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Toward integrated and sustainable prevention against diabetes in rural China: study rationale and protocol of eCROPS.

Feng R, Li K, Cheng J, Xie S, Chai J, Wei P, Wang D - BMC Endocr Disord (2013)

Bottom Line: These arrangements enable documentation of up to 6 years of consecutive measures and detection of lower incidence of progression into diabetes, improved body max index and blood pressure, and increased service use and involvement in healthy dietary and physical activities among pre-diabetics receiving the experimental intervention compared to themselves at baseline or those in the delayed-intervention control condition.This project is owned and managed by local health authorities and utilizes available resources.It introduces a package of long-term incentives, establishes ongoing mechanisms for continuous capacity building and quality improvement, and builds up an operational cycle for catalyzing similar efforts in the local prefecture even throughout rural China.

View Article: PubMed Central - HTML - PubMed

Affiliation: School of Health Services Management, Anhui Medical University, Hefei 230032, China. dbwang@vip.sina.com.

ABSTRACT

Background: Being an intermediate stage in the development of diabetes, pre-diabetics were estimated as high as 14% to 63% in China and one to three quarters of them will develop into diabetes within 10 years. It is well established that the risk of diabetes progression can be modified substantially and a whole range of proven guidelines, protocols and methodologies are available. Unfortunately, most proven interventions are seldom used in daily practice and this is especially true in resource poor rural China. This project aims at demonstrating that an evolutionary intervention package featuring low cost, integration with routine services, cultural sensitization and self-optimization, is effective and sustainable in preventing diabetes.

Methods/design: This project utilizes a quasi cluster randomized controlled trial and a batched implementation strategy in which villages are recruited in 7 blocks within 7 consecutive years respectively. Block 0 involves 3 villages and provides an opportunity for piloting and refining primitive intervention methodologies and protocols. The following 6 blocks consist of 14 villages each and serve as intervention arm; while all the villages not yet started intervention form the control arm. For each block, measurement happens at baseline and every 12 months (for plasma glucose) or monthly (for body weight and blood pressure) after baseline. These arrangements enable documentation of up to 6 years of consecutive measures and detection of lower incidence of progression into diabetes, improved body max index and blood pressure, and increased service use and involvement in healthy dietary and physical activities among pre-diabetics receiving the experimental intervention compared to themselves at baseline or those in the delayed-intervention control condition.

Discussion: China has a long history of separating disease prevention and treatment systems and there is a clear need to leverages key success factors in a synergetic way toward integrated and sustainable diabetes prevention. This project is owned and managed by local health authorities and utilizes available resources. It introduces a package of long-term incentives, establishes ongoing mechanisms for continuous capacity building and quality improvement, and builds up an operational cycle for catalyzing similar efforts in the local prefecture even throughout rural China.

Trial registration: Current Controlled Trials: ISRCTN66772711.

No MeSH data available.


Related in: MedlinePlus

Example pre-diabetics specific outcome plot. legend: in (a), red line divides pre-diabetes and diabetes, green line divides pre-diabetes and normal and blue line presents individualized fasting glucose; in (b), red line divides obese and overweight, orange line divides overweight and normal, green line divides normal and underweight and blue line presents individualized body weight; in (c) and (d), red line divides hypertension and normal blood pressure, green line divides normal blood pressure and hypotension and blue lines presents individualized blood pressure.
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Figure 3: Example pre-diabetics specific outcome plot. legend: in (a), red line divides pre-diabetes and diabetes, green line divides pre-diabetes and normal and blue line presents individualized fasting glucose; in (b), red line divides obese and overweight, orange line divides overweight and normal, green line divides normal and underweight and blue line presents individualized body weight; in (c) and (d), red line divides hypertension and normal blood pressure, green line divides normal blood pressure and hypotension and blue lines presents individualized blood pressure.

Mentions: Statistical analysis centers on two key stakeholders, i.e., managers and researchers, and participating village doctors. Analysis for the former comprises of two steps. Initial analysis consists of descriptive summaries intended to examine major project deliverables and patterns of the various measurements (Figure 2) and check for normality of the continuous variables. And necessary transformations are explored and selected, if necessary, to induce approximate normality. The next step analyses estimates, using two-sided test of the hypothesis, of the power of differences between the intervention and delayed intervention groups and between different time points in terms of diabetes prevalence rates, accumulated progression rates from pre-diabetics to diabetics, plasma glucose levels, SBP/DBP, BMI, and intervention compliance indicators. For village doctors, analysis produces: a) pre-diabetic specific outcome plots showing the trend in the aforementioned outcome indicators (FPG, BMI, DBP, SBP) compared with that of the normal group (Figure 3); b) village specific performance plots showing the aggregate trend in the outcome and compliance measures of all the participating pre-diabetics within specific villages contrasted with that of all the pre-diabetics in the villages of the same block; c) doctor specific IAS and ranges of top and bottom 25% IASs among all participating village doctors.


Toward integrated and sustainable prevention against diabetes in rural China: study rationale and protocol of eCROPS.

Feng R, Li K, Cheng J, Xie S, Chai J, Wei P, Wang D - BMC Endocr Disord (2013)

Example pre-diabetics specific outcome plot. legend: in (a), red line divides pre-diabetes and diabetes, green line divides pre-diabetes and normal and blue line presents individualized fasting glucose; in (b), red line divides obese and overweight, orange line divides overweight and normal, green line divides normal and underweight and blue line presents individualized body weight; in (c) and (d), red line divides hypertension and normal blood pressure, green line divides normal blood pressure and hypotension and blue lines presents individualized blood pressure.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3750596&req=5

Figure 3: Example pre-diabetics specific outcome plot. legend: in (a), red line divides pre-diabetes and diabetes, green line divides pre-diabetes and normal and blue line presents individualized fasting glucose; in (b), red line divides obese and overweight, orange line divides overweight and normal, green line divides normal and underweight and blue line presents individualized body weight; in (c) and (d), red line divides hypertension and normal blood pressure, green line divides normal blood pressure and hypotension and blue lines presents individualized blood pressure.
Mentions: Statistical analysis centers on two key stakeholders, i.e., managers and researchers, and participating village doctors. Analysis for the former comprises of two steps. Initial analysis consists of descriptive summaries intended to examine major project deliverables and patterns of the various measurements (Figure 2) and check for normality of the continuous variables. And necessary transformations are explored and selected, if necessary, to induce approximate normality. The next step analyses estimates, using two-sided test of the hypothesis, of the power of differences between the intervention and delayed intervention groups and between different time points in terms of diabetes prevalence rates, accumulated progression rates from pre-diabetics to diabetics, plasma glucose levels, SBP/DBP, BMI, and intervention compliance indicators. For village doctors, analysis produces: a) pre-diabetic specific outcome plots showing the trend in the aforementioned outcome indicators (FPG, BMI, DBP, SBP) compared with that of the normal group (Figure 3); b) village specific performance plots showing the aggregate trend in the outcome and compliance measures of all the participating pre-diabetics within specific villages contrasted with that of all the pre-diabetics in the villages of the same block; c) doctor specific IAS and ranges of top and bottom 25% IASs among all participating village doctors.

Bottom Line: These arrangements enable documentation of up to 6 years of consecutive measures and detection of lower incidence of progression into diabetes, improved body max index and blood pressure, and increased service use and involvement in healthy dietary and physical activities among pre-diabetics receiving the experimental intervention compared to themselves at baseline or those in the delayed-intervention control condition.This project is owned and managed by local health authorities and utilizes available resources.It introduces a package of long-term incentives, establishes ongoing mechanisms for continuous capacity building and quality improvement, and builds up an operational cycle for catalyzing similar efforts in the local prefecture even throughout rural China.

View Article: PubMed Central - HTML - PubMed

Affiliation: School of Health Services Management, Anhui Medical University, Hefei 230032, China. dbwang@vip.sina.com.

ABSTRACT

Background: Being an intermediate stage in the development of diabetes, pre-diabetics were estimated as high as 14% to 63% in China and one to three quarters of them will develop into diabetes within 10 years. It is well established that the risk of diabetes progression can be modified substantially and a whole range of proven guidelines, protocols and methodologies are available. Unfortunately, most proven interventions are seldom used in daily practice and this is especially true in resource poor rural China. This project aims at demonstrating that an evolutionary intervention package featuring low cost, integration with routine services, cultural sensitization and self-optimization, is effective and sustainable in preventing diabetes.

Methods/design: This project utilizes a quasi cluster randomized controlled trial and a batched implementation strategy in which villages are recruited in 7 blocks within 7 consecutive years respectively. Block 0 involves 3 villages and provides an opportunity for piloting and refining primitive intervention methodologies and protocols. The following 6 blocks consist of 14 villages each and serve as intervention arm; while all the villages not yet started intervention form the control arm. For each block, measurement happens at baseline and every 12 months (for plasma glucose) or monthly (for body weight and blood pressure) after baseline. These arrangements enable documentation of up to 6 years of consecutive measures and detection of lower incidence of progression into diabetes, improved body max index and blood pressure, and increased service use and involvement in healthy dietary and physical activities among pre-diabetics receiving the experimental intervention compared to themselves at baseline or those in the delayed-intervention control condition.

Discussion: China has a long history of separating disease prevention and treatment systems and there is a clear need to leverages key success factors in a synergetic way toward integrated and sustainable diabetes prevention. This project is owned and managed by local health authorities and utilizes available resources. It introduces a package of long-term incentives, establishes ongoing mechanisms for continuous capacity building and quality improvement, and builds up an operational cycle for catalyzing similar efforts in the local prefecture even throughout rural China.

Trial registration: Current Controlled Trials: ISRCTN66772711.

No MeSH data available.


Related in: MedlinePlus