Community-based Diabetes Prevention Research Articles

Participant recruitment into a community-based diabetes prevention trial in India: Learnings from the Kerala Diabetes Prevention Program.

BackgroundData on participant recruitment into diabetes prevention trials are limited in low- and middle-income countries (LMICs). We aimed to provide a detailed analysis of participant recruitment into a community-based diabetes prevention trial in India.MethodsThe Kerala Diabetes Prevention Program was conducted in 60 polling areas (electoral divisions) of the Neyyatinkara taluk (subdistrict) in Trivandrum district, Kerala state. Individuals (age 30–60 years) were screened with the Indian Diabetes Risk Score (IDRS) at their homes followed by an oral glucose tolerance test (OGTT) at community-based clinics. Individuals at high-risk of developing diabetes (IDRS score ≥60 and without diabetes on the OGTT) were recruited.ResultsA total of 1007 participants (47.2% women) were recruited over nine months. Pilot testing, personal contact and telephone reminders from community volunteers, and gender matching of staff were effective recruitment strategies. The major recruitment challenges were: (1) during home visits, one-third of potential participants could not be contacted, as they were away for work; and (2) men participated less frequently in the OGTT screening than women (75.2% vs. 84.2%). For non-participation, lack of time (42.0%) was most commonly cited followed by ‘I am already feeling healthy’ (30.0%), personal reasons (24.0%) and ‘no benefit to me or my family’ (4.0%). An average of 17 h were spent to recruit one participant with a cost of US$23. The initial stage of screening and recruitment demanded higher time and costs.ConclusionsThis study provides valuable information for future researchers planning to implement community-based diabetes prevention trials in India or other LMICs.Trial registrationAustralia and New Zealand Clinical Trials Registry: ACTRN12611000262909.

Integrating Local Knowledge into a National Programme: Evidence from a Community-Based Diabetes Prevention Education Programme.

Type 2 diabetes prevention is a major priority for healthcare services and public health. This study aimed to evaluate how a local authority in England piloted a diabetes prevention programme. The South Gloucestershire Diabetes Prevention (Pilot) Programme (SGDPP) comprised a group health education course over six weeks with subsequent support provision up to six months post-enrolment. Of the 300 patients invited onto the programme, 32% enrolled and 29% completed the full six-month programme. There was an attendance rate of 84% throughout group sessions and at a six-month follow-up. There were significant improvements across most measures at six months, including a 4 kg mean weight loss and a 3.45 mmol/mol mean HbA1c reduction. Clear goals, high quality organization and personal qualities of educators were identified as central for the programme’s success. The unit costs were similar to pilots of other healthy lifestyle programmes. The evaluation found evidence of reduced type 2 diabetes risk markers, positive impacts for dietary and physical activity, and potential cost-effectiveness for this format of group-based diabetes prevention intervention. Feedback from multiple stakeholders provided insight on how to successfully embed and scale-up delivery of diabetes prevention work. This evidence enables the integration of learning in local service delivery and provides a basis to support development of the national diabetes prevention programme.

Preliminary efficacy and feasibility of referral to exercise specialists, psychologists and provision of a technology-based behavior change support package to promote physical activity in school teachers ‘at risk' of, or diagnosed with, type 2 diabetes: The ‘SMART Health’ Pilot Study Protocol

IntroductionType 2 diabetes mellitus (T2DM) is a global public health concern. Aerobic physical activity (PA) and resistance training (RT) play significant roles in the prevention and management of T2DM. The aim of this pilot trial is to determine the preliminary efficacy and confirm feasibility of referral to exercise physiologists, psychologists, and provision of a technology-based behavior change support package to promote aerobic PA and RT in school teachers ‘at risk' of or diagnosed with T2DM. Research design and methodsThe SMART (Support, Motivation and Physical Activity Research for Teachers’) Health pilot study will be evaluated using a three-arm randomized controlled trial. The intervention will be guided by Social Cognitive Theory, Health Action Process Approach Model and Cognitive Behavioral Therapy strategies. The participants will be randomly allocated to one of three study groups: Group 1: wait-list control group; Group 2: 5 face-to-face visits with a psychologist and exercise specialist over 3 months; and Group 3: same as Group 2 plus technology-based behavior change support package for an additional 6 months. Assessments will be conducted at baseline, 3-, 9- (primary time-point) and 18-months post-baseline. The primary outcome will be PA measured with pedometers. DiscussionSMART Health is an innovative, multi-component intervention, that integrates referral to exercise specialists, psychologists and provision of a technology-based behavior support package to promote PA and RT in adults diagnosed with T2DM or ‘at risk' of T2DM. The findings will be used to guide future PA interventions and to develop effective community-based diabetes prevention and treatment programs. Trial RegistrationAustralian New Zealand Clinical Trials Registry No: ACTRN12616001309471

Evaluation of a Community-Based Diabetes Prevention Program in Thailand: A Cluster Randomized Controlled Trial.

Objectives: Lifestyle interventions have been shown to effectively reduce the incidence of diabetes, but evidence from middle-income countries is scarce. We evaluated the effectiveness of a lifestyle program to prevent diabetes in primary-care settings in Thailand. Methods: A matched-pair cluster randomized controlled trial was conducted in 68 primary care units in 8 provinces. The primary care units were randomly assigned to intervention or control arms. Individuals aged 30 to 65 years with impaired oral glucose tolerance were recruited and followed up for 2 years. The intervention included periodic group-based activities on healthy lifestyle behaviors; the control group received a one-time education program. The primary outcome was the incidence rate of type 2 diabetes at 24 months after the intervention. Results: A total of 1903 individuals participated (873 in the control group and 1030 in the intervention group). At baseline, participants’ characteristics did not differ between groups. After 24 months, the incidence rates (per 100 person-year) of diabetes was 12.1% (95% CI 10.7% to 13.8%) in the intervention group, and 16.6% (95% CI 14.6 to 18.8%) in the control group (P < .001). Overall, the adjusted hazard ratio for diabetes incidence was 0.72 (95% CI 0.60 to 0.86). A mean body weight reduction of 1.5 kg was observed in the intervention group, whereas, an increase of 0.4 kg was observed in the control group (P < .001). Conclusion: A community-based lifestyle modification through participatory group activities can prevent or delay the incidence of diabetes among Thai populations with impaired glucose tolerance.

Feasibility of Implementing Community Partnerships to Provide Diabetes Prevention Services to Youth.

Type 2 diabetes (T2D) in youth has increased as a result of the obesity epidemic. Diabetes prevention programming is needed for youth, at risk for T2D, and their families. However, there is a lack of diabetes prevention services for this population. There is evidence for the benefit of lifestyle modification for decreasing diabetes risk, however there are barriers for youth to access these services in a traditional clinical setting. Our Youth Diabetes Prevention Clinic (YDPC) created partnerships within the community to increase access to diabetes prevention services for at risk youth. YDPC personnel approached community organizations who had the expertise and capacity to partner in needed areas. These partnerships allowed for the development and facilitation of a community-based diabetes prevention group. Youth and their families participated in a 12 week diabetes prevention group. We measured attendance and participant satisfaction with the program. Families attended an average of 5.1 sessions from January to October 2016. Participant satisfaction was collected five times. Physical activity was rated as "awesome" or "good" by 88% of the respondents. The nutrition activities were rated as "awesome" or "good" by 97% of respondents. Physicians and families express a desire for diabetes prevention services, however barriers make it difficult for families to fully participate. Creating partnerships within the community allows for increased access to diabetes prevention services for high-risk, underserved families.

Cost-Effectiveness of a Community-Based Diabetes Prevention Program with Participation Incentives for Medicaid Beneficiaries.

To examine the cost-effectiveness of a community-based Diabetes Prevention Program (DPP) for Medicaid beneficiaries from the perspective of the health care sector. A total of 847 Medicaid enrollees at high risk for type 2 diabetes participating in a community-based DPP. Pre- and post clinical outcome and cost data were used as inputs into a validated diabetes simulation model. The model was used to evaluate quality-adjusted life years (QALYs) and health care costs over a 40-year time horizon from the perspective of the health care sector. Clinical outcome and cost data were derived from a study examining the effect of financial incentives on weight loss. Study participants lost an average of 4.2 lb (p<.001) and increased high-density lipoprotein cholesterol by 1.75mg/dl (p=.002). Intervention costs, which included financial incentives for participation and weight loss, were $915 per participant. The incremental cost-effectiveness ratio was estimated to be $14,011 per QALY but was sensitive to the time horizon studied. Widespread adoption of community-based DPP has the potential to reduce diabetes and cardiovascular-related morbidity and mortality for low-income persons at high risk for diabetes and may be a cost-effective investment for Medicaid programs.

Perceived Benefits and Barriers of a Community-Based Diabetes Prevention and Management Program.

This study examined the perceptions of benefits of and barriers to participating in a community-based diabetes program to improve program effectiveness. The Diabetes Prevention and Management (DPM) program was a twenty-two session, 1-year program, modeled after the evidence-based National Diabetes Prevention Program and AADE7 Self-Care Behaviors framework. Community-based participatory research approach was used to culturally tailor the curriculum. Participants included overweight or obese adults with dysglycemia. A benefits and barriers survey was developed to gather information on participants’ perception of the program, as well as information on demographics and health literacy levels. Eighty-nine adults participated in the DPM program (73% females; 62% diabetic; 77% had adequate health literacy); 79% of participants completed the benefits and barriers survey. Principal component analysis indicated two components representing benefits (Cronbach’s α = 0.83) and barriers (α = 0.65). The majority perceived high benefits and low barriers to program participation; benefits included helpful interaction with health coach or program leader (73%), improved lifestyle modification (65%) due to the program, and satisfaction with the program (75%). Open-ended questions confirmed themes related to benefits of program participation, suggestion for programmatic improvements as well as barriers to participation. Participant feedback could be used to guide interventions and tailor future program implementation.

Exploring the effects of coproduction on citizen trust in government a cross-national comparison of community-based diabetes prevention programmes in Thailand and the United States

ABSTRACTRecently, coproduction has become important in government thinking about new ways of delivering public health services. An equal and reciprocal relationship caused by coproduction is expected to enhance citizens’ trust in the health systems. However, there is still an ongoing debate about whether coproduction can help enhance citizen trust in government institutions. This study engages in the debate by analysing data from a comparative survey of citizens from a province in Northeast Thailand and a county in Northeast Illinois. In both jurisdictions, citizens have been encouraged to coproduce public health programmes to control and prevent various illnesses, particularly diabetes. The findings indicated that in general coproduction of diabetes-related programmes increased citizen trust in the local public health authorities. However, coproduction of advanced preventive programmes, such as diabetic foot ulcer treatment, was found to decrease citizen trust.

Implementing a community-based diabetes prevention programme in Ireland

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 5.120 (2020 JCR, received in June 2021)

Measuring the social value of prevention and management of type 2 diabetes in a community setting.

Background:Type 2 diabetes affects 1 in 20 people over the age of 65. Although there is growing evidence around the effectiveness of lifestyle interventions to prevent or delay the onset of this disease, there is limited evidence of the wider social outcomes and value of such programmes. Social Return on Investment (SROI) is a method of defining, measuring and valuing the wider social outcomes and describing the process of change through the eyes of those who benefit. This paper aims to evaluate the wider impact and social value of the Westbank Living Well, Taking Control (LWTC) community-based diabetes prevention and management education programme. Methods:The SROI methodology involves a mixed methods design. Qualitative methods were used to identify outcomes that were viewed as important by stakeholders in terms of the impact they create. A quantitative approach was used to define the numbers experiencing the outcomes, a monetary representation of the outcomes and their value. Results:SROI analysis found that for every £1 invested in LWTC, there is £5.80 of social return over a three-year period. The sensitivity analysis showed that the value of the social return for every £1 invested in the LWTC is likely to be between £1.30 and £6.57. Conclusions:The study demonstrates the potential social value of a community-based diabetes prevention and management education programme in terms of outcomes for participants, and also the wider outcomes for staff, volunteers, family and friends of the participants and the organisations involved. Better appreciation of such wider outcomes could have an important role in building partnerships, community engagement and political mandate for public health interventions.

Community-based healthy lifestyle and diabetes prevention program for women in East Jerusalem

Community-based healthy lifestyle and diabetes prevention program for women in East Jerusalem

An Elective Course to Train Student Pharmacists to Deliver a Community-based Group Diabetes Prevention Program

Objective. To develop and assess the impact of an elective course aimed at improving student knowledge of and confidence in delivering a group diabetes prevention program. Design. Two colleges of pharmacy collaborated to develop a 2-credit elective course using didactic and active-learning strategies to prepare students to serve as lifestyle coaches offering a proven group diabetes prevention program. Assessment. Students' confidence in their ability to deliver a group diabetes prevention program increased as a result of the class. However, their knowledge of diabetes prevention facts was unchanged from baseline. Conclusion. A diabetes prevention elective course improved students' confidence in their ability to teach a diabetes prevention program.

Evaluating the Public Health Impact of a Community-Based Family-Focused Diabetes Prevention Program Using RE-AIM

Evaluating the Public Health Impact of a Community-Based Family-Focused Diabetes Prevention Program Using RE-AIM

A Critical Examination of the Use of Trained Health Coaches to Decrease the Metabolic Syndrome for Participants of a Community-Based Diabetes Prevention and Management Program.

The epidemic of obesity and diabetes in the United States poses major challenge to the prevention and management of chronic diseases. Furthermore, when this is viewed in other components of the metabolic syndrome (i.e., the burden of high cholesterol and hypertension), the prevalence of the metabolic syndrome continues to rise in the USA continued challenge is how to deal with this epidemic from a medical and public health standpoint. Community Based Participatory Research (CBPR) is a unique approach and offers a novel perspective for answering this challenge. A critical set of goals for CBPR is to address health disparities and social inequalities while getting community members engaged in all aspects of the research process. Utilizing the West Virginia Diabetes Prevention and Management Program and trained Health Coaches as a model, we discuss topics of consideration related to CBPR, involving trained health coaches, optimizing early adoption of healthy lifestyle behaviors, and enhancing participation. Through careful project planning and design, questions regarding disparities increasing susceptibility and preventive efforts within the community can be addressed successfully. These topics are part of a broader integration of theories such as participatory research, community engagement, and outcomes measurement. The understanding of the pathophysiology and epidemiology of the metabolic syndrome can help frame an appropriate strategy for establishing long-term community-wide changes that promote health. In order to continue to improve investigations for preventing the metabolic syndrome, it will be necessary to have aggressive efforts at the individual and population level for developing culturally sensitive programs that start early and are sustainable in practical environments such as the workplace. In this comprehensive review, we will discuss practical considerations related to project design, implementation, and how to measure effectiveness in regards to reducing the burden of the metabolic syndrome.

Increasing Referrals to a YMCA-Based Diabetes Prevention Program: Effects of Electronic Referral System Modification and Provider Education in Federally Qualified Health Centers.

IntroductionThe Diabetes Prevention Program has been translated to community settings with varying success. Although primary care referrals are used for identifying and enrolling eligible patients in the Diabetes Prevention Program, little is known about the effects of strategies to facilitate and sustain eligible patient referrals using electronic health record systems.MethodsTo facilitate and sustain patient referrals, a modification to the electronic health record system was made and combined with provider education in 6 federally qualified health centers in the Bronx, New York. Referral data from April 2012 through November 2014 were analyzed using segmented regression analysis.ResultsPatient referrals increased significantly after the modification of the electronic health record system and implementation of the provider education intervention. Before the electronic system modification, 0 to 2 patients were referred per month. During the following year (September 2013 through August 2014), which included the provider education intervention, referrals increased to 1 to 9 per month and continued to increase to 5 to 11 per month from September through November 2014.ConclusionsModification of an electronic health record system coupled with a provider education intervention shows promise as a strategy to identify and refer eligible patients to community-based Diabetes Prevention Programs. Further refinement of the electronic system for facilitating referrals and follow-up of eligible patients should be explored.

Detecting Prediabetes and Diabetes: Agreement between Fasting Plasma Glucose and Oral Glucose Tolerance Test in Thai Adults.

Aim. To evaluate an agreement in identifying dysglycemia between fasting plasma glucose (FPG) and the 2 hr postprandial glucose tolerance test (OGTT) in a population with high risk of diabetes. Methods. A total of 6,884 individuals aged 35–65 years recruited for a community-based diabetes prevention program were tested for prediabetes including impaired fasting glucose (IFG) or impaired glucose tolerance (IGT), and diabetes. The agreement was assessed by Kappa statistics. Logistic regression was used to examine factors associated with missed prediabetes and diabetes by FPG. Results. A total of 2671 (38.8%) individuals with prediabetes were identified. The prevalence of prediabetes identified by FPG and OGTT was 32.2% and 22.3%, respectively. The proportions of diabetes classified by OGTT were two times higher than those identified by FPG (11.0% versus 5.4%, resp.). The Kappa statistics for agreement of both tests was 0.55. Overall, FPG missed 46.3% of all prediabetes and 54.7% of all diabetes cases. Prediabetes was more likely to be missed by FPG among female, people aged <45 yrs, and those without family history of diabetes. Conclusion. The detection of prediabetes and diabetes using FPG only may miss half of the cases. Benefit of adding OGTT to FPG in some specific groups should be confirmed.

The Healthy Living Partnerships to Prevent Diabetes Study

Since the Diabetes Prevention Project (DPP) demonstrated that lifestyle weight-loss interventions can reduce the incidence of diabetes by 58%, several studies have translated the DPP methods to public health-friendly contexts. Although these studies have demonstrated short-term effects, no study to date has examined the impact of a translated DPP intervention on blood glucose and adiposity beyond 12 months of follow-up.To examine the impact of a 24-month, community-based diabetes prevention program on fasting blood glucose, insulin, insulin resistance as well as body weight, waist circumference, and BMI in the second year of follow-up.An RCT comparing a 24-month lifestyle weight-loss program (LWL) to an enhanced usual care condition (UCC) in participants with prediabetes (fasting blood glucose=95-125 mg/dL). Data were collected in 2007-2011; analyses were conducted in 2011-2012.301 participants with prediabetes were randomized; 261 completed the study. The intervention was held in community-based sites.The LWL program was led by community health workers and sought to induce 7% weight loss at 6 months that would be maintained over time through decreased caloric intake and increased physical activity. The UCC received two visits with a registered dietitian and a monthly newsletter.The main measures were fasting blood glucose, insulin, insulin resistance, body weight, waist circumference, and BMI.Intent-to-treat analyses of between-group differences in the average of 18- and 24-month measures of outcomes (controlling for baseline values) revealed that the LWL participants experienced greater decreases in fasting glucose (-4.35 mg/dL); insulin (-3.01 μU/ml); insulin resistance (-0.97); body weight (-4.19 kg); waist circumference (-3.23 cm); and BMI (-1.40), all p-values <0.01.A diabetes prevention program administered through an existing community-based system and delivered by community health workers is effective at inducing significant long-term reductions in metabolic indicators and adiposity.

Lifestyle change in Kerala, India: needs assessment and planning for a community-based diabetes prevention trial

BackgroundType 2 Diabetes Mellitus (T2DM) has become a major public health challenge in India. Factors relevant to the development and implementation of diabetes prevention programmes in resource-constrained countries, such as India, have been under-studied. The purpose of this study is to describe the findings from research aimed at informing the development and evaluation of a Diabetes Prevention Programme in Kerala, India (K-DPP).MethodsData were collected from three main sources: (1) a systematic review of key research literature; (2) a review of relevant policy documents; and (3) focus groups conducted among individuals with a high risk of progressing to diabetes. The key findings were then triangulated and synthesised.ResultsPrevalence of risk factors for diabetes is very high and increasing in Kerala. This situation is largely attributable to rapid changes in the lifestyle of people living in this state of India. The findings from the systematic review and focus groups identified many environmental and personal determinants of these unhealthy lifestyle changes, including: less than ideal accessibility to and availability of health services; cultural values and norms; optimistic bias and other misconceptions related to risk; and low expectations regarding one’s ability to make lifestyle changes in order to influence health and disease outcomes. On the other hand, there are existing intervention trials conducted in India which suggests that risk reduction is possible. These programmes utilize multi-level strategies including mass media, as well as strategies to enhance community and individual empowerment. India’s national programme for the prevention and control of major non-communicable diseases (NCD) also provide a supportive environment for further community-based efforts to prevent diabetes.ConclusionThese findings provide strong support for undertaking more research into the conduct of community-based diabetes prevention in the rural areas of Kerala. We aim to develop, implement and evaluate a group-based peer support programme that will address cultural and family determinants of lifestyle risks, including family decision-making regarding adoption of healthy dietary and physical activity patterns. Furthermore, we believe that this approach will be feasible, acceptable and effective in these communities; with the potential for scale-up in other parts of India.

Lifestyle change in Kerala, India: needs assessment and planning for a community-based diabetes prevention trial

Lifestyle change in Kerala, India: needs assessment and planning for a community-based diabetes prevention trial

A Community-Based Participatory Diabetes Prevention and Management Intervention in Rural India Using Community Health Workers

The purpose of this study was to test the effectiveness of a 6-month community-based diabetes prevention and management program in rural Gujarat, India. A community-based participatory research method was used to plan and tailor the intervention by engaging trained community health workers as change agents to provide lifestyle education, serve as community advocates, and collect data from 1638 rural Indians (81.9% response rate). Ten culturally and linguistically appropriate health education messages were provided in face-to-face individual and group sessions (demonstrations of model meals and cooking techniques). Mean age was 41.9 ± 15.9 years. Overall point prevalence of diabetes, prediabetes, obesity, and hypertension were 7.2%, 19.3%, 16.7%, and 28%, respectively, with significant differences between the low socioeconomic status (SES) participants (agricultural workers) and the high SES participants (business community) due to differing diet and activity levels. The intervention significantly reduced blood glucose levels by 5.7 and 14.9 mg/dL for individuals with prediabetes and diabetes, respectively, and systolic and diastolic blood pressure by 8 mm Hg and 4 mm Hg, respectively, in the overall population. Knowledge of diabetes and cardiovascular disease improved by 50% in the high SES group and doubled in the low SES group; general and abdominal obesity also decreased by ≤ 1%. High rates of undiagnosed hypertension (26.1%) were surprising. Among individuals with diabetes, metabolic complications such as diabetic nephropathy and chronic kidney disease were noted. Through collective engagement of the community, participatory programs can serve as a prototype for future prevention and management efforts, which are rare and underutilized in India.