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A peer-support lifestyle intervention for preventing type 2 diabetes in India: A cluster-randomized controlled trial of the Kerala Diabetes Prevention Program

Thankappan, KR, Sathish, T, Tapp, RJ, Shaw, JE, Lotfaliany, M, Wolfe, R, Absetz, P, Mathews, E, Aziz, Z, Williams, ED, Fisher, EB, Zimmet, PZ, Mahal, A, Balachandran, S, D'Esposito, F, Sajeev, P, Thomas, E and Oldenburg, B 2018, A peer-support lifestyle intervention for preventing type 2 diabetes in India: A cluster-randomized controlled trial of the Kerala Diabetes Prevention Program, PLoS Medicine, vol. 15, no. 6, pp. 1-23, doi: 10.1371/journal.pmed.1002575.

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Title A peer-support lifestyle intervention for preventing type 2 diabetes in India: A cluster-randomized controlled trial of the Kerala Diabetes Prevention Program
Author(s) Thankappan, KR
Sathish, T
Tapp, RJ
Shaw, JE
Lotfaliany, MORCID iD for Lotfaliany, M orcid.org/0000-0001-6594-9004
Wolfe, R
Absetz, P
Mathews, E
Aziz, Z
Williams, ED
Fisher, EB
Zimmet, PZ
Mahal, A
Balachandran, S
D'Esposito, F
Sajeev, P
Thomas, E
Oldenburg, B
Journal name PLoS Medicine
Volume number 15
Issue number 6
Article ID e1002575
Start page 1
End page 23
Total pages 23
Publisher PLOS
Place of publication San Francisco, CA
Publication date 2018-06-06
ISSN 1549-1277
Keyword(s) Diabetes mellitus
Diabetes prevention
Cardiovascular disease risk
Physical activity
Medical risk factors
Alcohol consumption
Type 2 diabetes risk
India
Science & Technology
Life Sciences & Biomedicine
Medicine, General & Internal
General & Internal Medicine
IMPAIRED GLUCOSE-TOLERANCE
ASIAN INDIANS
HEALTH
RISK
PROGRESSION
CARE
CHOLESTEROL
METFORMIN
EFFICACY
MELLITUS
Summary Background: The major efficacy trials on diabetes prevention have used resource-intensive approaches to identify high-risk individuals and deliver lifestyle interventions. Such strategies are not feasible for wider implementation in low- and middle-income countries (LMICs). We aimed to evaluate the effectiveness of a peer-support lifestyle intervention in preventing type 2 diabetes among high-risk individuals identified on the basis of a simple diabetes risk score. Methods and findings: The Kerala Diabetes Prevention Program was a cluster-randomized controlled trial conducted in 60 polling areas (clusters) of Neyyattinkara taluk (subdistrict) in Trivandrum district, Kerala state, India. Participants (age 30–60 years) were those with an Indian Diabetes Risk Score (IDRS) ≥60 and were free of diabetes on an oral glucose tolerance test (OGTT). A total of 1,007 participants (47.2% female) were enrolled (507 in the control group and 500 in the intervention group). Participants from intervention clusters participated in a 12-month community-based peer-support program comprising 15 group sessions (12 of which were led by trained lay peer leaders) and a range of community activities to support lifestyle change. Participants from control clusters received an education booklet with lifestyle change advice. The primary outcome was the incidence of diabetes at 24 months, diagnosed by an annual OGTT. Secondary outcomes were behavioral, clinical, and biochemical characteristics and health-related quality of life (HRQoL). A total of 964 (95.7%) participants were followed up at 24 months. Baseline characteristics of clusters and participants were similar between the study groups. After a median follow-up of 24 months, diabetes developed in 17.1% (79/463) of control participants and 14.9% (68/456) of intervention participants (relative risk [RR] 0.88, 95% CI 0.66–1.16, p = 0.36). At 24 months, compared with the control group, intervention participants had a greater reduction in IDRS score (mean difference: −1.50 points, p = 0.022) and alcohol use (RR 0.77, p = 0.018) and a greater increase in fruit and vegetable intake (≥5 servings/day) (RR 1.83, p = 0.008) and physical functioning score of the HRQoL scale (mean difference: 3.9 score, p = 0.016). The cost of delivering the peer-support intervention was US$22.5 per participant. There were no adverse events related to the intervention. We did not adjust for multiple comparisons, which may have increased the overall type I error rate. Conclusions: A low-cost community-based peer-support lifestyle intervention resulted in a nonsignificant reduction in diabetes incidence in this high-risk population at 24 months. However, there were significant improvements in some cardiovascular risk factors and physical functioning score of the HRQoL scale. Trial registration: Australia and New Zealand Clinical Trials Registry ACTRN12611000262909.
Language eng
DOI 10.1371/journal.pmed.1002575
Indigenous content off
Field of Research 11 Medical and Health Sciences
HERDC Research category C1 Refereed article in a scholarly journal
Copyright notice ©2018, Thankappan et al.
Free to Read? Yes
Use Rights Creative Commons Attribution licence
Persistent URL http://hdl.handle.net/10536/DRO/DU:30144092

Document type: Journal Article
Collections: Faculty of Health
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Every reasonable effort has been made to ensure that permission has been obtained for items included in DRO. If you believe that your rights have been infringed by this repository, please contact drosupport@deakin.edu.au.