Predictors of completing a primary health care diabetes prevention intervention programme in people at high risk of type 2 diabetes: Experiences of the DE-PLAN project.

Medicine. 2018;97(5):e9790

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Plain language summary

As the prevalence of type 2 diabetes (T2D) begins to grow, the spotlight is on successful, cost-effective lifestyle interventions to help prevent it. Real-life implementation studies in various settings and with various people have shown than lower cost, less intensive interventions can help prevent T2D. The DE-PLAN (Diabetes in Europe: Prevention Using Lifestyle, Physical Activity and Nutritional Intervention) was implemented across 17 European countries, where it aimed to assess its application but also to create a network of trained professionals to deliver T2D prevention. This study aimed to explore the factors associated with completing the programme in primary healthcare in Poland. The study included nine GP practices in Krakow with 262 people at high risk of T2D (according to the Finnish Diabetes Risk Score). The prevention programme included 11 lifestyle counselling sessions, physical activity sessions and motivational phone calls/letters. Measurements including fasting glucose, body mass index and blood pressure were taken at baseline and 1 year after the programme. People who completed the whole programme were less likely to be employed, less likely to have high blood pressure and ate more fruits and vegetables each day. The authors concluded that people who healthier behaviours were more likely to complete the programme, whereas men and people who work were less likely to complete the programme. More strategies are needed to increase completion with these individuals.

Abstract

It has been shown that real-life implementation studies for the prevention of type 2 diabetes (DM2) performed in different settings and populations can be effective. However, not enough information is available on factors influencing the reach of DM2 prevention programmes. This study examines the predictors of completing an intervention programme targeted at people at high risk of DM2 in Krakow, Poland as part of the DE-PLAN project.A total of 262 middle-aged people, everyday patients of 9 general practitioners' (GP) practices, at high risk of DM2 (Finnish Diabetes Risk Score (FINDRISK) >14) agreed to participate in the lifestyle intervention to prevent DM2. Intervention consisted of 11 lifestyle counseling sessions, organized physical activity sessions followed by motivational phone calls and letters. Measurements were performed at baseline and 1 year after the initiation of the intervention.Seventy percent of the study participants enrolled completed the core curriculum (n = 184), 22% were men. When compared to noncompleters, completers had a healthier baseline diabetes risk profile (P <.05). People who completed the intervention were less frequently employed versus noncompleters (P = .037), less often had hypertension (P = .043), and more frequently consumed vegetables and fruit daily (P = .055).In multiple logistic regression model, employment reduced the likelihood of completing the intervention 2 times (odds ratio [OR] 0.45, 95% confidence interval [CI] 0.25-0.81). Higher glucose 2 hours after glucose load and hypertension were the independent factors decreasing the chance to participate in the intervention (OR 0.79, 95% 0.69-0.92 and OR 0.52, 95% CI 0.27-0.99, respectively). Daily consumption of vegetables and fruits increased the likelihood of completing the intervention (OR 1.86, 95% 1.01-3.41).In conclusion, people with healthier behavior and risk profile are more predisposed to complete diabetes prevention interventions. Male, those who work and those with a worse health profile, are less likely to participate and complete interventions. Targeted strategies are needed in real-life diabetes prevention interventions to improve male participation and to reach those who are working as well as people with a higher risk profile.

Functional medicine

Fundamental Clinical Imbalances : Hormonal
Patient Centred Factors : Antecedents/Health risk profile
Environmental Inputs : Diet ; Physical exercise ; Mind and spirit
Personal Lifestyle Factors : Relationships and network ; Exercise and movement
Functional Laboratory Testing : Blood

Methodological quality

Allocation concealment : Not applicable
Publication Type : Journal Article ; Observational Study

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