Effects of the Norfolk diabetes prevention lifestyle intervention (NDPS) on glycaemic control in screen-detected type 2 diabetes: a randomised controlled trial

A rapid systematic review of the effect of health or peer volunteers for diabetes self-management: Synthesizing evidence to guide social prescribing

Social prescribing is a model of care, usually in the community-setting, which aims to address people's unmet social needs. Volunteers support primary health care and community-based care in non-medical roles. However, few studies focus on volunteers in social prescribing, therefore, aimed to synthesize the effect of health or peer volunteer-led interventions on psychosocial and behavioural outcomes for middle-aged and older adults with Type 2 Diabetes Mellitus (T2DM) to inform future work for volunteering in social prescribing. We followed Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines and searched six databases and Google Scholar for peer-reviewed studies from 2013+ (last search May 16, 2024). We included randomized controlled trials (RCTs) from all languages, and synthesized data using the Cochrane's Synthesis Without Meta-analysis (SWiM) guidelines; and assessed risk of bias using the "Risk of Bias 2 Tool". We identified nine RCTs (reported in 10 publications). Interventions aimed to promote self-management of T2DM, and study duration ranged from one to 46 months. Training for volunteers varied between one to 32 hours, and most volunteers were offered a stipend. For psychosocial outcomes, only one outcome on social support favoured the intervention group, with the remaining outcomes reporting no differences between study groups. For behaviour, six outcomes (from three studies) favoured the intervention group, and for three outcomes there were no differences between study groups. In conclusion, volunteers bring a unique perspective to health interventions, but volunteer training, matching and retention, as well as intervention mode and duration, and geographical context need to be thoughtfully considered as important implementation factors. This work generates ideas for future studies focused on volunteers and T2DM management and social prescribing. Trial registration: PROSPERO registration: CRD42023453506.

Educational Model and Prevention on Prediabetes: A Systematic Review

BACKGROUND

Prediabetes is a reversible condition before the onset of Type 2 Diabetes Mellitus. Untreated condition of prediabetes will develop into diabetes and its complications. The prevalence of prediabetes has been emerging worldwide and has a considerable socioeconomic impact. The current study reviews the roles of early detection, educational models, life modification, and prophylaxis of individuals with prediabetes in preventing the progression of prediabetes into Type 2 Diabetes Mellitus and complications in the future.

METHODS

This study included published articles from several electronic databases. The obtained articles were limited to March 2023. Articles that were not open access and not in Indonesian or English were excluded. The protocol for this study used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020.

RESULTS

Of 39627 articles, 39601 were excluded due to duplication and did not meet the eligibility criteria. At the final, there were 26 articles that were eligible for systematic review.

CONCLUSION

Prevention of the development of prediabetes into diabetes is essential. A comprehensive understanding and training on intensive lifestyle modification protocols from local and national experts in diabetes prevention through digital-based education models and linguistically and culturally approach can be considered. Intensive lifestyle modification and pharmacological approaches may improve the outcome. Regular monitoring of glycemic control is also important for early diagnosis of diabetes, especially in patients with special conditions.

Self-management of Diabetes for Empty Nest Older Adults: A Randomized Controlled Trial

BACKGROUND

Despite much evidence showing the effectiveness of structured self-management education for diabetes, poor glycemic control remains a challenge among empty nest older adults.

OBJECTIVE

We explored the effect of a health education intervention based on the PRECEDE-PROCEED model on the self-management of empty nest older adults with type 2 diabetes in Lanzhou, China.

METHODS

We conducted a 2-armed, randomized controlled trial using a multistage sampling method. A total of 100 patients were randomly assigned to receive either community nurse-led diabetes education based on the PRECEDE-PROCEED model or general community diabetes education. Self-management scores and blood glucose were compared at baseline and at 3 and 6 months after the intervention.

RESULTS

Analyses were conducted on the 98 patients completing follow-up. In the experimental group, diabetes self-management knowledge (t = 7.578, P < .001), self-management attitude (t = 9.155, P < .001), self-management behavior (t = 7.809, P < .001), and overall self-management scores (t = 7.626, P < .001) improved, with hemoglobin A1c (t = -2.825, P = .006), fasting plasma glucose (t = -3.100, P = .003), 2-hour postprandial blood glucose (t = -3.812, P < .001), and diastolic blood pressure (t = -2.104, P = .038) decreasing compared with the control group at 6 months postintervention.

CONCLUSIONS

This study demonstrated that education based on the PRECEDE-PROCEED model was more effective than general health education in improving diabetes self-management and glycemic control among empty nest older adults.

Two decades of diabetes prevention efforts: A call to innovate and revitalize our approach to lifestyle change

The impact of global diabetes prevention efforts has been modest despite the promise of landmark diabetes prevention trials nearly twenty years ago. While national and regional initiatives show potential, challenges remain to adapt large-scale strategies in the real-world that fits individuals and their communities. Additionally, the sedentary lifestyle changes during the COVID-19 pandemic and guidelines that now call for earlier screening (e.g., US Preventative Task Force) will increase the pool of eligible adults worldwide. Thus, a more adaptable, person-centered approach that expands the current toolkit is urgently needed to innovate and revitalize our approach to diabetes prevention. This review identifies key priorities to optimize the population-level delivery of diabetes prevention based on a consensus-based evaluation of the current evidence among experts in global translational programs; key priorities identified include (1) participant eligibility, (2) intervention intensity, (3) delivery components, (4) behavioral economics, (5) technology, and (6) the role of pharmacotherapy. We offer a conceptual framework for a broader, person-centered approach to better address an individual's risk, readiness, barriers, and digital competency.

Type 2 Diabetes Prevention Programs-From Proof-of-Concept Trials to National Intervention and Beyond

The prevention of type 2 diabetes (T2D) in high-risk people with lifestyle interventions has been demonstrated by several randomized controlled trials. The intervention effect has sustained up to 20 years in post-trial monitoring of T2D incidence. In 2000, Finland launched the national T2D prevention plan. For screening for high T2D risk, the non-laboratory Finnish Diabetes Risk Score was developed and widely used, also in other countries. The incidence of drug-treated T2D has decreased steadily since 2010. The US congress authorized public funding for a national diabetes prevention program (NDPP) in 2010. It was built around a 16-visit program that relies on referral from primary care and self-referral of persons with either prediabetes or by a diabetes risk test. The program uses a train-the-trainer program. In 2015 the program started the inclusion of online programs. There has been limited implementation of nationwide T2D prevention programs in other countries. Despite the convincing results from RCTs in China and India, no translation to the national level was introduced there. T2D prevention efforts in low-and middle-income countries are still limited, but results have been promising. Barriers to efficient interventions are greater in these countries than in high-income countries, where many barriers also exist. Health disparities by socioeconomic status exist for T2D and its risk factors and form a challenge for preventive interventions. It seems that a stronger commitment to T2D prevention is needed, such as the successful WHO Framework Convention on Tobacco Control, which legally binds the countries to act.

Type 2 diabetes peer support interventions as a complement to primary care settings in high-income nations: A scoping review

OBJECTIVES

Inadequate social support make way for peer support initiatives to complement the health system delivery of diabetes self-management education programs for type 2 diabetes (T2D). This review synthesizes knowledge about T2D peer support in terms of their various models and impact, endorsement, and contextual information in high-income nations.

METHODS

A scoping review was conducted on published and grey literature in four electronic bibliographic databases between January 2007 to December 2021.

RESULTS

76 records were included. Face-to-face self-management programs and telephone-based peer support seem the most promising modalities given the largest scientific coverage on T2D outcomes. Face-to-face self-management programs were the most preferred by ethnic minority groups. Unlike peer supporters, healthcare professionals had mixed views about T2D peer support interventions. Managers of peer support programs perceived cultural competency as a cornerstone for peer support implementation. Care must be taken in recruiting, training and retaining peer supporters for sustainable practice.

CONCLUSIONS

Various T2D peer support models lie at the interface between primary care and community-based settings.

PRACTICE IMPLICATIONS

Fostering the role of peer support beyond healthcare organizations should be encouraged to engage the hardly reached, and to leverage community support to complement the health system.