Lifestyle interventions in preventing new type 2 diabetes in Asian populations

ObjectivesTo review the clinical outcomes of combined diet and physical activity interventions for populations at high risk of type 2 diabetes.DesignOverview of systematic reviews (search dates April–December 2015).SettingAny level of care; no geographical restriction.ParticipantsAdults at high risk of diabetes (as per measures of glycaemia, risk assessment or presence of risk factors).InterventionsCombined diet and physical activity interventions including ≥2 interactions with a healthcare professional, and ≥12 months follow-up.Outcome measuresPrimary: glycaemia, diabetes incidence. Secondary: behaviour change, measures of adiposity, vascular disease and mortality.Results19 recent reviews were identified for inclusion; 5 with AMSTAR scores <8. Most considered only randomised controlled trials (RCTs), and RCTs were the major data source in the remainder. Five trials were included in most reviews. Almost all analyses reported that interventions were associated with net reductions in diabetes incidence, measures of glycaemia and adiposity, at follow-up durations of up to 23 years (typically <6). Small effect sizes and potentially transient effect were reported in some studies, and some reviewers noted that durability of intervention impact was potentially sensitive to duration of intervention and adherence to behaviour change. Behaviour change, vascular disease and mortality outcome data were infrequently reported, and evidence of the impact of intervention on these outcomes was minimal. Evidence for age effect was mixed, and sex and ethnicity effect were little considered.ConclusionsRelatively long-duration lifestyle interventions can limit or delay progression to diabetes under trial conditions. However, outcomes from more time-limited interventions, and those applied in routine clinical settings, appear more variable, in keeping with the findings of recent pragmatic trials. There is little evidence of intervention impact on vascular outcomes or mortality end points in any context. ‘Real-world’ implementation of lifestyle interventions for diabetes prevention may be expected to lead to modest outcomes.

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“…Five studies had an AMSTAR score of ≤7 and were therefore excluded from sensitivity analyses (see above) 2630 34 37 40…”

Section: Resultsmentioning

confidence: 99%

Clinical impact of lifestyle interventions for the prevention of diabetes: an overview of systematic reviews

et al. 2016

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“…Therefore, in order to reduce the burden of the disease in patients with type 2 diabetes, measures should be taken to reduce drug costs in conjunction with the implementation of drug price reform policies in Hubei Province. Moreover, because diabetes is a metabolic disease, in addition to access to affordable medication, health education and lifestyle interventions are also very important, as many studies have shown [31, 32]. In this way, both LOS and hospital costs would decrease.…”

Section: Discussionmentioning

confidence: 99%

Assessment of hospital length of stay and direct costs of type 2 diabetes in Hubei Province, China

Chen

Shuai

Tan

et al. 2017

BMC Health Serv Res

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BackgroundThe incidence of type 2 diabetes is increasing, creating a huge burden for China’s social healthcare system. This study aimed to evaluate hospital length of stay (LOS) based on admission characteristics and direct costs correlated with various types of complications for type 2 diabetic inpatients in Hubei Province, China.MethodsA total of 1528 inpatients diagnosed with type 2 diabetes discharged between April 1, 2013, and March 31, 2014, were included in this study. Information regarding patients’ admission and hospitalization were obtained from the hospital information system. The relationship between admission characteristics and LOS, distribution of total costs, and types of complications were described and analysed.Results(1) The mean LOS was 11.65 days (median: 10 days). Multiple linear regression analysis demonstrated that inpatients with New Cooperative Medical Scheme (NCMS), aged 80 and above, had longer LOS than the reference group, and inpatients with chronic or acute + chronic complications had shorter LOS than those without. (2) Mean total costs per patient were US$159.72 ± 130.83 (median: US$135.33), US$240.60 ± 166.58 (median: US$192.09), and US$247.98 ± 166.22 (median: US$200.99) for inpatients with no complications, chronic complications, and acute + chronic complications, respectively. Total and individual costs were significantly less for patients without complications than for those with the two types of complications (p < 0.001). (3) Mean total costs per patient were US$225.40 ± 115.32 (median: US$200.34), US$221.25 ± 177.64 (median: US$170.05), and US$275.18 ± 193.14 (median: US$217.91) for inpatients with microvascular complications, macrovascular complications, and microvascular + macrovascular complications, respectively. Total costs were significantly higher for patients with microvascular + macrovascular complications than for those with other types of chronic complications (p < 0.001). (4) Drugs were the greatest expense for patients, and the least expensive treatment was nursing care.ConclusionsMedical insurance status, age, and type of complication may help to predict LOS for patients with type 2 diabetes in Hubei Province, China. The total and individual costs for patients with complications were higher than for those without, and hospitalization expenses posed a heavy burden. Efforts should be made to reduce the financial impact on patients by integrating the medical insurance system of urban and rural areas, and by reducing the risk of complications, especially microvascular complications.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-017-2140-4) contains supplementary material, which is available to authorized users.

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“…The WHO consultation group indeed recommended a lower cut-off of BMI for Asian with respect to native European populations [35] and the identified diagnostic cut-off for overweight in Chinese was 24 kg/m 2 [36]. This information is important in the light of prevention because the different cut-off value for obesity have to be adopted by physicians who are facing the new patients [37]. The existence of a distinct cut-off value is also to be communicated within the Chinese community because the emulation of native population might lead migrants to increased risk.…”

Section: Discussionmentioning

confidence: 99%

Prevalence, Awareness, Treatment, and Control of Hypertension among Chinese First-Generation Migrants and Italians in Prato, Italy: The CHIP Study

Modesti

Calabrese

Marzotti

et al. 2017

International Journal of Hypertension

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Data on health needs of Chinese living in the South of Europe are lacking. To compare prevalence, awareness, treatment, control, and risk factors for hypertension between Chinese migrants and Italian adults, a sample of 1200 first-generation Chinese migrants and 291 native Italians aged 35–59 years living in Prato (Italy) was recruited in a community-based participatory cross-sectional survey. Primary outcome measure was hypertension, diagnosed for blood pressure values ≥ 140/90 mmHg or current use of antihypertensive medications. Associations with exposures (including age, gender, body mass index, waist, education level, total cholesterol, and triglycerides) were examined using logistic regression. When compared with Italians, Chinese had higher hypertension prevalence (27.2% versus 21.3%, p < 0.01), with comparable levels of awareness (57.4% and 48.4%) but lower treatment rates (70.6% and 90.0%, resp.). In both ethnic groups age and parental history of hypertension were predictors of awareness and treatment, body mass index being predictor of hypertension diagnosis. In Chinese participants, where the optimum cut-off point for body mass index was ≥23.9 kg/m2, the sensibility and specificity prediction for hypertension were 61.7% and 59.8%, respectively (area under the ROC curve = 0.629). Implementation of specific, culturally adapted health programs for the Chinese community is now needed.

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Lifestyle interventions in preventing new type 2 diabetes in Asian populations

Cited by 28 publications

References 71 publications

Clinical impact of lifestyle interventions for the prevention of diabetes: an overview of systematic reviews

Clinical impact of lifestyle interventions for the prevention of diabetes: an overview of systematic reviews

Assessment of hospital length of stay and direct costs of type 2 diabetes in Hubei Province, China

Prevalence, Awareness, Treatment, and Control of Hypertension among Chinese First-Generation Migrants and Italians in Prato, Italy: The CHIP Study

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