence in Non-COmmunicable disease REsearch (ENCORE) program. J Investig Med 2024; 72:475-486. [PMID: 38378444 DOI: 10.1177/10815589241236156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
High-quality training and networking are pivotal for enhancing the research capacity of early- to mid-career researchers in the prevention and control of non-communicable diseases. Beyond building research skills, these professionals gain valuable insights from interdisciplinary mentorship, networking opportunities, and exposure to diverse cultures and health systems. Despite the significance of such initiatives, their implementation remains underexplored. Here, we describe the implementation and evaluation of the Excellence in Non-COommunicable disease REsearch (ENCORE) program, a collaborative initiative between Australia and India that was launched in 2016 and spanned a duration of 3 years. Led by a consortium that included the University of Melbourne and leading Indian research and medical institutions, ENCORE involved 15 faculty members and 20 early-mid career researchers. The program comprised various elements, including face-to-face forums, masterclasses, webinars, a health-technology conference, and roundtable events. ENCORE successfully trained the early-career researchers, resulting in over 30 peer-reviewed articles, 36 conference presentations, and the submission of seven grant applications, three of which received funding. Beyond individual achievements, ENCORE fostered robust research collaboration between Australian and Indian institutions, showcasing its broader impact on strengthening research capacities across borders.
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Affiliation(s)
- Nitin Kapoor
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College & Hospital, Vellore, Tamil Nadu, India
- Non-Communicable Disease Unit, The Nossal Institute for Global Health, University of Melbourne, Melbourne, VIC, Australia
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Tilahun Haregu
- Non-Communicable Disease Unit, The Nossal Institute for Global Health, University of Melbourne, Melbourne, VIC, Australia
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Kavita Singh
- Public Health Foundation of India, Gurugram, Haryana, India
- Centre for Chronic Disease Control, New Delhi, New Delhi, India
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Baden-Wurttemberg, Germany
| | - Anu Mary Oommen
- Community Health Department, Christian Medical College & Hospital, Vellore, Tamil Nadu, India
| | - Jennifer Audsley
- Department of Infectious Diseases, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC, Australia
| | - Priti Gupta
- Centre for Chronic Disease Control, New Delhi, New Delhi, India
| | - Smitha Jasper
- Department of Ophthalmology, Christian Medical College & Hospital, Vellore, Tamil Nadu, India
| | - G K Mini
- Global Institute of Public Health, Ananthapuri Hospitals and Research Institute, Trivandrum, Kerala, India
| | - Sathish Thirunavukkarasu
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, Georgia, USA
- Emory Global Diabetes Research Center (EGDRC), Woodruff Health Sciences Center, Emory University, Atlanta, GA, USA
| | - Brian Oldenburg
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
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3
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Gupta PC, Narake S, Sinha DN, Nagler E, Pednekar MS, Sorensen G. Upscaling a behavioural intervention program for tobacco use cessation - A randomised controlled study. Prev Med Rep 2023; 36:102476. [PMID: 37908199 PMCID: PMC10613902 DOI: 10.1016/j.pmedr.2023.102476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 10/12/2023] [Accepted: 10/13/2023] [Indexed: 11/02/2023] Open
Abstract
A randomised control trial was conducted among school teachers in Bihar, India for upscaling a tested, evidence-based tobacco intervention using train-the-trainer model. Six blocks in three districts were selected and randomised into intervention and control blocks. Cluster coordinators in intervention blocks were given training in the details of intervention. Cluster coordinators routinely train headmasters and they were asked to include intervention training in their routine. Except for the training material, no additional resources were provided to cluster coordinators and headmasters. Headmasters implemented the intervention along with the teachers in the school. Post-intervention random sample of 70 schools out of 219 schools from intervention blocks and 70 schools out of 224 schools in control blocks were surveyed. The survey was self-administered among 429 school teachers in intervention schools and 331 among control schools. For all 140 headmasters, the survey was interviewer administered. Almost all headmasters in intervention schools had attended the training and had involved teachers in the intervention program. Odds ratios for carrying out the recommended activities in intervention schools compared to control schools were very high and significant. In addition, intervention schools also conducted activities such as including intervention messages in classroom teaching and conveying them to parents, activities that were not directly recommended in intervention program. Thus, this train-the-trainer model demonstrated that it is possible to upscale the intervention programs successfully with the resources within the system.
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Affiliation(s)
| | | | | | - Eve Nagler
- Center for Community-Based Research, Dana-Farber Cancer Institute, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, USA
| | | | - Glorian Sorensen
- Center for Community-Based Research, Dana-Farber Cancer Institute, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, USA
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Nagler EM, Pednekar M, Sinha DN, Stoddard AM, Narake S, Adhikari K, Jones L, Lando H, Vriniotis M, Gupta P, Sorensen G. Implementation of an evidence-based tobacco control intervention for school teachers in India: Evaluating the effects of a capacity-building strategy. IMPLEMENTATION RESEARCH AND PRACTICE 2023; 4:26334895231159428. [PMID: 37091538 PMCID: PMC10037724 DOI: 10.1177/26334895231159428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023] Open
Abstract
Background Tobacco-Free Teachers, Tobacco-Free Society (TFT-TFS) is an evidence-based intervention that promotes tobacco use cessation among teachers and tobacco control policies among schools in India. This study tested an implementation model to build Bihar Department of Education (DOE) capacity to support and deliver TFT-TFS within schools, leveraging DOE training infrastructure. Method We used a training-of-trainers (TOT) "cascade" implementation strategy to embed the TFT-TFS program into the Bihar DOE infrastructure. We trained 46 Cluster Coordinators to train and support Headmasters to implement TFT-TFS in their schools over one academic year. We selected three school districts, representing approximately 46 clusters and 219 schools. We used the RE-AIM framework to assess program adoption (Headmaster participation in at least one of six TFT-TFS trainings), implementation (of four core program components), and reach (teachers' participation in three or more group discussions). Using a non-inferiority design, we hypothesized that program adoption, implementation, and reach would not be inferior to the high standards demonstrated when TFT-TFS was originally tested in the Bihar School Teachers Study. We used self-reported checklists to measure outcomes and SPSS Version 25 to analyze data. Results For adoption, 94% of Headmasters attended the first training, although participation declined by the sixth training. Among the 112 schools out of 219 with complete Headmaster checklist data, all met our minimum criteria for implementing TFT-TFS. Over 99% of schools posted a school tobacco control policy and distributed quit booklets. However, only 69% of schools met our criteria for program reach. Conclusions This study outlines the processes for taking a tobacco control intervention to scale and implementing it through the Bihar DOE infrastructure. These findings provide a foundation for other Indian states and low- and middle-income countries to implement tobacco control and other health programs for schoolteachers. Trial registration NCT05346991. Plain Language Summary Each year in India, more than 1.2 million people die from tobacco-related causes, and India has the world's highest oral cancer burden. The world needs more evidence on how to bring cost-effective tobacco control interventions to scale, especially in low- and middle-income countries (LMICs). To address this gap, from 2017 to 2021, we examined the process of scaling up Tobacco-Free Teachers, Tobacco-Free Society (TFT-TFS), an evidence-based intervention promoting tobacco use cessation among teachers and tobacco control policies in schools. Our study tested an implementation model aimed at building the Bihar State Department of Education (DOE) capacity to support and deliver TFT-TFS. We used a training-of-trainers model to embed TFT-TFS into Bihar DOE infrastructure, training 46 Cluster Coordinators to in turn train and support Headmasters to implement TFT-TFS over one academic year. We hypothesized that program adoption, implementation, and reach would not be inferior to the high standards demonstrated when we originally tested TFT-TFS through the Bihar School Teachers Study (2013-2017). For adoption, 94% of Headmasters attended the first training, although participation declined by the sixth training. Of 112 schools (out of 219 with complete Headmaster checklist data), all met our minimum criteria for implementing TFT-TFS. Over 99% of schools posted a school tobacco control policy and distributed quit booklets. However, only 69% of schools met our criteria for program reach. Study findings offer other Indian states and LMICs lessons to implement tobacco control and other health programs for schoolteachers within educational systems.
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Affiliation(s)
- Eve M. Nagler
- Center for Community-Based Research,
Dana-Farber
Cancer Institute, Boston, MA, USA
- Department of Social and Behavioral Sciences,
Harvard T.H.
Chan School of Public Health, Boston, MA,
USA
| | - Mangesh Pednekar
- Healis-Sekhsaria Institute for Public
Health, Navi Mumbai, India
| | | | - Anne M. Stoddard
- Center for Community-Based Research,
Dana-Farber
Cancer Institute, Boston, MA, USA
| | - Sameer Narake
- Healis-Sekhsaria Institute for Public
Health, Navi Mumbai, India
| | - Keyuri Adhikari
- School of Pharmacy, West Virginia
University, Morgantown, WV, USA
| | - Leah Jones
- Center for Community-Based Research,
Dana-Farber
Cancer Institute, Boston, MA, USA
| | - Harry Lando
- School of
Public Health, University of Minnesota,
Minneapolis, MN, USA
| | - Mary Vriniotis
- Brown-Lifespan Center for Digital Health,
Rhode Island
Hospital, Providence, RI, USA
| | - Prakash Gupta
- Healis-Sekhsaria Institute for Public
Health, Navi Mumbai, India
| | - Glorian Sorensen
- Center for Community-Based Research,
Dana-Farber
Cancer Institute, Boston, MA, USA
- Department of Social and Behavioral Sciences,
Harvard T.H.
Chan School of Public Health, Boston, MA,
USA
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5
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Haregu T, Lim SC, Miranda M, Pham CT, Nguyen N, Suya I, Ilagan R, Poowanasatien A, Kowal P, Oldenburg B. Practical Strategies for Improving Sustainability and Scale-up of Noncommunicable Disease-related Public Health Interventions: Lessons from the Better Health Program in Southeast Asia. WHO South East Asia J Public Health 2023; 12:15-37. [PMID: 37843178 DOI: 10.4103/who-seajph.who-seajph_140_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
Introduction The Better Health Program has been addressing key health system issues in the prevention and control of noncommunicable diseases (NCDs) in Malaysia, Thailand, Vietnam, and the Philippines. As the program comes to an end, the sustainability and scaling-up of issues have assumed importance. Objectives The objective is to assess how well sustainability and scale-up strategies have been integrated into the design and implementation of a 3-year multicountry technical program; to explore enablers and barriers of sustainability and scaling up; and to identify practical strategies that can improve sustainability and scale-up of Better Health Program interventions. Methods We applied a staged approach to explore barriers and enablers and to identify practical strategies to improve sustainability and scale-up of four NCD interventions: community-based obesity prevention, front-of-pack labeling, local learning networks (LLNs), and NCD surveillance. We extracted evidence from peer-reviewed literature and local documents. We also conducted in-depth interviews with the implementation teams and key stakeholders. We conducted a thematic synthesis of the resulting information to identify practical strategies that improve sustainability and scale-up of the four interventions. Results Strong engagement of stakeholders at higher levels of the health system was identified as the main enabler, while limited funding and commitment from local governments were identified as a key barrier to sustainability and scale-up. Strengthening the social and institutional anchors of community health volunteers, enhancing evidence-based advocacy for front-of-pack labeling, trailblazing the LLN innovation, and securing the commitment of local governments in the implementation of NCD surveillance were among the key strategies for improving sustainability and scale-up of Better Health Program interventions in Malaysia, Thailand, Philippines, and Vietnam, respectively. Conclusions This study identified practical strategies for improving sustainability and scale-up of NCD-related interventions. Implementation of the strategies that had high priority and feasibility will improve the sustainability of critical elements of the program in the respective countries.
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Affiliation(s)
- Tilahun Haregu
- Noncommunicable Disease and Implementation Science Lab, Baker Heart and Diabetes Institute; Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | | | | | | | | | - Inthira Suya
- FHI 360 Asia Pacific Regional Office, Bangkok, Thailand
| | | | | | - Paul Kowal
- Australian National University and Better Health Programme Southeast Asia, Yangon, Myanmar
| | - Brian Oldenburg
- Noncommunicable Disease and Implementation Science Lab, Baker Heart and Diabetes Institute; Baker Department of Cardiovascular Research, Translation and Implementation, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
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Abstract
The global diabetes burden is staggering, and prevention efforts are needed to reduce the impact on individuals and populations. There is strong evidence from efficacy trials showing that lifestyle interventions promoting increased physical activity, improvements in diet, and/or weight loss significantly reduce diabetes incidence and improve cardiometabolic risk factors. Implementation research assessing the feasibility, effectiveness, and cost-effectiveness of delivering these proven programs at the community level has shown success, but more research is needed to overcome barriers to implementation in different settings globally. New avenues of research should be considered to combat this public health issue.
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Affiliation(s)
- Mary Beth Weber
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, Atlanta, GA 30322, USA.
| | - Saria Hassan
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, Atlanta, GA 30322, USA; Department of Medicine, Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA 30322, USA
| | - Rakale Quarells
- Cardiovascular Research Institute, Morehouse School of Medicine, 720 Westview Drive, SW NCPC-318, Atlanta, GA 30310, USA
| | - Megha Shah
- Department of Family and Preventive Medicine, Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA 30322, USA
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Weber MB, Gujral UP, Jagannathan R, Shah M. Lifestyle Interventions for Diabetes Prevention in South Asians: Current Evidence and Opportunities. Curr Diab Rep 2021; 21:23. [PMID: 34097137 DOI: 10.1007/s11892-021-01393-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/28/2021] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW This review summarizes the burden of diabetes in South Asian populations and reviews recent evidence for diabetes prevention through lifestyle modification among South Asians worldwide. We indicate important gaps in the current literature and point to opportunities for additional research in this area. RECENT FINDINGS Randomized, controlled, efficacy studies and implementation research show that lifestyle intervention can be an effective, cost-effective, and feasible method for reducing diabetes risk, improving cardiometabolic health, and improving lifestyle behaviors in South Asian populations, a population at high diabetes risk and elevated rates of diabetes risk factors. Additional research is needed to address diabetes risk reduction in normal-weight South Asians and individuals with impaired fasting glucose; improve community-level implementation, individual uptake, and dissemination of proven programs; and assess long-term outcomes of interventions.
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Affiliation(s)
- Mary Beth Weber
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, Atlanta, GA, 30322, USA.
| | - Unjali P Gujral
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, Atlanta, GA, 30322, USA
| | - Ram Jagannathan
- Division of Hospital Medicine, School of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Megha Shah
- Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, GA, USA
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Lotfaliany M, Sathish T, Shaw J, Thomas E, Tapp RJ, Kapoor N, Thankappan KR, Oldenburg B. Effects of a lifestyle intervention on cardiovascular risk among high-risk individuals for diabetes in a low- and middle-income setting: Secondary analysis of the Kerala Diabetes Prevention Program. Prev Med 2020; 139:106068. [PMID: 32194098 DOI: 10.1016/j.ypmed.2020.106068] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 01/09/2020] [Accepted: 03/14/2020] [Indexed: 11/19/2022]
Abstract
We aimed to examine whether a lifestyle intervention was effective in reducing cardiovascular disease (CVD) risk in individuals at high-risk of developing diabetes in a low- and middle-income setting. The Kerala Diabetes Prevention Program was evaluated by a cluster-randomized controlled trial (2013-2016) of 1007 individuals (aged 30-60 years) at high-risk for diabetes (Indian Diabetes Risk Score ≥ 60 and without diabetes) in Kerala state, India. Sixty polling areas in Kerala were randomized to intervention or control groups by an independent statistician using a computer-generated randomization sequence. Participants from 30 intervention communities received a 12-month structured peer-support lifestyle intervention program involving 15 group sessions and linked community activities, aimed at supporting and maintaining lifestyle change. The primary outcome for this analysis was the predicted 10-year CVD risk at two years, assessed using the Framingham Risk Score. The mean age at baseline was 46.0 (SD: 7.5) years, and 47.2% were women. Baseline 10-year CVD risk was similar between study groups. The follow-up rate at two years was 95.7%. The absolute risk reduction in predicted 10-year CVD risk between study groups was 0.69% (95% CI: 0.09% to 1.29%, p=0.024) at one year and 0.69% (95% CI: 0.10% to 1.29%, p=0.023) at two years. The favorable change in CVD risk with the intervention condition was mainly due to the reduction in tobacco use (change index: -0.25, 95% CI: -0.42 to -0.09). Our findings suggest that a community-based peer-support lifestyle intervention could reduce CVD risk in individuals at high-risk of developing diabetes in India. TRIAL REGISTRATION: Australia and New Zealand Clinical Trials Registry ACTRN12611000262909.
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Affiliation(s)
- Mojtaba Lotfaliany
- Melbourne School of Population and Global Health, University of Melbourne, Australia
| | - Thirunavukkarasu Sathish
- Melbourne School of Population and Global Health, University of Melbourne, Australia; Population Health Research Institute, McMaster University, Hamilton, Canada.
| | - Jonathan Shaw
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Emma Thomas
- Melbourne School of Population and Global Health, University of Melbourne, Australia; Centre for Online Health, Centre for Health Services Research, University of Queensland, Australia
| | - Robyn Jennifer Tapp
- Melbourne School of Population and Global Health, University of Melbourne, Australia; School of Biomedical Engineering and Imaging Sciences, Kings College London, United Kingdom
| | - Nitin Kapoor
- Melbourne School of Population and Global Health, University of Melbourne, Australia; Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, India
| | - Kavumpurathu Raman Thankappan
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, India; Department of Public Health and Community Medicine, Central University of Kerala, Kasaragod, Kerala, India
| | - Brian Oldenburg
- Melbourne School of Population and Global Health, University of Melbourne, Australia; WHO Collaborating Centre on Implementation Research for Prevention & Control of NCDs, University of Melbourne, Australia
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Sathish T, Oldenburg B, Thankappan KR, Absetz P, Shaw JE, Tapp RJ, Zimmet PZ, Balachandran S, Shetty SS, Aziz Z, Mahal A. Cost-effectiveness of a lifestyle intervention in high-risk individuals for diabetes in a low- and middle-income setting: Trial-based analysis of the Kerala Diabetes Prevention Program. BMC Med 2020; 18:251. [PMID: 32883279 PMCID: PMC7472582 DOI: 10.1186/s12916-020-01704-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 07/10/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Data on the cost-effectiveness of lifestyle-based diabetes prevention programs are mostly from high-income countries, which cannot be extrapolated to low- and middle-income countries. We performed a trial-based cost-effectiveness analysis of a lifestyle intervention targeted at preventing diabetes in India. METHODS The Kerala Diabetes Prevention Program was a cluster-randomized controlled trial of 1007 individuals conducted in 60 polling areas (electoral divisions) in Kerala state. Participants (30-60 years) were those with a high diabetes risk score and without diabetes on an oral glucose tolerance test. The intervention group received a 12-month peer-support lifestyle intervention involving 15 group sessions delivered in community settings by trained lay peer leaders. There were also linked community activities to sustain behavior change. The control group received a booklet on lifestyle change. Costs were estimated from the health system and societal perspectives, with 2018 as the reference year. Effectiveness was measured in terms of the number of diabetes cases prevented and quality-adjusted life years (QALYs). Three times India's gross domestic product per capita (US$6108) was used as the cost-effectiveness threshold. The analyses were conducted with a 2-year time horizon. Costs and effects were discounted at 3% per annum. One-way and multi-way sensitivity analyses were performed. RESULTS Baseline characteristics were similar in the two study groups. Over 2 years, the intervention resulted in an incremental health system cost of US$2.0 (intervention group: US$303.6; control group: US$301.6), incremental societal cost of US$6.2 (intervention group: US$367.8; control group: US$361.5), absolute risk reduction of 2.1%, and incremental QALYs of 0.04 per person. From a health system perspective, the cost per diabetes case prevented was US$95.2, and the cost per QALY gained was US$50.0. From a societal perspective, the corresponding figures were US$295.1 and US$155.0. For the number of diabetes cases prevented, the probability for the intervention to be cost-effective was 84.0% and 83.1% from the health system and societal perspectives, respectively. The corresponding figures for QALY gained were 99.1% and 97.8%. The results were robust to discounting and sensitivity analyses. CONCLUSIONS A community-based peer-support lifestyle intervention was cost-effective in individuals at high risk of developing diabetes in India over 2 years. TRIAL REGISTRATION The trial was registered with Australia and New Zealand Clinical Trials Registry ( ACTRN12611000262909 ). Registered 10 March 2011.
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Affiliation(s)
- Thirunavukkarasu Sathish
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia. .,Population Health Research Institute, McMaster University, 237 Barton Street East, Hamilton, L8L 2X2, ON, Canada.
| | - Brian Oldenburg
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.,WHO Collaborating Centre on Implementation Research for Prevention & Control of NCDs, University of Melbourne, Melbourne, Australia
| | - Kavumpurathu R Thankappan
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.,Department of Public Health and Community Medicine, Central University of Kerala, Kasaragod, Kerala, India
| | - Pilvikki Absetz
- Department of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.,Faculty of Social Sciences, Tampere University, Tampere, Finland
| | | | - Robyn J Tapp
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.,School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.,Centre for Intelligent Healthcare, Faculty of Health and Life Sciences, Coventry University, Coventry, Australia
| | - Paul Z Zimmet
- Central Clinical School, Monash University, Melbourne, UK
| | - Sajitha Balachandran
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.,Population Research Centre, University of Kerala, Trivandrum, Kerala, India
| | - Suman S Shetty
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Zahra Aziz
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.,School of Psychological Sciences, Monash University, Melbourne, Kerala, Australia
| | - Ajay Mahal
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
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10
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Lifestyle Changes Observed among Adults Participating in a Family- and Community-Based Intervention for Diabetes Prevention in Europe: The 1 st Year Results of the Feel4Diabetes-Study. Nutrients 2020; 12:nu12071949. [PMID: 32629949 PMCID: PMC7399917 DOI: 10.3390/nu12071949] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 06/17/2020] [Accepted: 06/28/2020] [Indexed: 01/06/2023] Open
Abstract
The Feel4Diabetes intervention was a school and community-based intervention aiming to promote healthy lifestyle and tackle obesity and obesity-related metabolic risk factors for the prevention of type 2 diabetes (T2D) among families at risk of developing this disease. The current study aims to present the results on lifestyle behaviors obtained from parents during the first year of the Feel4Diabetes intervention. This multicomponent intervention had a cluster randomized design and was implemented in Belgium, Bulgaria, Finland, Greece, Hungary and Spain over two years (2016-2018). Standardized protocols and procedures were used by the participating centers in all countries to collect data on parents' lifestyle behaviors (diet, physical activity, sedentary behavior). The Feel4Diabetes intervention was registered at clinicaltrials.gov (registration number: NCT02393872). In total, 2110 high-risk parents participated in the baseline and 12-month follow-up examination measurements. Participants allocated to the intervention group reduced their daily consumption of sugary drinks (p = 0.037) and sweets (p = 0.031) and their daily screen time (p = 0.032), compared with the control group. In addition, participants in the intervention group in Greece and Spain increased their consumption of breakfast (p = 0.034) and fruits (p = 0.029), while in Belgium and Finland they increased their water intake (p = 0.024). These findings indicate that the first year of the Feel4Diabetes intervention resulted in the improvement of certain lifestyle behaviors in parents from high-risk families.
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