Prevention of type 2 diabetes by lifestyle intervention in primary health care setting in Poland: Diabetes in Europe Prevention using Lifestyle, physical Activity and Nutritional intervention (DE-PLAN) project

Gilis‐Januszewska, Aleksandra; Szybiński, Z; Kissimova-Skarbek, Katarzyna; Piwońska-Solska, Beata; Pach, Dorota; Topór-Mądry, Roman; Tuomilehto, Jaakko; Lindström, Jaana; Peltonen, Markku; Schwarz, Peter E. H.; Hubalewska‐Dydejczyk, Alicja

doi:10.1177/1474651411412429

Cited by 25 publications

(49 citation statements)

References 24 publications

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“…We calculated the mean change by subtracting the baseline mean value from the mean at 12 months. We calculated the SD from reported P values or CI, as recommended by the Cochrane Collaboration (29). Where data were insufficient, to allow calculation of the SD, we imputed values for each outcome based on the correlation estimates from those studies that reported; for weight, the correlation used in these imputations was 0.95 (30-34).…”

Section: Data Synthesis and Analysismentioning

confidence: 99%

Diabetes Prevention in the Real World: Effectiveness of Pragmatic Lifestyle Interventions for the Prevention of Type 2 Diabetes and of the Impact of Adherence to Guideline Recommendations

et al. 2014

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OBJECTIVETo summarize the evidence on effectiveness of translational diabetes prevention programs, based on promoting lifestyle change to prevent type 2 diabetes in realworld settings and to examine whether adherence to international guideline recommendations is associated with effectiveness. RESEARCH DESIGN AND METHODSBibliographic databases were searched up to July 2012. Included studies had a follow-up of ‡12 months and outcomes comparing change in body composition, glycemic control, or progression to diabetes. Lifestyle interventions aimed to translate evidence from previous efficacy trials of diabetes prevention into realworld intervention programs. Data were combined using random-effects metaanalysis and meta-regression considering the relationship between intervention effectiveness and adherence to guidelines. RESULTSTwenty-five studies met the inclusion criteria. The primary meta-analysis included 22 studies (24 study groups) with outcome data for weight loss at 12 months. The pooled result of the direct pairwise meta-analysis shows that lifestyle interventions resulted in a mean weight loss of 2.32 kg (95% 22.92 to 21.72; I 2 = 93.3%). Adherence to guidelines was significantly associated with a greater weight loss (an increase of 0.4 kg per point increase on a 12-point guideline-adherence scale). CONCLUSIONSEvidence suggests that pragmatic diabetes prevention programs are effective. Effectiveness varies substantially between programs but can be improved by maximizing guideline adherence. However, more research is needed to establish optimal strategies for maximizing both cost-effectiveness and longer-term maintenance of weight loss and diabetes prevention effects.

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Section: Data Synthesis and Analysismentioning

confidence: 99%

Diabetes Prevention in the Real World: Effectiveness of Pragmatic Lifestyle Interventions for the Prevention of Type 2 Diabetes and of the Impact of Adherence to Guideline Recommendations

et al. 2014

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“…Additional analysis comparing the difference in weight lost Gilis-Januszewska 2011 69 Ruggerio 2011 88 Kramer 2012 (CPC) 81 Kramer 2012 (TPC) 81 Laatikainen 2012 93 Kanaya et al 94 and Penn et al 95 ) have been added; therefore, the subtotal line and overall line in the plots have changed, as they now include additional data. Boxes and horizontal lines represent mean weight change and 95% CI for each study.…”

Section: Meta-analysismentioning

confidence: 99%

“…This is most likely to be a result of the fact that the WHO began recommending the use of HbA 1c as a T2DM diagnostic tool only in 2011, whereas many studies in this review predate this introduction. 50,62,[69][70][71][72][73][74][75][76][77][78][79][80]82,[85][86][87]89,96,97,99,102,106 Unpublished literature was not considered for inclusion in this review, leading to potential selection bias. Further bias may have also been introduced via the decision to limit studies to English-language studies only.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

“…Appendix 3 Coding scores for study interventions 2008 75 Almeida, 2010 76 Boltri, 2008 77 Costa, 2012 78 DavisSmith, 2007 79 Faridi, 2010 62 GilisJanuszewska, 2011 69 Janus, 2012 93 Kanaya, 2012 94 Katula, 2011 80 Kramer, 2009 70 Kramer, 2012 81 Kramer, 2012 81 71 Laatikainen, 2012 98 Makrilakis, 2010 73 Mensink, 2003 82 Ockene, 2012 84 Parikh, 2010 85 Payne, 2008 86 Penn, 2009 87 Penn, 2013 95 Ruggerio, 2011 88 Saaristo, 2010 89 Sakane, 2011 90 Yates 86 Penn et al 87 Penn et al 95 Ruggerio et al…”

Section: Data Sharing Statementmentioning

confidence: 99%

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A community-based primary prevention programme for type 2 diabetes mellitus integrating identification and lifestyle intervention for prevention: a cluster randomised controlled trial

Davies

Gray

Ahrabian

et al. 2017

Programme Grants Appl Res

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BackgroundPrevention of type 2 diabetes mellitus (T2DM) is a global priority; however, there is a lack of evidence investigating how to effectively translate prevention research into a primary care setting.Objectives(1) To develop and validate a risk score to identify individuals at high risk of T2DM in the UK; and (2) to establish whether or not a structured education programme targeting lifestyle and behaviour change was clinically effective and cost-effective at preventing progression to T2DM in people with prediabetes mellitus (PDM), identified through a risk score screening programme in primary care.DesignA targeted screening study followed by a cluster randomised controlled trial (RCT), with randomisation at practice level. Participants were followed up for 3 years.SettingA total of 44 general practices across Leicestershire, UK. The intervention took place in the community.ParticipantsA total of 17,972 individuals from 44 practices identified through the risk score as being at high risk of T2DM were invited for screening; of these, 3449 (19.2%) individuals attended. All received an oral glucose tolerance test. PDM was detected in 880 (25.5%) of those screened. Those with PDM were included in the trial; of these, 36% were female, the average age was 64 years and 16% were from an ethnic minority group.InterventionPractices were randomised to receive either standard care or the intervention. The intervention consisted of a 6-hour group structured education programme, with an annual refresher and regular telephone contact.Main outcome measuresThe primary outcome was progression to T2DM. The main secondary outcomes were changes in glycated haemoglobin concentrations, blood glucose levels, cardiovascular risk, the presence of metabolic syndrome, step count and the cost-effectiveness of the intervention.ResultsA total of 22.6% of the intervention group did not attend the education and 29.1% attended all sessions. A total of 131 participants developed T2DM (standard care,n = 67; intervention,n = 64). There was a 26% reduced risk of T2DM in the intervention arm compared with standard care, but this did not reach statistical significance (hazard ratio 0.74, 95% confidence interval 0.48 to 1.14;p = 0.18). There were statistically significant improvements in glycated haemoglobin concentrations, low-density lipoprotein cholesterol levels, psychosocial well-being, sedentary time and step count in the intervention group. The intervention was found to result in a net gain of 0.046 quality-adjusted life-years over 3 years at a cost of £168 per patient, with an incremental cost-effectiveness ratio of £3643 and a probability of 0.86 of being cost-effective at a willingness-to-pay threshold of £20,000.ConclusionsWe developed and validated a risk score for detecting those at high risk of undiagnosed PDM/T2DM. We screened > 3400 people using a two-stage screening programme. The RCT showed that a relatively low-resource pragmatic programme may lead to a reduction in T2DM and improved biomedical and psychosocial outcomes, and is cost-effective.LimitationsOnly 19% of those invited to screening attended, which may limit generalisability. The variation in cluster size in the RCT may have limited the power of the study.Future workFuture work should focus on increasing attendance to both screening and prevention programmes and offering the programme in different modalities, such as web-based modalities. A longer-term follow-up of the RCT participants would be valuable.Trial registrationCurrent Controlled Trials ISRCTN80605705.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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“…The project group obtained considerable experience in developing lifestyle interventions aiming at preventing T2D in high-risk individuals [73]. The DE-PLAN project has also formed a basis for the IMAGE project that is currently developing the European guideline for the prevention of T2D [74]. …”

Section: Primary Prevention Of Type 2 Diabetes Mellitusmentioning

confidence: 99%

Primary Prevention of Obesity and Type 2 Diabetes Mellitus

Szybiński¹

2016

Epidemiology (Sunnyvale)

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The prevalence of type 2 diabetes mellitus has exceeded 22million people in Europe and according to WHO, it will increase from 135 million in 1935 to 300 million in 2025. In 1989 Saint Vincent Declaration, elaborated by the International Diabetes Federation (IDF) called all the European countries to take action aimed at reducing the prevalence of type 2diabetes mellitus and its complications on the population level. Poland has signed the Declaration within the "Polish Multicenter Study in Diabetes Epidemiology (PMSD) program (implemented in the cities of Kraków, Łódź, and Lublin), financed by the Ministry of Health, and developed within the years of 1998-2000. The program was coordinated by the Chair and Department of Endocrinology, Jagiellonian University, Collegium Medicum in Kraków. It revealed over 2 million diabetics in Poland, half of which represented the so-called unknown diabetes, diagnosed for the first time in the course of investigation. The prevalence of type 2 diabetes mellitus is still growing up owing to the increasing prevalence of its main risk factors: overweight and obesity, mainly the visceral type. The basic method of preventing of the type 2 diabetes mellitus within the PMSD is body weight reduction with an increase in physical activity and an appropriate educational program. The second basic goal of the program in the highest risk group of type 2 diabetes mellitus is to decrease blood pressure in hypertensive patients.Hypertension management is based on salt intake reduction, however, salt is the main carrier of iodine in the iodine prophylactic system in Poland so iodine must be additionally supplemented with additional carriers, such as milk or iodized mineral water: "Ustronianka" "Jodavit" or "Wysowianka". The results of the program point out that the process of type 2 diabetes mellitus formation is reversible, but under the condition of early intervention. Additional parts of the program are economic burden evaluation and resort management. The resort of "Wysowa S.A." has already been prepared to implement prevention and management in patients with overweight, obesity, and type 2 diabetes mellitus.

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Prevention of type 2 diabetes by lifestyle intervention in primary health care setting in Poland: Diabetes in Europe Prevention using Lifestyle, physical Activity and Nutritional intervention (DE-PLAN) project

Cited by 25 publications

References 24 publications

Diabetes Prevention in the Real World: Effectiveness of Pragmatic Lifestyle Interventions for the Prevention of Type 2 Diabetes and of the Impact of Adherence to Guideline Recommendations

Diabetes Prevention in the Real World: Effectiveness of Pragmatic Lifestyle Interventions for the Prevention of Type 2 Diabetes and of the Impact of Adherence to Guideline Recommendations

A community-based primary prevention programme for type 2 diabetes mellitus integrating identification and lifestyle intervention for prevention: a cluster randomised controlled trial

Primary Prevention of Obesity and Type 2 Diabetes Mellitus

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