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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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Følling IS, Klöckner C, Devle MT, Kulseng B. Preventing type 2 diabetes, overweight and obesity in the Norwegian primary healthcare: a longitudinal design with 60 months follow-up results and a cross-sectional design with comparison of dropouts versus completers. BMJ Open 2022; 12:e054841. [PMID: 35264353 PMCID: PMC8915299 DOI: 10.1136/bmjopen-2021-054841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES Studies have demonstrated that it is possible to prevent type 2 diabetes for individuals at high risk, but long-term results in the primary healthcare are limited and high dropout rates have been reported. DESIGN A longitudinal design was used to study changes in participants' diabetes risk and anthropometrics from baseline to 60 months follow-up. A cross-sectional design was applied to investigate differences between dropouts and completers of the 60 months follow-up. SETTING Healthy Life Centres in the Norwegian primary healthcare. PARTICIPANTS 189 individuals aged >18 years with a Finnish Diabetes Risk Score ≥12 and/or a body mass index (BMI) ≥25 kg/m2 were included and offered to attend Healthy Life Centre programmes for 12 months. Measurements were performed annually up to 60 months after inclusion. INTERVENTIONS Healthy Life Centres arrange behavioural programmes including physical activity offers and dietary courses as part of the primary healthcare. This study offered individuals to attend Healthy Life Centre programmes and followed them for 60 months. PRIMARY OUTCOME Assess changes in participants' diabetes risk, cardiovascular measures and anthropometrics from baseline to 60 months. SECONDARY OUTCOME Investigate characteristics of dropouts compared with completers of 60 months follow-up. RESULTS For participants at 60 months follow-up, diabetes risk and anthropometrics decreased (p<0.001). Out of 65 participants classified as high risk for diabetes at baseline, 27 (42%) changed to being at moderate risk at 60 months follow-up. Remission of diabetes was seen for six of nine participants. Of 189 participants enrolled in the programme, 54 (31%) dropped out at any given point before 60 months follow-up. Dropouts were younger with higher, BMI, weight and waist circumference compared with the completers (p<0.001). CONCLUSIONS Having a long-term commitment for participants in primary healthcare interventions could be beneficial for the reduction of diabetes risk and improvement of anthropometrics as shown at the 60 months follow-up. TRIAL REGISTRATION NUMBER NCT01135901.
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Affiliation(s)
- Ingrid Sørdal Følling
- Centre for Obesity Research (ObeCe), Department of Surgery, St. Olavs University Hospital, Trondheim, Norway
- Faculty of Education and Arts, Nord Universitet-Levanger Campus, Levanger, Norway
| | - Christian Klöckner
- Centre for Obesity Research (ObeCe), Department of Surgery, St. Olavs University Hospital, Trondheim, Norway
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Monica Tømmervold Devle
- Centre for Obesity Research (ObeCe), Department of Surgery, St. Olavs University Hospital, Trondheim, Norway
| | - Bård Kulseng
- Centre for Obesity Research (ObeCe), Department of Surgery, St. Olavs University Hospital, Trondheim, Norway
- Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
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Nagamine H, Lyu X, Maruyama K, Morita K. Implementation and evaluation of a primary diabetes prevention programme for young adult employees in Japan: A non-randomized controlled trial. Nurs Open 2020; 7:137-149. [PMID: 31871697 PMCID: PMC6917952 DOI: 10.1002/nop2.372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 08/21/2019] [Indexed: 12/04/2022] Open
Abstract
Aim To determine the effects of a primary diabetes prevention programme created for healthy young adults. Design This study was a non-randomized controlled trial. Methods The participants were 20-39-year-old employees of two automobile sales companies. The intervention group (N = 154) received six original educational brochures and films created specifically for young adults, while the control group (N = 157) received none. Data were collected pre-intervention and immediately after and 10 weeks after intervention. Change in knowledge about diabetes, its prevention and health management were measured. Results Overall, 129 interventions and 141 controls completed the trial. In items related to diabetes prevention, the intervention group increased their knowledge relative to controls (all p < .05). Awareness of susceptibility to diabetes also increased more in the interventions (p = .029). The interventions also improved more with items related to dietary behaviour (p < .05). This trial has been registered with UMIN-CTR clinical trial (UMIN000023749).
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Affiliation(s)
- Hitomi Nagamine
- Community Health Promotion NursingGraduate School of Health Care SciencesTokyo Medical and Dental UniversityTokyoJapan
| | - Xiaowei Lyu
- Community Health Promotion NursingGraduate School of Health Care SciencesTokyo Medical and Dental UniversityTokyoJapan
| | - Kayo Maruyama
- Community Health Promotion NursingGraduate School of Health Care SciencesTokyo Medical and Dental UniversityTokyoJapan
| | - Kumiko Morita
- Community Health Promotion NursingGraduate School of Health Care SciencesTokyo Medical and Dental UniversityTokyoJapan
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Katangwe T, Family H, Sokhi J, Kirkdale CL, Twigg MJ. The community pharmacy setting for diabetes prevention: A mixed methods study in people with 'pre-diabetes'. Res Social Adm Pharm 2019; 16:1067-1080. [PMID: 31734102 DOI: 10.1016/j.sapharm.2019.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 09/26/2019] [Accepted: 11/03/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND Diabetes Prevention Programs (DPPs) comprising intensive lifestyle interventions may delay or even prevent the onset of type 2 diabetes in people with pre-diabetes. However, engagement with DPPs is variable with session times and transportation being reported amongst barriers; this may be addressed by community pharmacy (CP) involvement given its recognition for accessibility. OBJECTIVES To explore factors influencing engagement with the National Health Service (NHS) DPP and the role of CP in diabetes prevention. METHODS Nine hundred and sixty-two questionnaires were posted to people with pre-diabetes identified from five general practices in Norfolk, England between November 2017 and May 2018. Follow-up semi-structured interviews (n = 10) and a focus group (n = 6) were conducted with a sample of questionnaire respondents. Questionnaire data were analysed quantitatively using SPSS and qualitative data analysed inductively using thematic analysis. Themes relating to engagement and the role of CP in pre-diabetes were further analysed using the COM-B model of behaviour change. RESULTS A total of 181 (18.8%) questionnaire responses were received, a quarter of whom reported to have either dropped out or declined attending the national DPP. DPP engagers were more likely to report the program location and session times as convenient. Community pharmacy was perceived as an acceptable setting for delivering diabetes prevention services (DPS) and a preferable alternative for regular pharmacy users and people with work and social commitments. Participants felt that opportunity to engage with CP DPS is enhanced by its accessibility and flexibility in making appointments. Knowledge about the DPS provided in CP and previous experience with CP services were central influences of capability and motivation to engage respectively. CONCLUSIONS This research outlines factors that could influence engagement with community pharmacy-based DPS and provides evidence to inform intervention development. Further research would be required to determine the feasibility and cost-effectiveness of such interventions.
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Affiliation(s)
- Thando Katangwe
- School of Pharmacy, University of East Anglia, Norwich Research Park, Norwich, United Kingdom.
| | - Hannah Family
- Medical School, University of Bristol, Bristol, United Kingdom
| | - Jeremy Sokhi
- School of Pharmacy, University of East Anglia, Norwich Research Park, Norwich, United Kingdom
| | | | - Michael J Twigg
- School of Pharmacy, University of East Anglia, Norwich Research Park, Norwich, United Kingdom
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Karamanakos G, Costa-Pinel B, Gilis-Januszewska A, Velickiene D, Barrio-Torrell F, Cos-Claramunt X, Mestre-Miravet S, Piwońska-Solska B, Hubalewska-Dydejczyk A, Tuomilehto J, Liatis S, Makrilakis K. The effectiveness of a community-based, type 2 diabetes prevention programme on health-related quality of life. The DE-PLAN study. PLoS One 2019; 14:e0221467. [PMID: 31603914 PMCID: PMC6788719 DOI: 10.1371/journal.pone.0221467] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 08/05/2019] [Indexed: 01/10/2023] Open
Abstract
Background and aims The DE-PLAN was a European multicenter study, with the primary objective of testing whether a community-based lifestyle modification programme could serve as a means of primary prevention for type 2 diabetes (T2D) in high-risk individuals (based on the FINDRISC questionnaire). The aim of this study was to examine the impact of a 1-year community-based lifestyle intervention on health-related quality of life (HRQOL) in individuals from four participating European centers (Athens, Barcelona, Krakow, Kaunas), through a post-hoc analysis. Materials and methods Each center was allowed to implement different intervention strategies specifically tailored to the needs of their corresponding population sample. Before and after the intervention, participants underwent clinical evaluation, anthropometric measurements, an oral glucose tolerance test and lipid profile measurements. Health-related quality of life was assessed using the validated HRQOL-15D questionnaire. A difference of ±0.015 in the 15D questionnaire score was set as the threshold of clinically meaningful change. Results Data from 786 participants (67% females, mean age 59.7±9.4 years, BMI 31.5±4.5 kg/m2) with complete data regarding the HRQOL were analyzed (Athens: 104, Barcelona: 434, Krakow: 175, Kaunas: 70). After 1 year, a significant overall improvement in HRQOL was shown, as depicted by a change of 15D score from baseline value (0.88±0.9) to post-intervention (0.90±0.87, P<0.001), achieving the threshold of clinically meaningful change. A significant weight reduction was also observed (-0.8±4.0 kg, P<0.001). In multivariate analysis, improvement in HRQOL was independently associated with lower 15D score at baseline (P<0.001) and self-reported increase in overall exercise time (P<0.001) as assessed through specifically designed trial questionnaires. Conclusion A community-based lifestyle intervention programme aiming at T2D prevention, applied on a heterogeneous population and with varied methods, was shown to improve overall health-related quality of life to a clinically meaningful degree.
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Affiliation(s)
- Georgios Karamanakos
- First Department of Propaedeutic Medicine, Diabetes Center, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
- * E-mail:
| | - Bernardo Costa-Pinel
- Catalan Diabetes Prevention Research Group, Jordi Gol Primary Care Research Institute, Catalan Health Institute, Primary Health Care Division, Reus-Barcelona, Spain
| | | | - Dzilda Velickiene
- Lithuanian University of Health Sciences, Institute of Endocrinology, Kaunas, Lithuania, LT
| | - Francisco Barrio-Torrell
- Catalan Diabetes Prevention Research Group, Jordi Gol Primary Care Research Institute, Catalan Health Institute, Primary Health Care Division, Reus-Barcelona, Spain
| | - Xavier Cos-Claramunt
- Catalan Diabetes Prevention Research Group, Jordi Gol Primary Care Research Institute, Catalan Health Institute, Primary Health Care Division, Reus-Barcelona, Spain
| | - Santiago Mestre-Miravet
- Catalan Diabetes Prevention Research Group, Jordi Gol Primary Care Research Institute, Catalan Health Institute, Primary Health Care Division, Reus-Barcelona, Spain
| | - Beata Piwońska-Solska
- Department of Endocrinology, Jagiellonian University, Medical College, Krakow, Poland
| | | | - Jaakko Tuomilehto
- Department of Public Health Solutions, 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
| | - Stavros Liatis
- First Department of Propaedeutic Medicine, Diabetes Center, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Konstantinos Makrilakis
- First Department of Propaedeutic Medicine, Diabetes Center, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
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Gilis-Januszewska A, Barengo NC, Lindström J, Wójtowicz E, Acosta T, Tuomilehto J, Schwarz PEH, Piwońska-Solska B, Szybiński Z, Windak A, Hubalewska-Dydejczyk A. Predictors of long term weight loss maintenance in patients at high risk of type 2 diabetes participating in a lifestyle intervention program in primary health care: The DE-PLAN study. PLoS One 2018; 13:e0194589. [PMID: 29570724 PMCID: PMC5865727 DOI: 10.1371/journal.pone.0194589] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 03/06/2018] [Indexed: 02/02/2023] Open
Abstract
Lifestyle interventions in type 2 diabetes (DM2) prevention implementation studies can be effective and lasting. Long-term weight loss maintenance enhances the intervention effect through a significant decrease in diabetes incidence over time. Our objective was to identify factors predicting long-term successful weight reduction maintenance achieved during a DM2 prevention program in patients with high DM2 risk in primary health care. Study participants (n = 263), middle-aged, slightly obese with baseline increased DM2 risk (Finnish Diabetes Risk Score (FINDRISC)>14), but no diabetes were invited to receive 11 lifestyle counselling sessions, guided physical activity sessions and motivational support during 10-months. The study participants had three clinical examinations during the study (baseline, one and three years). Stepwise regression analysis was used to determine demographic, clinical, and lifestyle predictors of weight reduction maintenance two years after the discontinuation of the intervention. Out of 105 patients who completed all three examinations (baseline age 56.6 (standard deviation (SD) = 10.7), body mass index 31.1 kg/m2 (SD = 4.9), FINDRISC 18.6 (SD = 3.1)), 73 patients (70%) showed weight loss during the intervention (mean weight loss 4.2 kg, SD = 5.1). The total weight loss achieved in the maintainers (27 of 73 study participants) two years after the intervention had finished was 6.54 kg (4.47 kg+2.0 kg). The non-maintainers, on the other hand, returned to their initial weight at the start of the intervention (+0.21 kg). In multivariable analysis baseline history of increased glucose (odds ratio (OR) = 3.7; 95% confidence interval (CI) 1.0-13.6) and reduction of total fat in diet during follow-up (OR = 4.3; 95% CI 1.5-12.2) were independent predictors of successful weight loss. Further studies exploring predictors of weight loss maintenance in diabetes prevention are needed to help health care providers to redesign interventions and improve long-term outcomes of real life interventions.
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Affiliation(s)
| | - Noël C. Barengo
- Department of Medical and Population Health Science Research, Herbert Wertheim College of Medicine, Florida International University, Miami, United States of America
| | - Jaana Lindström
- Chronic Disease Prevention Unit, National Institute for Health and Welfare (THL), Helsinki, Finland
| | - Ewa Wójtowicz
- Chair and Department of Endocrinology, Jagiellonian University, Medical College, Krakow, Poland
| | - Tania Acosta
- Department of Public Health, Universidad del Norte, Barranquilla, Colombia
| | - Jaakko Tuomilehto
- Centre for Vascular Prevention, Danube-University Krems, Krems, Austria
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland
- Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
- Dasman Diabetes Institute, Dasman, Kuwait
| | - Peter E. H. Schwarz
- Department for Prevention & Care of Diabetes, Medical Clinic Unit III, University Clinic Carl Gustav Carus at Technical University Dresden, Dresden, Germany
- Paul Langerhans Institute Dresden of the Helmholtz Center Munich at University Hospital and Faculty of Medicine, Technical University Dresden, Dresden, Germany
- German Center for Diabetes Research, Neuherberg, Germany
| | - Beata Piwońska-Solska
- Chair and Department of Endocrinology, Jagiellonian University, Medical College, Krakow, Poland
| | - Zbigniew Szybiński
- Chair and Department of Endocrinology, Jagiellonian University, Medical College, Krakow, Poland
| | - Adam Windak
- Department of Family Medicine, Chair of Medicine and Gerontology, Jagiellonian University Medical College, Krakow, Poland
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