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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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Li YY, Yang YM, Zhu S, Cheng H, Hernandez J, Huang W, Wang HHX, Li YT. Changes in body weight and cardiovascular risk factors in a Chinese population with type 2 diabetes mellitus: a longitudinal study. Front Endocrinol (Lausanne) 2023; 14:1112855. [PMID: 37124734 PMCID: PMC10130380 DOI: 10.3389/fendo.2023.1112855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 03/03/2023] [Indexed: 05/02/2023] Open
Abstract
Introduction The primary care management of blood glucose, blood pressure, lipid profiles, and body weight is important among patients with type 2 diabetes mellitus (T2DM) to prevent disease progression. Information on how weight changes would improve or deteriorate cardiovascular (CV) risk factors is warranted for making primary care recommendations. We aimed to investigate the changes in body weight and CV risk factors and to analyse their association in a Chinese population with T2DM. Methods We retrieved longitudinal data between 2020 and 2021 from 1,758 adult primary care patients enrolled in a diabetic retinopathy (DR) screening programme. Linear associations of changes in body weight with CV risk factors were explored. Multivariable logistic regression analysis was performed to examine associations between different weight change categories and the worsening of CV risk factors. Results The mean age of all the participants was 63.71 years, and over half of participants were females. During a one-year follow-up period, 24.7% of patients had a weight loss of ≥3%, while 22.2% of patients had a weight gain of ≥3%. Patients who had a weight loss of ≥3% were more likely to prevent the worsening of haemoglobin A1c (HbA1c) and triglycerides, while those who had a weight gain of ≥3% tended to have worsened HbA1c, lipid profiles, and blood pressure. Conclusion Results from this real-world investigation suggested the concurrent need for weight loss intervention among patients who are overweight or obese and weight gain prevention among patients whose body weight falls within the normal range in the context of community-based diabetes management.
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Affiliation(s)
- Yun-Yi Li
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Yu-Meng Yang
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Sufen Zhu
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Hui Cheng
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Jose Hernandez
- Faculty of Medicine and Health, EDU, Digital Education Holdings Ltd., Kalkara, Malta
- Green Templeton College, University of Oxford, Oxford, United Kingdom
| | - Wenyong Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Harry H. X. Wang
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Usher Institute, Deanery of Molecular, Genetic & Population Health Sciences, The University of Edinburgh, Scotland, United Kingdom
| | - Yu Ting Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
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O'Reilly SL, May CR, Ford D, Dunbar JA. Implementing primary care diabetes prevention for women with previous gestational diabetes: a mixed-methods study. Fam Pract 2022; 39:1080-1086. [PMID: 35412623 PMCID: PMC9680660 DOI: 10.1093/fampra/cmac022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The implementation of diabetes prevention for women with previous gestational diabetes (GDM) has been stymied by many barriers that are located within routine general practice (GP). We aimed to unpack the GP factors and understand the mechanisms that explain why a diabetes prevention intervention for this population succeeds or fails. METHODS We performed a mixed-methods study with a Normalization Process Theory framework that included clinical audits, semistructured interviews, and focus groups within mixed urban and rural primary care practices in Victoria, Australia. Staff of primary care practices and external support staff who provide services to women with previous GDM participated in a 12-month quality improvement collaborative intervention. We compared diabetes screening and prevention activity planning with the strategies and factors identified through a process evaluation of full-, moderate-, and low-active participating practices. RESULTS The intervention doubled screening rates (26%-61%) and 1-in-10 women received a diabetes prevention planning consultation. Critical improvement factors were: mothers being seen as participants in the quality improvement work; staff collectively building care strategies; staff taking a long-term care of a community perspective rather than episodic service delivery; and feedback processes being provided and acted on across the practice. The observable factors from the external perspective were: leadership by identified practice staff, reminder systems in action and practice staff driving the process collectively. CONCLUSIONS Successful engagement in diabetes prevention for women with previous GDM requires proactive building of the critical improvement factors and audit feedback into routine GP.
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Affiliation(s)
- Sharleen L O'Reilly
- School of Exercise and Nutrition Sciences, Institute of Physical Activity and Nutrition, Deakin University, Burwood, Australia
| | - Carl R May
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Dale Ford
- Improvement Foundation, Adelaide, Australia
| | - James A Dunbar
- Deakin Rural Health, School of Medicine, Faculty of Health, Deakin University, Warrnambool, Australia
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Martiskainen TM, Lamidi ML, Venojärvi M, Tikkanen H, Laatikainen T. Effectiveness of physical activity counselling provided for people with type 2 diabetes mellitus in primary healthcare in North Karelia, Finland: a register-based evaluation study. BMJ Open 2022; 12:e058546. [PMID: 35788078 PMCID: PMC9255411 DOI: 10.1136/bmjopen-2021-058546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Physical activity (PA) plays a significant role in the treatment of type two diabetes (T2D). This study evaluated the effectiveness of PA counselling in primary healthcare (PHC) on clinical outcome measures in patients with T2D, comparing them with a registry-based controls. SETTING The study was carried out in North Karelia, Finland, among PHC clients who have been diagnosed with T2D in 2016-2018. PARTICIPANTS The study population consisted of patients aged 19-87 years diagnosed with T2D (n=1803). Altogether 546 patients were referred to the PA educator of whom 521 participated the counselling. In totally 1382 sex, age, time of diagnosis and intervention time-matched controls were used to see the effect of intervention. INTERVENTIONS Patients with T2D followed up in PHC were offered to participate in PA counselling provided by trained PA educators. The number of counselling sessions and their content were tailored according to patients needs and willingness to participate. To assess the effects of PA to management of T2D clinical outcome measures such as weight and Haemoglobin A1c (HbA1c) and lipid levels were assessed using data from electronic patient records. Each patient was followed up from records at least for a year. RESULTS Weight and body mass index (BMI) decreased in both groups and mean yearly changes did not differ between the groups. HbA1c levels declined in the intervention and increased in the control group with statistically significant difference in the mean yearly change between the groups (p=0.001). The low-density lipoprotein declined in both groups. The decline was bigger in the intervention group, but the difference did not quite reach the statistical significance (p=0.096). CONCLUSIONS This study shows that PA counselling in PHC offers significant benefits in the treatment outcomes of T2D although no significant declines were not observed in the weight or BMI.
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Affiliation(s)
- Tuula Marketta Martiskainen
- Joint municipal authority for North Karelia social and health services (Siun sote), Joensuu, Finland
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Marja-Leena Lamidi
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Mika Venojärvi
- Institute of Biomedicine/Sports and Exercise Medicine, University of Eastern Finland, Kuopio, Finland
| | - Heikki Tikkanen
- Institute of Biomedicine/Sports and Exercise Medicine, University of Eastern Finland, Kuopio, Finland
| | - Tiina Laatikainen
- Joint municipal authority for North Karelia social and health services (Siun sote), Joensuu, Finland
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
- Department of Public Health and Social Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
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Honda T, Ishida Y, Oda M, Noguchi K, Chen S, Sakata S, Oishi E, Furuta Y, Yoshida D, Hirakawa Y, Hata J, Kitazono T, Ninomiya T. Changes in Body Weight and Concurrent Changes in Cardiovascular Risk Profiles in Community Residents in Japan: the Hisayama Study. J Atheroscler Thromb 2022; 29:252-267. [PMID: 33455974 PMCID: PMC8803559 DOI: 10.5551/jat.59394] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 11/20/2020] [Indexed: 11/26/2022] Open
Abstract
AIM We investigated the influence of weight change on concurrent changes in predicted cardiovascular disease (CVD) risk and individual CVD risk factors over time. METHODS A total of 2,140 community-dwellers aged 40-74 years participated in both 2002 and 2007 health examinations. Obesity was defined as body mass index ≥ 25 kg/m2. Weight trajectories were classified as: "stable obese" (obese at both examinations), "obese to nonobese" (obese in 2002 but nonobese in 2007), "nonobese to obese" (nonobese in 2002 but obese in 2007), or "stable nonobese" (nonobese at both examinations). We compared changes in the model-predicted risk for CVD and individual CVD risk factors across weight-change categories. RESULTS The predicted risk for CVD increased during 5 years in all groups; the increment in the predicted risk for CVD was smallest in the obese to nonobese participants and steepest in the nonobese to obese subjects. Compared with the stable obese participants, the obese to nonobese participants had greater favorable changes in waist circumferences, blood pressure, fasting plasma glucose, serum high-density lipoprotein cholesterol, serum triglycerides, and liver enzymes. For all these parameters, opposite trends were observed when comparing the nonobese to obese participants with the stable nonobese group. CONCLUSIONS We demonstrated the favorable association of losing weight in obese people and avoiding excessive weight gain in nonobese people with global risk of future CVD and individual CVD risk factors in a real-world setting. The findings could improve behavioral lifestyle interventions that provide information on the health consequences of weight change at health checkups.
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Affiliation(s)
- Takanori Honda
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yuki Ishida
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masaaki Oda
- Clinical Science Division, R&D Janssen Pharmaceutical K. K. 3-5-2 Nishi-kanda, Chiyoda, Tokyo, Japan
| | - Kenichi Noguchi
- Clinical Science Division, R&D Janssen Pharmaceutical K. K. 3-5-2 Nishi-kanda, Chiyoda, Tokyo, Japan
| | - Sanmei Chen
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Satoko Sakata
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Emi Oishi
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshihiko Furuta
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Medical-Engineering Collaboration for Healthy Longevity, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Daigo Yoshida
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoichiro Hirakawa
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Jun Hata
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takanari Kitazono
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Toshiharu Ninomiya
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Opie RS, Jacka FN, Marx W, Rocks T, Young C, O’Neil A. Designing Lifestyle Interventions for Common Mental Disorders: What Can We Learn from Diabetes Prevention Programs? Nutrients 2021; 13:3766. [PMID: 34836024 PMCID: PMC8619252 DOI: 10.3390/nu13113766] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/19/2021] [Accepted: 10/21/2021] [Indexed: 12/19/2022] Open
Abstract
Lifestyle factors including diet, sleep, physical activity, and substance use cessation, are recognised as treatment targets for common mental disorders (CMDs). As the field of lifestyle-based mental health care evolves towards effectiveness trials and real-world translation, it is timely to consider how such innovations can be integrated into clinical practice. This paper discusses the utility and scale-up of lifestyle interventions for CMDs and draws on diabetes prevention literature to identify enablers and barriers to translation efforts. We discuss the extent to which lifestyle interventions aimed at managing CMDs and preventing diabetes share commonalities (program content, theoretical underpinnings, program structures, interventionists, frameworks promoting fidelity, quality, sustainability). Specific considerations when utilising these programs for mental health include personalising content with respect to symptoms and trajectories of depression and anxiety, medication regimen and genetic risk profile. As this field moves from efficacy to effectiveness and implementation, it is important to ensure issues in implementation science, including "voltage drop", "program drift", logistics, funding, and resourcing, are in line with evidence-based models that are effective in research settings. Ongoing considerations includes who is best placed to deliver this care and the need for models to support implementation including long-term financing, workforce training, supervision, stakeholder and organisational support.
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Affiliation(s)
- Rachelle S Opie
- Food and Mood Centre, IMPACT—The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong 3220, Australia; (F.N.J.); (W.M.); (T.R.); (C.Y.); (A.O.)
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Rastogi S, Singh N, Gutch M, Bhattacharya A. Predicting and preventing diabetes: Translational potential of Ayurveda information on pre-diabetes. J Ayurveda Integr Med 2021; 12:733-738. [PMID: 34275702 PMCID: PMC8642666 DOI: 10.1016/j.jaim.2021.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/15/2021] [Accepted: 05/21/2021] [Indexed: 11/07/2022] Open
Abstract
Continued rise in incidence and prevalence of diabetes globally warrants an effective strategy for its prevention and control. Prevention of diabetes seems more logical to attempt seeing its health care burden, long dormancy, systemic affliction and poor general awareness. Pre-diabetes is the intermediate state of erratic glucose metabolism without overt features of diabetes. This state seems to be a crossroad having a possibility to either convert into clinical diabetes, remain dormant or return to normal glucose control depending upon the efforts made. Unfortunately, due to the paucity of apparent clinical symptoms, this state embedded with reversal possibility, remains unexplored. Ayurveda account of prameha purvarupa (subclinical features of diabetes) may be proposed as the foundation upon which clinic-based pre-diabetes identification and subsequent prevention may be explored. Knowing the symptoms for their reliable proximity with upcoming diabetes may turn to be sensible sensitizers prompting the people to abort the disease process in an effective and timely manner. Considering diabetes from its purvarupa to complications as disease continuum and exploring the opportunities to intervene in order to prevent, or manage the disease on the basis of shada kriyaa kaala therefore, has a huge translational potential warrants an urgent exploration.
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Affiliation(s)
- Sanjeev Rastogi
- PG Department of Kaya Chikitsa, State Ayurvedic College and Hospital, Lucknow University, Lucknow, India.
| | - Neelendra Singh
- PG Department of Kaya Chikitsa, State Ayurvedic College and Hospital, Lucknow University, Lucknow, India
| | - Manish Gutch
- Endocrinology and Diabetology, Medanta Hospital, Lucknow, India
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Versace VL, Beks H, Wesley H, McNamara K, Hague W, Anjana RM, Mohan V, Khunti K, Dunbar JA. Metformin for Preventing Type 2 Diabetes Mellitus in Women with a Previous Diagnosis of Gestational Diabetes: A Narrative Review. Semin Reprod Med 2021; 38:366-376. [PMID: 33860488 DOI: 10.1055/s-0041-1727203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Women with a history of gestational diabetes mellitus (GDM) are at greater risk of developing type 2 diabetes mellitus (T2DM) when compared with women who have not had GDM. To delay or prevent T2DM, guidelines recommend regular screening in the primary care setting and lifestyle interventions that are largely focused on dietary and physical activity modifications. As the postpartum period can be challenging for women, uptake and engagement in screening and lifestyle interventions have been poor. Poor uptake and engagement places women with a history of GDM at heightened risk for future morbidity and development of T2DM. Metformin has been a longstanding and safe treatment for the control of blood glucose in people with T2DM. Research has supported the efficacy of metformin, used as an adjunct to a lifestyle intervention or as a stand-alone treatment, in preventing T2DM in people at high risk of T2DM. Findings from longitudinal studies have demonstrated the potential for metformin to reduce conversion to T2DM when used by women with a previous diagnosis of GDM. This review examines the potential effectiveness of metformin to reduce the incidence of T2DM among women with a previous diagnosis of GDM in the "real-world" setting.
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Affiliation(s)
| | - Hannah Beks
- School of Medicine, Deakin University, Geelong, Australia
| | - Hannah Wesley
- School of Medicine, Deakin University, Geelong, Australia.,Madras Diabetes Research Foundation, Chennai, India
| | - Kevin McNamara
- School of Medicine, Deakin University, Geelong, Australia
| | - William Hague
- Robinson Research Institute, The University of Adelaide, Adelaide, Australia
| | | | | | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, United Kingdom
| | - James A Dunbar
- School of Medicine, Deakin University, Geelong, Australia
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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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Begum S, Povey R, Ellis N, Gidlow C. A systematic review of recruitment strategies and behaviour change techniques in group-based diabetes prevention programmes focusing on uptake and retention. Diabetes Res Clin Pract 2020; 166:108273. [PMID: 32590009 DOI: 10.1016/j.diabres.2020.108273] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/26/2020] [Accepted: 06/14/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Many countries worldwide have developed diabetes prevention programmes (DPPs) that involve lifestyle modification. Research has shown that uptake and retention of DPPs are important and by exploring recruitment strategies and behaviour change techniques (BCTs) used, factors that are most effective in promoting uptake and retention can be identified. OBJECTIVES This review aims to identify recruitment strategies of group-based DPPs that are associated with high uptake and common BCTs associated with high retention. METHODS Papers were identified with a systematic literature search. Programmes that were predominantly group-based and involved lifestyle modification and in which uptake and/or retention could be determined, were included. Intervention details were extracted, recruitment strategies and BCTs identified, and response, uptake and retention rates were calculated. RESULTS A range of recruitment strategies were used making it difficult to discern associations with uptake rates. For BCTs, all programmes used a credible source, 81% used instruction on how to perform a behaviour and 71% used goal setting (behaviour). BCTs more commonly found in high retention programmes included problem-solving, demonstrating the behaviour, using behavioural practice and reducing negative emotions. CONCLUSIONS Recommendations include that DPPs incorporate BCTs like problem-solving and demonstrating the behaviour to maximise retention.
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Affiliation(s)
- Sonia Begum
- School of Life Sciences and Education, Science Centre, Staffordshire University, Stoke-on-Trent ST4 2DF, UK.
| | - Rachel Povey
- School of Life Sciences and Education, Science Centre, Staffordshire University, Stoke-on-Trent ST4 2DF, UK
| | - Naomi Ellis
- School of Life Sciences and Education, Science Centre, Staffordshire University, Stoke-on-Trent ST4 2DF, UK
| | - Christopher Gidlow
- School of Life Sciences and Education, Science Centre, Staffordshire University, Stoke-on-Trent ST4 2DF, UK
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Rodrigues AM, Haste A, Penn L, Bell R, Summerbell C, White M, Adamson AJ, Sniehotta FF. Stakeholders' perceptions and experiences of the National Health Service diabetes prevention programme in England: qualitative study with service users, intervention providers and deliverers, commissioners and referrers. BMC Health Serv Res 2020; 20:307. [PMID: 32293424 PMCID: PMC7158071 DOI: 10.1186/s12913-020-05160-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 03/26/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The National Health Service diabetes prevention programme in England, (NHS DPP) aims to identify people at high risk of type 2 diabetes (T2D) and offer them a face-to-face, group-based, behaviour change intervention for at least 9 months. The NHS DPP was rolled out in phases. We aimed to elicit stakeholders' perceptions and experiences of the factors influencing implementation of, and participation in, the programme during the development phase. METHODS Individual, semi-structured telephone interviews were conducted with 50 purposively sampled stakeholders: service users (n = 20); programme commissioners (n = 7); referrers (n = 8); and intervention deliverers (n = 15). Topic guides were structured using a pragmatic, theory-informed approach. Analysis employed the framework method. RESULTS We identified factors that influenced participation: Risk communication at referral - stakeholders identified point of referral as a window of opportunity to offer brief advice, to provide an understanding of T2D risk and information about the programme; Perceived impact of the NHS DPP - service users highlighted the positive perceived impact on their behaviour change, the peer support provided by participating in the programme, the option to involve a relative, and the 'knock on' effect on others. Service users also voiced disappointment when blood test results still identified them at high risk after the programme; and Behavioural maintenance - participants highlighted the challenges linked to behavioural maintenance (e.g. discontinuation of active support). Factors influencing implementations were also identified: Case finding - stakeholders suggested that using community involvement to identify service users could increase reach and ensure that the workload was not solely on GP practices; Adaptability: intervention deliverers acknowledged the need to tailor advice to service users' preferences and needs; Accountability - the need to acknowledge who was responsible for what at different stages of the NHS DPP pathway; and Fidelity - stakeholders described procedures involved in monitoring service users' satisfaction, outcome data collection and quality assurance assessments. CONCLUSIONS The NHS DPP offers an evidence-informed behavioural intervention for T2D prevention. Better risk communication specification could ensure consistency at the referral stage and improve participation in the NHS DPP intervention. Cultural adaptations and outreach strategies could ensure the NHS DPP contributes to reducing health inequalities.
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Affiliation(s)
- Angela M. Rodrigues
- Department of Psychology, Northumbria University, Northumberland Building, Newcastle upon Tyne, NE1 8ST UK
- Population Health Sciences Institute, Newcastle University, Baddiley Clark Building, Newcastle upon Tyne, NE2 4AX UK
- Fuse: UKCRC Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
| | - Anna Haste
- Fuse: UKCRC Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
- Department of Psychology, School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, TS1 3BX UK
| | - Linda Penn
- Population Health Sciences Institute, Newcastle University, Baddiley Clark Building, Newcastle upon Tyne, NE2 4AX UK
- Fuse: UKCRC Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
- Human Nutrition Research Centre, Newcastle University, Newcastle upon Tyne, UK
| | - Ruth Bell
- Population Health Sciences Institute, Newcastle University, Baddiley Clark Building, Newcastle upon Tyne, NE2 4AX UK
| | - Carolyn Summerbell
- Fuse: UKCRC Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
- Faculty of Social Sciences and Health, Durham University, Durham City, DH1 3HN UK
| | - Martin White
- Population Health Sciences Institute, Newcastle University, Baddiley Clark Building, Newcastle upon Tyne, NE2 4AX UK
- MRC Epidemiology Unit, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0QQ UK
| | - Ashley J. Adamson
- Population Health Sciences Institute, Newcastle University, Baddiley Clark Building, Newcastle upon Tyne, NE2 4AX UK
- Fuse: UKCRC Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
- Human Nutrition Research Centre, Newcastle University, Newcastle upon Tyne, UK
| | - Falko F. Sniehotta
- Population Health Sciences Institute, Newcastle University, Baddiley Clark Building, Newcastle upon Tyne, NE2 4AX UK
- Fuse: UKCRC Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
- NIHR Policy Research Unit Behavioural Science, Baddiley Clark Building, Newcastle upon Tyne, NE2 4AX UK
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Move-It: A Cluster-Randomised Digital Worksite Exercise Intervention in China: Outcome and Process Evaluation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16183451. [PMID: 31533292 PMCID: PMC6766073 DOI: 10.3390/ijerph16183451] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 09/06/2019] [Accepted: 09/07/2019] [Indexed: 01/27/2023]
Abstract
We evaluate the outcomes and processes of a video and web-based worksite exercise intervention for sedentary office workers in China, in a 2-arm cluster-randomised wait-list control trial (n = 282: intervention (INT) n = 196 and wait-list control (WLC) n = 86). Eligible clusters were two sites of a major organisation in China randomly allocated to each group (INT: Guangzhou; WLC: Beijing); eligible participants were site employees (n = 690). A theoretically informed digital workplace intervention (Move-It) involving a 10 min Qigong exercise session (video demonstration via website) was delivered twice a day at set break times during the working day for 12 consecutive weeks. Individual-level outcomes were assessed. Participants' physical activity increased significantly from baseline to post-intervention similarly in both the intervention and the control group. There was a significantly smaller increase in weekday sitting hours in intervention than controls (by 4.66 h/week), and work performance increased only in the control group. Process evaluation (including six focus groups) was conducted using the RE-AIM (reach, effectiveness, adoption, implementation and maintenance) framework. The intervention had wide reach and was successfully marketed to all employees with good uptake. The participatory approach increased perceived organisational support and enhanced adoption. The intervention was implemented broadly as planned. Qigong worksite exercise intervention can be successfully delivered to sedentary office workers in China using video and web-based platforms. It may increase physical activity and does not adversely affect perceived work performance. The study highlights the complexity of conducting health promotion research in real-world organisational settings.
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Fazli GS, Moineddin R, Bierman AS, Booth GL. Ethnic differences in prediabetes incidence among immigrants to Canada: a population-based cohort study. BMC Med 2019; 17:100. [PMID: 31122233 PMCID: PMC6533737 DOI: 10.1186/s12916-019-1337-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 04/30/2019] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Prediabetes appears to be increasing worldwide. This study examined the incidence of prediabetes among immigrants to Canada of different ethnic origins and the age at which ethnic differences emerged. METHODS We assembled a cohort of Ontario adults (≥ 20 years) with normoglycemia based on glucose testing performed between 2002 and 2011 through a single commercial laboratory database (N = 1,772,180). Immigration data were used to assign ethnicity based on country of origin, mother tongue, and surname. Individuals were followed until December 2013 for the development of prediabetes, defined using either the World Health Organization/Diabetes Canada (WHO/DC) or American Diabetes Association (ADA) thresholds. Multivariate competing risk regression models were derived to examine the effect of ethnicity and immigration status on prediabetes incidence. RESULTS After a median follow-up of 8.0 years, 337,608 individuals developed prediabetes. Using definitions based on WHO/DC, the adjusted cumulative incidence of prediabetes was 40% (HR 1.40, CI 1.38-1.41) higher for immigrants relative to long-term Canadian residents (21.2% vs 16.0%, p < 0.001) and nearly twofold higher among South Asian than Western European immigrants (23.6%; HR 1.95, CI1.87-2.03 vs 13.1%; referent). Cumulative incidence rates based on ADA thresholds were considerably higher (47.1% and 32.3% among South Asians and Western Europeans, respectively). Ethnic differences emerged at young ages. South Asians aged 20-34 years had a similar prediabetes incidence as Europeans who were 15 years older (35-49 years), regardless of which prediabetes definition was used (WHO/DC 14.4% vs 15.7%; ADA 38.0% vs 33.0%). CONCLUSION Prediabetes incidence was substantially higher among non-European immigrants to Canada, highlighting the need for early prevention strategies in these populations.
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Affiliation(s)
- Ghazal S. Fazli
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, Toronto, Ontario M5C 1N8 Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, 155 College Street Health Science Building, Toronto, Ontario M5T 3M7 Canada
| | - Rahim Moineddin
- Institute for Clinical Evaluative Sciences, G1 06, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5 Canada
- Department of Family and Community Medicine, University of Toronto, 263 McCaul Street, Toronto, Ontario M5T 1W7 Canada
| | - Arlene S. Bierman
- Institute of Health Policy Management and Evaluation, University of Toronto, 155 College Street Health Science Building, Toronto, Ontario M5T 3M7 Canada
| | - Gillian L. Booth
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, Toronto, Ontario M5C 1N8 Canada
- Institute for Clinical Evaluative Sciences, G1 06, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5 Canada
- Department of Medicine, University of Toronto, 1 Kings College Circle, Toronto, Ontario M5S 1A8 Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, 155 College Street Health Science Building, Toronto, Ontario M5T 3M7 Canada
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Lim S, Versace VL, O'Reilly S, Janus E, Dunbar J. Weight Change and Cardiometabolic Outcomes in Postpartum Women with History of Gestational Diabetes. Nutrients 2019; 11:nu11040922. [PMID: 31022932 PMCID: PMC6520842 DOI: 10.3390/nu11040922] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 04/16/2019] [Accepted: 04/22/2019] [Indexed: 12/21/2022] Open
Abstract
Weight gain after childbirth is a significant risk factor for type 2 diabetes (T2DM) development after gestational diabetes mellitus (GDM). The level of weight loss achieved in diabetes prevention programs for women after GDM is often low but its effects on the cardiometabolic risk are not known. In a secondary analysis of a diabetes prevention program in postpartum women with history of gestational diabetes, we evaluated the effect of weight change on the cardiometabolic outcomes at 1-year follow-up. Of the 284 women randomized to the intervention arm, 206 with the final outcome measurements were included in the analyses. Participants were categorized into weight loss (>2 kg, n = 74), weight stable (±2 kg, n = 74) or weight gain (>2 kg, n = 58) groups. The weight loss group had significantly greater decrease in glycated hemoglobin (HbA1c) than the weight gain group (−0.1 + 0.4% vs. 0 + 0.4%, p = 0.049). The weight loss group had significantly greater decrease in total cholesterol and low-density lipoprotein cholesterol cholesterol than the other two groups (p < 0.05). The weight gain group had significantly greater increase in triglyceride and triglyceride:high-density lipoprotein cholesterol ratio compare with the other groups (p < 0.01). Overall, a small amount of weight loss and prevention of further weight gain was beneficial to the cardiometabolic outcomes of postpartum women after GDM.
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Affiliation(s)
- Siew Lim
- Monash Centre for Health Research and Implementation, Monash University, 3168 Clayton, Australia.
| | - Vincent L Versace
- Deakin Rural Health, School of Medicine, Deakin University, 3217 Geelong, Australia.
| | - Sharleen O'Reilly
- Institute of Food and Health, School of Agriculture and Food Science, University College Dublin, Belfield, Dublin 4, Ireland.
| | - Edward Janus
- General Internal Medicine Unit, Western Health and Department of Medicine, Melbourne Medical School-Western Precinct, University of Melbourne, 3010 Melbourne, Australia.
| | - James Dunbar
- Deakin Rural Health, School of Medicine, Deakin University, 3217 Geelong, Australia.
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Fagg J, Valabhji J. How do we identify people at high risk of Type 2 diabetes and help prevent the condition from developing? Diabet Med 2019; 36:316-325. [PMID: 30466172 PMCID: PMC6590463 DOI: 10.1111/dme.13867] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/20/2018] [Indexed: 12/20/2022]
Abstract
AIMS To review the evidence regarding the identification of those at high risk of Type 2 diabetes and the conceptual and clinical criteria defining high risk, the prevention or delay of onset of Type 2 diabetes through lifestyle interventions, and the evolution of evidence from efficacy trials, through effectiveness trials in real-world settings, to implementation programmes at scale. METHOD The wide scope of this review precluded a systematic approach, therefore, we present a narrative review that highlights key themes and contemporary developments, drawing on landmark studies, previous systematic and expert reviews, and previous meta-analyses. RESULTS While the diagnostic thresholds for Type 2 diabetes are accepted, international consensus on whether, and how, to classify those at high risk of Type 2 diabetes has not been achieved. There is ongoing debate about which laboratory test to use and each test's corresponding inclusion threshold, about where the balance of clinical benefits and harms sit when defining thresholds, and about how affordability of subsequent preventative interventions might influence the derivation of such thresholds within any particular population. A remarkable international effort has seen the evolution of interventions for those at high risk move from efficacy trials, through effectiveness trials, to implementation at scale, and the evidence supporting each stage is reviewed. CONCLUSIONS To achieve healthcare system sustainability, many countries are now focusing on disease prevention. To complement population-level interventions that address the obesogenic environment, lifestyle interventions that empower individuals at high risk of Type 2 diabetes to modify this risk beneficially are now being implemented at scale.
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Affiliation(s)
- J. Fagg
- Public Health EnglandLondonUK
| | - J. Valabhji
- NHS EnglandImperial College Healthcare NHS TrustImperial College LondonLondonUK
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Abstract
PURPOSE OF THE REVIEW Causality has been demonstrated for few of the many putative risk factors for type 2 diabetes (T2D) emerging from observational epidemiology. Genetic approaches are increasingly being used to infer causality, and in this review, we discuss how genetic discoveries have shaped our understanding of the causal role of factors associated with T2D. RECENT FINDINGS Genetic discoveries have led to the identification of novel potential aetiological factors of T2D, including the protective role of peripheral fat storage capacity and specific metabolic pathways, such as the branched-chain amino acid breakdown. Consideration of specific genetic mechanisms contributing to overall lipid levels has suggested that distinct physiological processes influencing lipid levels may influence diabetes risk differentially. Genetic approaches have also been used to investigate the role of T2D and related metabolic traits as causal risk factors for other disease outcomes, such as cancer, but comprehensive studies are lacking. Genome-wide association studies of T2D and metabolic traits coupled with high-throughput molecular phenotyping and in-depth characterisation and follow-up of individual loci have provided better understanding of aetiological factors contributing to T2D.
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Affiliation(s)
- Laura B. L. Wittemans
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Box 285 Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, CB2 0QQ UK
| | - Luca A. Lotta
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Box 285 Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, CB2 0QQ UK
| | - Claudia Langenberg
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Box 285 Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, CB2 0QQ UK
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Atlantis E, Ghassem Pour S, Girosi F. Incremental predictive value of screening for anxiety and depression beyond current type 2 diabetes risk models: a prospective cohort study. BMJ Open 2018; 8:e018255. [PMID: 29362254 PMCID: PMC5786131 DOI: 10.1136/bmjopen-2017-018255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES We sought to determine whether screening for anxiety and depression, an emerging risk factor for type 2 diabetes (T2D), adds clinically meaningful information beyond current T2D risk assessment tools. DESIGN Prospective cohort. PARTICIPANTS AND SETTING The 45 and Up Study is a large-scale prospective cohort of men and women aged 45 years and over, randomly sampled from the general population of New South Wales, Australia. 51 588 participants without self-reported diabetes at baseline (2006-2009) were followed up for approximately 3 years (2010). METHODS T2D status was determined by self-reported doctor who diagnosed diabetes after the age of 30 years, and/or current use of metformin. Current symptoms of anxiety and/or depression were measured by the 10-item Kessler Psychological Distress Scale (K10). We determined the optimal cut-off point for K10 for predicting T2D using Tjur's R2 and tested risk models with and without the K10 using logistic regression. We assessed performance measures for the incremental value of the K10 using the area under the receiver operating characteristic (AROC), net reclassification improvement (NRI) and net benefit (NB) decision analytics with sensitivity analyses. RESULTS T2D developed in 1076 individuals (52.4% men). A K10 score of ≥19 (prevalence 8.97%), adjusted for age and gender, was optimal for predicting incident T2D (sensitivity 77%, specificity 53% and positive predictive value 3%; OR 1.70 (95% CI 1.41 to 2.03, P<0.001). K10 score predicted incident T2D independent of current risk models, but did not improve corresponding AROC, NRI and NB statistics. Sensitivity analyses showed that this was partially explained by the baseline model and the small effect size of the K10 that was similar compared with other risk factors. CONCLUSIONS Anxiety and depressing screening with the K10 adds no meaningful incremental value in addition to current T2D risk assessments. The clinical importance of anxiety and depression screening in preventing T2D requires ongoing consideration.
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Affiliation(s)
- Evan Atlantis
- School of Nursing and Midwifery, Western Sydney University, Sydney, New South Wales, Australia
- School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
- Capital Markets CRC, Sydney, New South Wales, Australia
| | - Shima Ghassem Pour
- Capital Markets CRC, Sydney, New South Wales, Australia
- Translation Health Research Institute, Western Sydney University, Kingswood, New South Wales, Australia
| | - Federico Girosi
- Capital Markets CRC, Sydney, New South Wales, Australia
- Translation Health Research Institute, Western Sydney University, Kingswood, New South Wales, Australia
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Lee CMY, Versace VL, Malo JA, Shaw JE, Dunbar JA, Colagiuri S. Screening for diabetes prevention with diabetes risk scores - A balancing act. Diabetes Res Clin Pract 2018; 135:120-127. [PMID: 29155122 DOI: 10.1016/j.diabres.2017.11.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 11/10/2017] [Indexed: 11/19/2022]
Abstract
AIMS To compare the diabetes prevention impact and cost of several screening scenarios for diabetes prevention programs with the scenario which included an oral glucose tolerance test (OGTT). METHODS We included 4864 participants of the Australian Diabetes, Obesity and Lifestyle study who were aged ≥40 years, did not have known diabetes at baseline, and attended the five year follow-up. The proportions of participants eligible or ineligible for diabetes prevention program were estimated for each scenario. The costs of screening and diabetes prevention programs were also estimated. RESULTS Screening with OGTT alone identified 21% of participants as eligible for diabetes prevention. While 3.1% of the cohort were identified as high risk and developed diabetes after five years, 1.0% of the cohort were identified as low risk and developed diabetes. The population prevention potential (i.e. sensitivity) for OGTT alone was 76.5%. Screening all Australian adults aged ≥40 years in 2015 by OGTT would have cost a total of AU$2025 million (AU$1031 million on screening and AU$994 million on prevention programs). The total costs of screening and prevention were substantially lower when AUSDRISK was used alone or in combination with a blood test. However, the population prevention potentials were also lower (ranged from 20.1% to 50.7%). CONCLUSIONS A blood test post non-invasive risk assessment is a worthwhile step in the process of enrolling participants in a diabetes prevention program. Nevertheless, there will be ineligible individuals who proceed to diabetes.
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Affiliation(s)
- Crystal Man Ying Lee
- Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Level 2 Charles Perkins Centre D17, University of Sydney, NSW 2006, Australia; School of Public Health, Curtin University, GPO Box U1987, Perth, WA 6845, Australia
| | - Vincent L Versace
- School of Medicine, Deakin Rural Health, Deakin University, PO Box 423, VIC 3280, Australia
| | - Jonathan A Malo
- Communicable Diseases Branch, Queensland Health, Level 3, 15 Butterfield St, Herston, QLD 4005, Australia; National Centre for Epidemiology and Public Health, Australian National University, Acton, ACT 2601, Australia
| | - Jonathan E Shaw
- Baker Heart and Diabetes Institute, PO Box 6492, Melbourne, VIC 3004, Australia
| | - James A Dunbar
- Centre for Population Health Research, Deakin University, Melbourne, VIC 3125, Australia
| | - Stephen Colagiuri
- Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Level 2 Charles Perkins Centre D17, University of Sydney, NSW 2006, Australia.
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Sakane N. Diabetes prevention in the real world: Insights from the JDPP and J-DOIT1. J Gen Fam Med 2017; 18:325-330. [PMID: 29264060 PMCID: PMC5729318 DOI: 10.1002/jgf2.85] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Accepted: 12/12/2016] [Indexed: 11/07/2022] Open
Abstract
Type 2 diabetes (T2D) is associated with increased risks of morbidity and mortality. Diabetes prevention is an urgent issue in Japan. The Finnish Diabetes Prevention Study and US Diabetes Prevention Program revealed that intensive lifestyle intervention can prevent or delay the development of T2D in high-risk populations. Translational research varies in hospitals, primary care, communities, the workplace, and other settings. Translational research is feasible but less effective. There have been no long-term follow-ups. The outcome of the studies was mainly weight changes. The Japan Diabetes Prevention Program (JDPP) is a trial to test the efficacy of a lifestyle intervention program, which carried out in a primary healthcare setting using existing resources. The Japan Diabetes Outcome Trial-1 (J-DOIT1) is a nationwide telephone-delivered lifestyle intervention in a real-world setting. This review will focus on the effectiveness of a diabetes prevention program (recruitment, target population, method of intervention, and evaluation) in the real world and insights from the JDPP and J-DOIT1.
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Affiliation(s)
- Naoki Sakane
- Division of Preventive Medicine Clinical Research Institute National Hospital Organization Kyoto Medical Center Kyoto Japan
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Dunbar JA. Diabetes Prevention in Australia: 10 Years Results and Experience. Diabetes Metab J 2017; 41:160-167. [PMID: 28537055 PMCID: PMC5489495 DOI: 10.4093/dmj.2017.41.3.160] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 11/22/2016] [Indexed: 11/10/2022] Open
Abstract
Clinical trials have demonstrated the efficacy of lifestyle modification for the prevention of type 2 diabetes mellitus but it was achieved at higher cost than can be sustained in routine health services. The first clinical trial to report was the Finnish Diabetes Prevention Study. This paper describes how Australia worked with Finnish colleagues to adapt the findings of that study to achieve a statewide diabetes prevention program. Small evaluative, effectiveness trials have been conducted in a number of countries to see if the results of the clinical trials can be replicated in routine health services. The Australian evaluative trial, Greater Green Triangle Diabetes Prevention Program is described in detail to demonstrate the ingredients for success in moving a program from one country to another. Few countries have managed to scale up from evaluative trials to statewide or national programs. The Australian experience is described in detail including lessons learned about what reduced the effectiveness, particularly the need for policy makers in government, people from the implementing organisation and researchers to work together from the start of the evaluative trial and throughout the first 5 years of a national program.
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Affiliation(s)
- James A Dunbar
- Centre for Population Health Research, Deakin University, Melbourne, Australia.
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21
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O'Reilly SL. Translational research: The ingredients are only the start of the recipe for better dietetic practice. Nutr Diet 2016. [DOI: 10.1111/1747-0080.12308] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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