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Adherence to diabetes prevention program reduces risk for disease progression
Patients with prediabetes who adhered to a relatively low-cost, practical diabetes prevention program progressed to diabetes at a lower rate than those who attended only one program session or who received standard care, according to recent study findings.
Laura J. Gray, MSc, PhD, of the department of health sciences at the University of Leicester in the United Kingdom, and colleagues evaluated 880 participants from the previously completed Let’s Prevent Diabetes trial, a cluster randomized controlled trial that randomly assigned 43 general practices to provide patients with a type 2 diabetes prevention education program (n = 447) or usual care (n = 433).
Eligible study participants were white European patients aged 40 to 75 years and South Asian patients aged 25 to 75 years, and all were identified as having nondiabetic hyperglycemia through a two-stage risk score screening program.
The intervention program was a group-based education program reinforced by psychological concepts designed to promote realistic perceptions of nondiabetic hyperglycemia and encourage specific health behaviors, such as weight loss, healthy diet and increased exercise. The program entailed a 6-hour baseline session followed by 3-hour refreshers at 12 and 24 months. Participants in the standard care cohort were given information booklets detailing risk factors for type 2 diabetes and the impact of diet and lifestyle changes on prevention progression.
The trial’s primary outcome was defined as progression to type 2 diabetes at 3 years. Participants in the intervention arm were stratified by attendance at sessions. The baseline characteristics of patients who attended the first education session (engagers) were compared with those who did not (nonengagers). Additionally, those who attended all intervention sessions (retainers) were also compared to those who did not attend all sessions (nonretainers). The researchers compared the number of people to develop type 2 diabetes over the 3-year period by education attendance level.
Of participants randomized to the intervention program, 77% attended the initial 6-hour education session and were deemed engagers, while 29.1% attended all sessions and were designated retainers. Fifty-five percent of participants attended the initial session plus at least one refresher session.
While the intention-to-treat primary analysis of the Let’s Prevent Diabetes trial revealed no decrease in the incidence of type 2 diabetes (incidence rate, 57.60 per 1,000 person-years in the intervention group vs. 63.16 per 1,000 person-years in standard care group), a dose-response relationship was observed when comparing the incidence between intervention and standard care group by attendance. A greater decrease in incidence was seen with increasing retention in the education program, with retainers showing an incidence rate of 16.86 per 1,000 person-years. Compared with standard care, a statistically significant decrease in type 2 diabetes incidence was seen in patients who attended the first session and at least one refresher session (30 patients out of 248 vs. 67 patients out of 433; HR = 0.38; 95% CI, 0.236-0.62) and in retainers (7 patients out of 130 vs. 67 patients out of 433; HR = 0.12; 95% CI, 0.05-0.28). These findings persisted in an analysis adjusting for age, sex, socioeconomic deprivation score, smoking status and BMI.
Retainers also demonstrated statistically significant improvements in fasting and 2-hour glucose and HbA1c vs. standard care patients and nonretainers, with an average 0.16% lower HbA1c values vs. standard care at 3 years. Retainers had lower weight, BMI and weight circumference vs. standard care and non-retainers, weighing an average of 1.7 kg less than nonretainers and 1.28 less than standard care patients. Retainers had lower levels of anxiety and higher quality of life measures vs. standard care, and had a significantly higher daily step count (925 steps) vs. those in the standard care arm.
[type 2 diabetes], we have shown a large difference in [type 2 diabetes] incidence over 3 years in those who attended all education sessions compared to standard care,” the researchers wrote. “Importantly, these relationships were independent of age, sex, smoking status, deprivation score, and BMI.” – by Jennifer Byrne
Disclosure: Gray reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.