A community based primary prevention programme for type 2 diabetes integrating identification and lifestyle intervention for prevention: the Let's Prevent Diabetes cluster randomised controlled trial
A community based primary prevention programme for type 2 diabetes integrating identification and lifestyle intervention for prevention: the Let's Prevent Diabetes cluster randomised controlled trial
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DOI：
10.1016/j.ypmed.2015.12.012
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发表时间：
2016-03-01
影响因子：
5.1
通讯作者：
Yates, Thomas
中科院分区：
文献类型：
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作者：
Davies, Melanie J.;Gray, Laura J.;Yates, Thomas
目标。预防2型糖尿病(T2 DM)是医疗保健领域的优先事项，但缺乏调查如何将预防研究有效地转化为英国初级保健环境的证据。我们评估了针对生活方式和行为改变的结构化教育计划在预防糖尿病前期患者进展为T2 DM方面是否有效。材料和方法。44名普通医生随机接受标准护理或6小时的团体结构化教育计划，其中包括年度进修课程和定期电话联系。对参与者进行了3年的随访。主要结果是进展到T2 DM。共纳入880名受试者(女性36%，平均年龄岁，少数民族占16%)；与标准护理组相比，干预组发生T2 DM的风险降低了26%(HR为0.74，95%CI为0.48，1.14，p=0.18)。排除那些没有参加最初教育课程的人，T2 DM风险的降低也没有显著意义(HR为0.65，0.41，1.03，p=0.07)。对所有时间点的数据进行分析后，糖化血红蛋白(-0.06，-0.11，-0.01)、低密度脂蛋白(-0.08，-0.15，-0.01)、久坐时间(-26.29，-45.26，-7.32)和步数(498.15,162.10,834.20)均有显著改善。这项研究表明，资源相对较少、实用的糖尿病预防计划对生物医学、生活方式和心理社会结果的益处不大，但对T2 DM风险的降低并不显著。这一发现对未来的研究和初级保健具有重要意义。(C)2016 Elsevier Inc.保留所有权利。
Objectives. Prevention of type 2 diabetes (T2DM) is a priority in healthcare, but there is a lack of evidence investigating how to effectively translate prevention research into a UK primary care setting. We assessed whether a structured education programme targeting lifestyle and behaviour change was effective at preventing progression to T2DM in people with pre-diabetes.Materials and methods. Forty-four general practices were randomised to receive either standard care or a 6 hour group structured education programme with an annual refresher course, and regular phone contact. Participants were followed up for 3 years. The primary outcome was progression to T2DM.Results. Eight hundred and eighty participants were included (36% female, mean age 64 years, 16% ethnic minority group); 131 participants developed T2DM. There was a non-significant 26% reduced risk of developing T2DM in the intervention arm compared to standard care (HR 0.74, 95% CI 0.48, 1.14, p = 0.18). The reduction in T2DM risk when excluding those who did not attend the initial education session was also non-significant (HR 0.65, 0.41, 1.03, p = 0.07). There were statistically significant improvements in HbA1c (-0.06, - 0.11, -0.01), LDL cholesterol (- 0.08, - 0.15, - 0.01), sedentary time (-26.29, - 45.26, -7.32) and step count (498.15, 162.10, 834.20) when data were analysed across all time points.Conclusions. This study suggests that a relatively low resource, pragmatic diabetes prevention programme resulted in modest benefits to biomedical, lifestyle and psychosocial outcomes, however the reduction to the risk of T2DM did not reach significance. The findings have important implications for future research and primary care. (C) 2016 Elsevier Inc. All rights reserved.