Evaluation of progression to diabetes in high-risk patients eligible to attend the ‘Walking Away from Diabetes’ educational intervention: a retrospective cohort study
DOI:
https://doi.org/10.15277/bjd.2020.238Keywords:
diabetes, education, exercise, lifestyle, patient education, diabetes riskAbstract
Aims: To retrospectively assess the efficacy of a pragmatic education programme called ‘Walking Away from Diabetes’ (WAD), a single-session intervention aimed at patients who are at risk of developing type 2 diabetes mellitus (T2DM).
Methods: Baseline and follow-up data for 6,116 patients, identified as ‘at risk of diabetes’ in the period April 2012 to March 2016, were assessed for T2DM status in January 2018. Any differences in outcome between WAD attenders and non-attenders was explored using Kaplan–Meier, log rank testing and Cox regression analyses.
Results: During the follow-up period, 426 of 3,470 (12.3%) WAD attenders and 349 of 2,646 (13.2%) non-attenders were diagnosed with T2DM (p=0.068, log rank test). Cox regression showed that HbA1c (hazard ratio (HR) 1.23, p<0.001) and high density lipid levels (HR 0.67, p<0.001) rather than WAD attendance (HR 0.89, p=0.11) were the two main factors associated with progress from ‘at risk’ to T2DM.
Conclusions: Although the wider health impact of the WAD programme was not considered here, session attendance does not appear to reduce the risk of developing T2DM. However, other factors influence the risk of developing T2DM. It is essential for educational programmes, designed to have a preventative effect for people at risk of diabetes, to be assessed for short- and long-term efficacy.
References
Tuomilehto J, Lindstrom J, Eriksson JG, et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 2001;344:1343–50. https://doi.org/10.1056/NEJM200105033441801
Yamaoka K, Tango T. Efficacy of lifestyle education to prevent type 2 diabetes: a meta-analysis of randomized controlled trials. Diabetes Care 2005; 28:2780–6. https://doi.org/10.2337/diacare.28.11.2780
Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002;346:393–403. https://doi.org/10.1056/NEJMoa012512
Kosaka K, Noda M, Kuzuya T. Prevention of type 2 diabetes by lifestyle intervention: a Japanese trial in IGT males. Diabetes Res Clin Pract 2005; 67:152–62.
Ramachandran A, Snehalatha C, Mary S, et al. The Indian Diabetes Prevention Programme shows that lifestyle modification and metformin prevent type 2 diabetes in Asian Indian subjects with impaired glucose tolerance (IDPP-1). Diabetologia 2006;49:289–97. https://doi.org/10.1007/s00125-005-0097-z
Yates T, Davies M, Gorely T, Bull F, Khunti K. Effectiveness of a pragmatic education programme aimed at promoting walking activity in individuals with impaired glucose tolerance: a randomized controlled trial. Diabetes Care 2009;32:1404–10. https://doi.org/10.2337/dc09-0130
Gray LJ, Taub NA, Khunti K, et al. The Leicester Risk Assessment score for detecting undiagnosed type 2 diabetes and impaired glucose regulation for use in a multiethnic UK setting. Diabet Med 2010;27:887–95. https://doi.org/10.1111/j.1464-5491.2010.03037.x
Westgate R, Yates T, Troughton J, Stribling B, Khunti K, Davies MJ. Implementation of a structured education programme aimed at the prevention of type 2 diabetes within routine primary care: p280. Diabetes UK conference, 2011.
Cumbria Observatory, population data on ethnicity, 2011. https://www.cumbriaobservatory.org.uk/population/ (accessed 3 July 2019)
Index of Multiple Deprivation. https://www.gov.uk/government/statistics/english-indices-of-deprivation-2015 (accessed 3 July 2019)
Edelman D, Olsen MK, Dudley TK, Harris AC, Oddone EZ. Utility of hemoglobin A1c in predicting diabetes risk. J Gen Intern Med 2004; 19:1175–80. https://doi.org/10.1111/j.1525-1497.2004.40178.x
Schmidt MI, Duncan BB, Bang H et al. Identifying individuals at high risk for diabetes: The Atherosclerosis Risk in Communities study. Diabetes care 2005;28:2013-18. https://doi.org/10.2337/diacare.28.8.2013
Look AHEAD Research Group. Long term effects of a lifestyle intervention on weight and cardiovascular risk factors in individuals with type 2 diabetes: four year results of the Look AHEAD trial. Arch Intern Med 2010; 170:1566–75. https://doi.org/10.1001/archinternmed.2010.334
Lindström J, Ilanne-Parikka P, Peltonen M, et al. Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: follow-up of the Finnish Diabetes Prevention Study. Lancet 2006;368(9548):1673–9. https://doi.org/10.1016/S0140-6736(06)69701-8
NHS Diabetes Prevention Programme. https://www.england.nhs.uk/diabetes/diabetes-prevention/ (accessed 3 July 2019)
Healthier You Diabetes Prevention Programme. https://preventing-diabetes.co.uk/ (accessed 3 July 2019).
Penn L, Rodrigues A, Haste A, et al. NHS Diabetes Prevention Programme in England: formative evaluation of the programme in early phase implementation. BMJ Open 2018;8(2):e019467. http://dx.doi.org/10.1136/bmjopen-2017-019467
Barron E, Clark R, Hewings R, Smith J, Valabhji J. Progress of the Healthier You: NHS Diabetes Prevention Programme: referrals, uptake and participant characteristics. Diabet Med 2018;35:513–18. https://doi.org/10.1111/dme.13562
References not cited in text
Diabetes UK. Cost of diabetes care in the UK. https://www.diabetes.co.uk/costof-diabetes.html (accessed 3 July 2019).
Ali MK, Echouffo-Tcheugui JB, Williamson DF. How effective were lifestyle interventions in real-world settings that were modeled on the Diabetes Prevention Program? Health Affairs 2012;31:67–75.
NICE. Public health guideline [PH38]. Type 2 diabetes: prevention in people at high risk. https://www.nice.org.uk/guidance/PH38/
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