A randomized trial to test the effectiveness of two technology-enhanced diabetes prevention programs in primary care: The DiaBEAT-it Study. (Preprint)

2021 ◽  
Author(s):  
Fabio Araujo Almeida ◽  
Wen You ◽  
Fabiana Almeida Brito ◽  
Thais Favero Alves ◽  
Cody L Goessl ◽  
...  
Keyword(s):  
Physical Activity ◽  
Type 2 Diabetes ◽  
Primary Care ◽  
At Risk ◽  
Weight Loss ◽  
Small Group ◽  
Diabetes Prevention ◽  
Action Plan ◽  
Activity Class

BACKGROUND Lifestyle interventions targeting physical activity and improved eating habits have demonstrated that modest weight loss can prevent or delay the onset of type-2 diabetes. However, translation of these interventions into typical clinical programs remains a challenge. OBJECTIVE To evaluate the effectiveness of two technology-enhanced interventions for diabetes prevention among adults at risk for developing diabetes in a primary care setting. METHODS The DiaBEAT-it study employed a hybrid 2-group preference (Choice) and 3-group randomized controlled (RCT) design. This paper presents the weight related primary outcomes of the RCT arm. Patients from Southwest Virginia were identified through the Carilion Clinic electronic health records. Eligible participants (18 and older, BMI≥25, no Type 2 Diabetes) were randomized to either Choice (n=264) or RCT (n=334). RCT individuals were further randomized to one of three groups: (1) a 2-hour small group class to help patients develop a personal action plan to prevent diabetes (SC, n=117); (2) a 2-hour small group class plus automated telephone calls using an interactive voice response system (IVR) to help participants initiate weight loss through a healthful diet and regular physical activity (Class/IVR, n=110); or (3) a DVD with same content as the class plus the same IVR calls over a period of 12 months (DVD/IVR, n=107). Height was assessed with a calibrated stadiometer, weight with a calibrated Health-O-Meter stand-on scale. RESULTS Intention to treat analyses, controlling for gender, race, age and baseline BMI, showed that DVD/IVR and Class/IVR led to reductions in BMI at 6 (DVD/IVR -0.94, p<.001; Class/IVR -0.70, p<.01), 12 (DVD/IVR -0.88, p<.001; Class/IVR-0.82, p<.001) and 18 (DVD/IVR -0.78, p<.001; Class/IVR -0.58, p<.01) months. All three groups showed a significant number of participants losing at least 5% of their body weight at 12 months (DVD/IVR 26.87%; Class/IVR 21.62%; SC 16.85%). When comparing groups, DVD/IVR were significantly more likely to decrease BMI at 6 months (p<.05) and maintain the reduction at 18 months (p<.05) when compared to SC. There were no differences between the other groups. CONCLUSIONS These findings suggest that both IVR delivered interventions were effective in reducing and maintaining weight reduction in a group of primary care patients at risk for developing type 2 diabetes. The DiaBEAT-it interventions show promise in responding to the need for scalable, effective methods to manage obesity and prevent diabetes in primary care settings that do not over burden primary care clinics and providers. CLINICALTRIAL clinicaltrials.gov NCT02162901, https://clinicaltrials.gov/ct2/show/NCT02162901 INTERNATIONAL REGISTERED REPORT RR2-doi: 10.1016/j.cct.2014.06.010

How to Maintain a Healthy Body Weight

2006 ◽  
Vol 76 (4) ◽  
pp. 208-215 ◽  
Author(s):  
Astrup
Keyword(s):  
Physical Activity ◽  
Type 2 Diabetes ◽  
Weight Loss ◽  
Body Weight ◽  
Glycemic Index ◽  
Dairy Products ◽  
Weight Control ◽  
Healthy Body Weight ◽  
Healthy Body

The epidemic of both obesity and type 2 diabetes is due to environmental factors, but the individuals developing the conditions possess a strong genetic predisposition. Observational surveys and intervention studies have shown that excess body fatness is the major environmental cause of type 2 diabetes, and that even a minor weight loss can prevent its development in high-risk subjects. Maintenance of a healthy body weight in susceptible individuals requires 45–60 minutes physical activity daily, a fat-reduced diet with plenty of fruit, vegetables, whole grain, and lean meat and dairy products, and moderate consumption of calorie containing beverages. The use of table values to predict the glycemic index of meals is of little – if any – value, and the role of a low-glycemic index diet for body weight control is controversial. The replacement of starchy carbohydrates with protein from lean meat and lean dairy products enhances satiety, and facilitate weight control. It is possible that dairy calcium also promotes weight loss, although the mechanism of action remains unclear. A weight loss of 5–10% can be induced in almost all obese patients providing treatment is offered by a professional team consisting of a physician and dieticians or nurses trained to focus on weight loss and maintenance. Whereas increasing daily physical activity and regular exercise does not significantly effect the rate of weight loss in the induction phase, it plays an important role in the weight maintenance phase due to an impact on daily energy expenditure and also to a direct enhancement of insulin sensitivity.

Weight and Physical Activity: a 12-month follow-up of a digital diabetes prevention program (VP Transform for Prediabetes) in adults with prediabetes (Preprint)

2020 ◽  
Author(s):  
Ryan Batten ◽  
Meshari F Alwashmi ◽  
Gerald Mugford ◽  
Misa Muccio ◽  
Angele Besner ◽  
...  
Keyword(s):  
Physical Activity ◽  
Type 2 Diabetes ◽  
Prevention Program ◽  
Diabetes Prevention ◽  
Secondary Analysis ◽  
Diabetes Prevention Program ◽  
Global Scale ◽  
Lifestyle Modifications ◽  
Behavior Tracking

BACKGROUND The prevalence of diabetes increasingly rapidly. Previous research has demonstrated the efficacy of a diabetes prevention program (DPP) in lifestyle modifications which can prevent or delay the onset of type 2 diabetes among individuals at-risk. Digital DPPs have the potential to utilize technology, in conjunction with behavior change science, to prevent prediabetes on a national and global scale OBJECTIVE The aim of this study was to investigate the effects of a digital DPP (VP Transform for Prediabetes) on weight loss and physical activity among participants who had completed twelve months of the program. METHODS This study was a secondary analysis of retrospective data of adults with prediabetes who were enrolled in VP Transform for Prediabetes for 12 months of the program. The program incorporates interactive mobile computing, remote monitoring, an evidence-based curriculum, behavior tracking tools, health coaching and online peer support to prevent or delay the onset of type 2 diabetes. Analysis included data that were collected at baseline and after 12 months of the VP Transform for Prediabetes DPP. RESULTS The sample (N=1,095) comprised people with prediabetes who completed 12 months of the VP Transform for Prediabetes program. Participants included 67.7% female, with a mean age of 53.6 (SD 9.75). On average, participants decreased their weight by 10.9 pounds (5.5%) and increased their physical activity by 91.2 minutes per week. CONCLUSIONS These results suggest that VP Transform for Prediabetes is effective at preventing type 2 diabetes through significant reduction in body weight and increase of physical activity. Furthermore, these results suggest that the DPP remains effective 12 months after beginning the program. A prospective, controlled clinical study is warranted to validate these findings.

scholarly journals Effectiveness of two procedures for deploying a facilitated collaborative modeling implementation strategy—the PVS-PREDIAPS strategy—to optimize type 2 diabetes prevention in primary care: the PREDIAPS cluster randomized hybrid type II implementation trial

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Alvaro Sanchez ◽  
◽  
Susana Pablo ◽  
Arturo Garcia-Alvarez ◽  
Silvia Dominguez ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Diabetes Prevention ◽  
Implementation Strategy ◽  
Type Ii ◽  
Collaborative Process ◽  
Type 2 Diabetes Prevention ◽  
Cluster Randomized ◽  
Implementation Trial

Abstract Background The most efficient procedures to engage and guide healthcare professionals in collaborative processes that seek to optimize practice are unknown. The PREDIAPS project aims to assess the effectiveness and feasibility of different procedures to perform a facilitated interprofessional collaborative process to optimize type 2 diabetes prevention in routine primary care. Methods A type II hybrid cluster randomized implementation trial was conducted in nine primary care centers of the Basque Health Service. All centers received training on effective healthy lifestyle promotion. Headed by a local leader and an external facilitator, centers conducted a collaborative structured process—the PVS-PREDIAPS implementation strategy—to adapt the intervention and its implementation to their specific context. The centers were randomly allocated to one of two groups: one group applied the implementation strategy globally, promoting the cooperation of all health professionals from the beginning, and the other performed it sequentially, centered first on nurses, who later sought the pragmatic cooperation of physicians. The following patients were eligible for inclusion: all those aged ≥ 30 years old with at least one known cardiovascular risk factor and an impaired fasting glucose level (≥ 110-125 mg/dl) but without diabetes who attended centers during the study period. The main outcome measures concerned changes in type 2 diabetes prevention practice indicators after 12 months. Results After 12 months, 3273 eligible patients at risk of type 2 diabetes had attended their family physician at least once, and of these, 490 (15%) have been addressed by assessing their healthy lifestyles in both comparison groups. The proportion of at-risk patients receiving a personalized prescription of lifestyle change was slightly higher (8.6%; range 13.5-5.9% vs 6.8%; range 7.2-5.8%) and 2.3 times more likely (95% CI for adjusted hazard ratio, 1.38-3.94) in the sequential than in the global centers, after 8 months of the intervention program implementation period. The probability of meeting the recommended levels of physical activity and fruit and vegetable intake were four- and threefold higher after the prescription of lifestyle change than only assessment and provision of advice. The procedure of engagement in and execution of the implementation strategy does not modify the effect of prescribing healthy habits (p interaction component of intervention by group, p > 0.05). Discussion Our results show that the PVS-PREDIAPS implementation strategy manages to integrate interventions with proven efficacy in the prevention of type 2 diabetes in clinical practice in primary care. Further, they suggest that implementation outcomes were somewhat better with a sequential facilitated collaborative process focused on enhancing the autonomy and responsibility of nurses who subsequently seek a pragmatic cooperation of GPs. Trial registration Clinicaltrials.gov identifier: NCT03254979. Registered 16 August 2017—retrospectively registered.

scholarly journals Physical activity versus metformin for increasing insulin sensitivity in children and adolescents at-risk for type 2 diabetes

2016 ◽  
Vol 85 (2) ◽  
pp. 26-28
Author(s):  
Andrew D Hanna ◽  
Natalie V Scime
Keyword(s):  
Physical Activity ◽  
Type 2 Diabetes ◽  
At Risk ◽  
Insulin Sensitivity ◽  
Children And Adolescents ◽  
Pediatric Population ◽  
Current Evidence ◽  
Beneficial Effects ◽  
Pediatric Populations

Global rates of type 2 diabetes (T2D) among children and adolescents are steadily rising. As such, an increasing amount of attention and research has begun to focus on strategies to prevent this chronic and burdensome disease in pediatric populations. The purpose of this article is to briefly review current evidence pertaining to the effectiveness of physical activity versus metformin in improving insulin sensitivity of children at-risk (ie, obese and/or insulin resistant) for developing T2D. Potential barriers to each preventative intervention will also be discussed. Physical activity, both aerobic and resistance, has demonstrated effectiveness in a moderate number of demographically diverse pediatric studies. However, the pediatric population is already alarmingly sedentary with barriers such as lack of motivation, social stigma and discomfort presenting a challenge. A small number of studies have demonstrated the beneficial effects of metformin in children and adolescents for improved insulin sensitivity. However, longer and larger studies are required to confirm these findings and elucidate upon the long-term safety and efficacy of this pharmaceutical in pediatric populations. While no head-to-head studies examining physical activity and metformin exist in pediatric populations and more research is needed, current evidence seems to favour the use of physical activity given the larger quantity of studies and generalizability of its beneficial effects. Thus, physical activity should be emphasized in clinical and public health practice when targeting at-risk children and adolescents to prevent a T2D diagnosis.

scholarly journals Sleep Restriction Decreases the Physical Activity of Adults at Risk for Type 2 Diabetes

SLEEP ◽  
2012 ◽  
Vol 35 (7) ◽  
pp. 977-984 ◽  
Author(s):  
Lindsay E. Bromley ◽  
John N. Booth ◽  
Jennifer M. Kilkus ◽  
Jacqueline G. Imperial ◽  
Plamen D. Penev
Keyword(s):  
Physical Activity ◽  
Type 2 Diabetes ◽  
At Risk ◽  
Sleep Restriction

scholarly journals Importance of Weight Loss Maintenance and Risk Prediction in the Prevention of Type 2 Diabetes: Analysis of European Diabetes Prevention Study RCT

PLoS ONE ◽  
2013 ◽  
Vol 8 (2) ◽  
pp. e57143 ◽  
Author(s):  
Linda Penn ◽  
Martin White ◽  
Jaana Lindström ◽  
Annemieke Th. den Boer ◽  
Ellen Blaak ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Weight Loss ◽  
Risk Prediction ◽  
Diabetes Prevention ◽  
Weight Loss Maintenance ◽  
Prevention Study ◽  
Diabetes Prevention Study
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