Obtaining evidence base for the development of Feel4Diabetes intervention to prevent type 2 diabetes – a narrative literature review

Abstract

Background: Feel4Diabetes was a school and community based intervention aiming to promote healthy lifestyle and tackle obesity for the prevention of type 2 diabetes among families in 6 European countries. We conducted this literature review in order to guide the development of evidence-based implementation of the Feel4Diabetes intervention. We focused on type 2 diabetes prevention strategies, including all the phases from risk identification to implementation and maintenance. Special focus was given to prevention among vulnerable groups and people under 45 years. relevant studies using electronic databases. To present the literature review findings in a systematic way, we used the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. A complementary literature search from February 2015 to December 2018 was also conducted. Results: The initial review included 27 studies with a follow-up ≥12 months and 9 studies with a follow-up ≥6 months and with a participant mean age < 45 years. We found out that interventions should be targeted at people at risk to improve recruiting and intervention effectiveness. Screening questionnaires (primarily Finnish Diabetes Risk Score FINDRISC) and blood glucose measurement can both be used for screening; the method does not appear to affect intervention effectiveness. Screening and recruitment is time-consuming, especially when targeting lower socioeconomic status and age under 45 years. The intervention intensity is more important for effectiveness than the mode of delivery. Moderate changes in several lifestyle habits lead to good intervention results. A minimum of 3-year follow-up seemed to be required to show a reduction in diabetes risk in high-risk individuals. In participants < 45 years, the achieved results in outcomes were less pronounced. The complementary review included 12 studies, with similar results regarding intervention targets and delivery modes, as well as clinical significance.

Az elhízás kezelése és megelőzése: táplálkozás, testmozgás, orvosi lehetőségek

“…A különféle sportok jól kombinálhatók, és az életkorral ezek prioritása, gyakorisága változtatható. A családon kívül fontos minta az iskola és a lakóközösség is, amelyek prevenciós tevékenységeit koor dinálni szükséges [50]. Partnerséget kell kialakítani a kormányzati szervekkel, a helyi szervezetekkel, akár a hitélet szervezőivel, hogy mindenki több fizikai aktivitást végezzen.…”

Lifestyle Changes Observed among Adults Participating in a Family- and Community-Based Intervention for Diabetes Prevention in Europe: The 1st Year Results of the Feel4Diabetes-Study

“…The design of the Feel4Diabetes intervention was based on the PRECEDE-PROCEED and the HAPA models, which led to the identification of the lifestyle behaviors that are associated with the risk factors to develop T2D in vulnerable population groups, as well as their determinants, which were the targets of the implemented intervention [7,8].…”

“…Previous randomized controlled trials (RCTs) have shown lifestyle interventions to be effective in improving lifestyle behaviors in individuals at high risk of developing T2D [7]. Still, given the nature of these interventions, including their intensity (frequent counseling sessions), duration (3-10 years), high demands in infrastructure and health professionals' skills and opportunistic screening procedures (i.e., recruitment of high-risk individuals via hospitals, door-to-door procedures or by providing incentives to possible participants), they cannot be scaled up and applied to the whole population in real-life conditions.…”

Towards precision cardiometabolic prevention: results from a machine learning, semi-supervised clustering approach in the nationwide population-based ORISCAV-LUX 2 study

“…However, these strategies may be sub-optimal and do not rely on a complete understanding of the detailed cardiometabolic profiles of the general population 5 . Most of the screening and prevention strategies are simply based on a few factors such as age, body mass index, metabolic syndrome, hyperglycemia or risk score such as Findrisc 6 to identify eligible people. We tend to omit a potentially high variability in individuals at a given level of risk, for instance in terms of genetic profiles 7 , inflammation, oxidative stress 8 , insulin resistance 9 and hepatic gluconeogenesis 10 , that could open a window of opportunity for more relevant strategies.…”