Challenges of diabetes prevention in the real world : results and lessons from the Melbourne diabetes prevention study
Dunbar, James A., Hernan, Andrea L., Janus, Edward D., Vartiainen, Erkki, Laatikainen, Tiina, Versace, Vincent L., Reynolds, John, Best, James D., Skinner, Timothy C., O'Reilly, Sharleen L., Mc Namara, Kevin P., Stewart, Elizabeth, Coates, Michael, Bennett, Catherine M. and Carter, Rob 2015, Challenges of diabetes prevention in the real world : results and lessons from the Melbourne diabetes prevention study, BMJ open diabetes research and care, vol. 3, no. 1, pp. 1-13, doi: 10.1136/bmjdrc-2015-000131.
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.
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