Melanie J Davies1, Laura J Gray2, Jacqui Troughton3, Alastair Gray4, Jaakko Tuomilehto5, Azhar Farooqi6, Kamlesh Khunti7, Thomas Yates8. 1. Diabetes Research Centre, University of Leicester, Leicester, UK; Leicester-Loughborough Diet, Lifestyle and Physical Activity Biomedical Research Unit, Leicester, UK. Electronic address: melanie.davies@uhl-tr.nhs.uk. 2. Department of Health Sciences, University of Leicester, Leicester, UK. Electronic address: lg48@le.ac.uk. 3. Leicester Diabetes Centre, University Hospitals of Leicester, Leicester, UK. Electronic address: Jacqui.Troughton@uhl-tr.nhs.uk. 4. Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK. Electronic address: alastair.gray@dph.ox.ac.uk. 5. Centre for Vascular Prevention, Danube University Krems, 3500 Krems, Austria; Department of Chronic Disease Prevention, National Institute for Health and Welfare, 00271 Helsinki, Finland; Diabetes Research Group, King Abdulaziz University, 21589 Jeddah, Saudi Arabia. Electronic address: jaakko.tuomilehto@thl.fi. 6. Diabetes Research Centre, University of Leicester, Leicester, UK. Electronic address: azhar_farooqi@hotmail.com. 7. Diabetes Research Centre, University of Leicester, Leicester, UK. Electronic address: kk22@le.ac.uk. 8. Diabetes Research Centre, University of Leicester, Leicester, UK; Leicester-Loughborough Diet, Lifestyle and Physical Activity Biomedical Research Unit, Leicester, UK. Electronic address: ty20@le.ac.uk.
Abstract
OBJECTIVES: Prevention of type 2 diabetes (T2DM) is a priority in healthcare, but there is a lack of evidence investigating how to effectively translate prevention research into a UK primary care setting. We assessed whether a structured education programme targeting lifestyle and behaviour change was effective at preventing progression to T2DM in people with pre-diabetes. MATERIALS AND METHODS: Forty-four general practices were randomised to receive either standard care or a 6hour group structured education programme with an annual refresher course, and regular phone contact. Participants were followed up for 3years. The primary outcome was progression to T2DM. RESULTS: Eight hundred and eighty participants were included (36% female, mean age 64years, 16% ethnic minority group); 131 participants developed T2DM. There was a non-significant 26% reduced risk of developing T2DM in the intervention arm compared to standard care (HR 0.74, 95% CI 0.48, 1.14, p=0.18). The reduction in T2DM risk when excluding those who did not attend the initial education session was also non-significant (HR 0.65, 0.41, 1.03, p=0.07). There were statistically significant improvements in HbA1c (-0.06, -0.11, -0.01), LDL cholesterol (-0.08, -0.15, -0.01), sedentary time (-26.29, -45.26, -7.32) and step count (498.15, 162.10, 834.20) when data were analysed across all time points. CONCLUSIONS: This study suggests that a relatively low resource, pragmatic diabetes prevention programme resulted in modest benefits to biomedical, lifestyle and psychosocial outcomes, however the reduction to the risk of T2DM did not reach significance. The findings have important implications for future research and primary care.
OBJECTIVES: Prevention of type 2 diabetes (T2DM) is a priority in healthcare, but there is a lack of evidence investigating how to effectively translate prevention research into a UK primary care setting. We assessed whether a structured education programme targeting lifestyle and behaviour change was effective at preventing progression to T2DM in people with pre-diabetes. MATERIALS AND METHODS: Forty-four general practices were randomised to receive either standard care or a 6hour group structured education programme with an annual refresher course, and regular phone contact. Participants were followed up for 3years. The primary outcome was progression to T2DM. RESULTS: Eight hundred and eighty participants were included (36% female, mean age 64years, 16% ethnic minority group); 131 participants developed T2DM. There was a non-significant 26% reduced risk of developing T2DM in the intervention arm compared to standard care (HR 0.74, 95% CI 0.48, 1.14, p=0.18). The reduction in T2DM risk when excluding those who did not attend the initial education session was also non-significant (HR 0.65, 0.41, 1.03, p=0.07). There were statistically significant improvements in HbA1c (-0.06, -0.11, -0.01), LDL cholesterol (-0.08, -0.15, -0.01), sedentary time (-26.29, -45.26, -7.32) and step count (498.15, 162.10, 834.20) when data were analysed across all time points. CONCLUSIONS: This study suggests that a relatively low resource, pragmatic diabetes prevention programme resulted in modest benefits to biomedical, lifestyle and psychosocial outcomes, however the reduction to the risk of T2DM did not reach significance. The findings have important implications for future research and primary care.
Authors: Matthew D Campbell; Thirunavukkarasu Sathish; Paul Z Zimmet; Kavumpurathu R Thankappan; Brian Oldenburg; David R Owens; Jonathan E Shaw; Robyn J Tapp Journal: Nat Rev Endocrinol Date: 2020-02-14 Impact factor: 43.330
Authors: Rebecca Gossage-Worrall; Richard I G Holt; Katharine Barnard; Marian E Carey; Melanie J Davies; Chris Dickens; Yvonne Doherty; Charlotte Edwardson; Paul French; Fiona Gaughran; Kathryn Greenwood; Sridevi Kalidindi; Daniel Hind; Kamlesh Khunti; Paul McCrone; Jonathan Mitchell; John Pendlebury; Shanaya Rathod; David Shiers; Najma Siddiqi; Lizzie Swaby; Stephen Wright Journal: Trials Date: 2016-09-29 Impact factor: 2.279