Engagement key to diabetes prevention success
medwireNews: A “relatively low-resource, pragmatic” intervention can prevent high-risk patients from progressing to Type 2 diabetes, but only if their engagement is sustained, shows analysis of the Let’s Prevent Diabetes trial.
The intervention involved a 6-hour structured education session on healthy behaviours, with 3-hour refresher sessions after 12 and 24 months and supportive 15-minute phone calls every 3 months.
In the trial’s previously published primary analysis, this intervention did not reduce the risk of patients with prediabetes progressing to diabetes, compared with standard care. But the latest analysis shows that those patients who remained engaged with the intervention throughout (29.1% of 447 patients) had a significant 88% reduced risk of progressing to diabetes, relative to the 433 patients who received standard care.
And the 55.5% of patients who attended the initial session plus one of the refresher courses had a significant 62% reduced risk, report Laura Gray (University of Leicester, UK) and study co-authors in PLoS Medicine.
The diabetes incidence rates per 1000 person–years were 16.86 among patients who attended all sessions, 39.61 among those who missed one refresher session, 53.04 among those who attended the initial session only and 63.13 among those assigned to standard care.
“Importantly, these relationships were independent of age, sex, smoking status, deprivation score, and [body mass index]”, says the team.
Patients who remained engaged throughout also did better than those in standard care for some key secondary outcomes, including change in glucose levels, glycated haemoglobin, waist circumference and step count.
Patients who did not even attend the first session were younger than those who did, at an average of 62.5 versus 64.3 years.
“The younger age may be related to employment and availability to attend multiple sessions run during the working week,” say the researchers. “Prevention programmes in clinical practice should offer sessions at a variety of times and at weekends or in the workplace.”
Non-engagers were also more likely than engagers to be smokers (21.8 vs 4.6%) and they had a higher average body mass index, indicating a higher-risk group that it is essential to engage in preventive measures, say Gray et al. Patients who did not engage also had a higher deprivation score than engagers, but this was not a factor in retaining patients.
The researchers believe their findings could be relevant to the NHS Diabetes Prevention Programme (NDPP), which is being implemented this year, saying that “the providers of the NDPP may want to focus some additional resources on these hard-to-engage-and-retain groups, such as those of working age and those from deprived areas.”
medwireNews is an independent medical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2016