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Challenges of diabetes prevention in the real world: results and lessons from the Melbourne Diabetes Prevention Study.

Dunbar JA, Hernan AL, Janus ED, Vartiainen E, Laatikainen T, Versace VL, Reynolds J, Best JD, Skinner TC, O'Reilly SL, Mc Namara KP, Stewart E, Coates M, Bennett CM, Carter R - BMJ Open Diabetes Res Care (2015)

Bottom Line: In PPS analyses, intervention participants significantly improved in weight (-1.13 kg, p=0.016), waist circumference (-1.35 cm, p=0.044), systolic (-5.2 mm Hg, p=0.028) and diastolic blood pressure (-3.2 mm Hg, p=0.030) compared with controls.Absolute 5-year cardiovascular disease (CVD) risk reduced significantly for intervention participants by 0.97 percentage points from 9.35% (10.4% relative risk reduction).The net effect for the change in CVD risk was -1.08 percentage points of absolute risk (p=0.013).

View Article: PubMed Central - PubMed

Affiliation: Faculty of Health , Deakin Population Health Strategic Research Centre, Deakin University, Melbourne Burwood Campus , Burwood, Victoria , Australia.

ABSTRACT

Objective: To assess effectiveness and implementability of the public health programme Life! Taking action on diabetes in Australian people at risk of developing type 2 diabetes.

Research design and methods: Melbourne Diabetes Prevention Study (MDPS) was a unique study assessing effectiveness of Life! that used a randomized controlled trial design. Intervention participants with AUSDRISK score ≥15 received 1 individual and 5 structured 90 min group sessions. Controls received usual care. Outcome measures were obtained for all participants at baseline and 12 months and, additionally, for intervention participants at 3 months. Per protocol set (PPS) and intention to treat (ITT) analyses were performed.

Results: PPS analyses were considered more informative from our study. In PPS analyses, intervention participants significantly improved in weight (-1.13 kg, p=0.016), waist circumference (-1.35 cm, p=0.044), systolic (-5.2 mm Hg, p=0.028) and diastolic blood pressure (-3.2 mm Hg, p=0.030) compared with controls. Based on observed weight change, estimated risk of developing diabetes reduced by 9.6% in the intervention and increased by 3.3% in control participants. Absolute 5-year cardiovascular disease (CVD) risk reduced significantly for intervention participants by 0.97 percentage points from 9.35% (10.4% relative risk reduction). In control participants, the risk increased by 0.11 percentage points (1.3% relative risk increase). The net effect for the change in CVD risk was -1.08 percentage points of absolute risk (p=0.013).

Conclusions: MDPS effectively reduced the risk of diabetes and CVD, but the intervention effect on weight and waist reduction was modest due to the challenges in recruiting high-risk individuals and the abbreviated intervention.

No MeSH data available.


Related in: MedlinePlus

Structure of the Melbourne Diabetes Prevention Study (MDPS).
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BMJDRC2015000131F1: Structure of the Melbourne Diabetes Prevention Study (MDPS).

Mentions: The intervention consisted of an initial 30–45 min individual session followed by five structured 90 min group sessions. The goals were: ≤30% energy from fat; ≤10% energy from saturated fat; ≥15 g/1000 kcal fiber; ≥30 min/day moderate-intensity physical activity; and ≥5% body weight reduction.4 Lifestyle change processes and detailed goals were individually tailored using problem-solving and goal-setting approaches. Trained MDPS facilitators (backgrounds in psychology, nutrition/dietetics and nursing) delivered all intervention sessions. The individual session was designed to maximize participant retention, increase personal risk awareness, undertake goal setting, and motivate change. Four group sessions followed at two-week intervals (generally 8–15 participants per group) and the final fifth session occurred 8 months after the initial group session (figure 1). Control participants were told of their high risk but continued with usual care from their GPs.


Challenges of diabetes prevention in the real world: results and lessons from the Melbourne Diabetes Prevention Study.

Dunbar JA, Hernan AL, Janus ED, Vartiainen E, Laatikainen T, Versace VL, Reynolds J, Best JD, Skinner TC, O'Reilly SL, Mc Namara KP, Stewart E, Coates M, Bennett CM, Carter R - BMJ Open Diabetes Res Care (2015)

Structure of the Melbourne Diabetes Prevention Study (MDPS).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4597415&req=5

BMJDRC2015000131F1: Structure of the Melbourne Diabetes Prevention Study (MDPS).
Mentions: The intervention consisted of an initial 30–45 min individual session followed by five structured 90 min group sessions. The goals were: ≤30% energy from fat; ≤10% energy from saturated fat; ≥15 g/1000 kcal fiber; ≥30 min/day moderate-intensity physical activity; and ≥5% body weight reduction.4 Lifestyle change processes and detailed goals were individually tailored using problem-solving and goal-setting approaches. Trained MDPS facilitators (backgrounds in psychology, nutrition/dietetics and nursing) delivered all intervention sessions. The individual session was designed to maximize participant retention, increase personal risk awareness, undertake goal setting, and motivate change. Four group sessions followed at two-week intervals (generally 8–15 participants per group) and the final fifth session occurred 8 months after the initial group session (figure 1). Control participants were told of their high risk but continued with usual care from their GPs.

Bottom Line: In PPS analyses, intervention participants significantly improved in weight (-1.13 kg, p=0.016), waist circumference (-1.35 cm, p=0.044), systolic (-5.2 mm Hg, p=0.028) and diastolic blood pressure (-3.2 mm Hg, p=0.030) compared with controls.Absolute 5-year cardiovascular disease (CVD) risk reduced significantly for intervention participants by 0.97 percentage points from 9.35% (10.4% relative risk reduction).The net effect for the change in CVD risk was -1.08 percentage points of absolute risk (p=0.013).

View Article: PubMed Central - PubMed

Affiliation: Faculty of Health , Deakin Population Health Strategic Research Centre, Deakin University, Melbourne Burwood Campus , Burwood, Victoria , Australia.

ABSTRACT

Objective: To assess effectiveness and implementability of the public health programme Life! Taking action on diabetes in Australian people at risk of developing type 2 diabetes.

Research design and methods: Melbourne Diabetes Prevention Study (MDPS) was a unique study assessing effectiveness of Life! that used a randomized controlled trial design. Intervention participants with AUSDRISK score ≥15 received 1 individual and 5 structured 90 min group sessions. Controls received usual care. Outcome measures were obtained for all participants at baseline and 12 months and, additionally, for intervention participants at 3 months. Per protocol set (PPS) and intention to treat (ITT) analyses were performed.

Results: PPS analyses were considered more informative from our study. In PPS analyses, intervention participants significantly improved in weight (-1.13 kg, p=0.016), waist circumference (-1.35 cm, p=0.044), systolic (-5.2 mm Hg, p=0.028) and diastolic blood pressure (-3.2 mm Hg, p=0.030) compared with controls. Based on observed weight change, estimated risk of developing diabetes reduced by 9.6% in the intervention and increased by 3.3% in control participants. Absolute 5-year cardiovascular disease (CVD) risk reduced significantly for intervention participants by 0.97 percentage points from 9.35% (10.4% relative risk reduction). In control participants, the risk increased by 0.11 percentage points (1.3% relative risk increase). The net effect for the change in CVD risk was -1.08 percentage points of absolute risk (p=0.013).

Conclusions: MDPS effectively reduced the risk of diabetes and CVD, but the intervention effect on weight and waist reduction was modest due to the challenges in recruiting high-risk individuals and the abbreviated intervention.

No MeSH data available.


Related in: MedlinePlus