Prevention of Diabetes

Background: A longstanding challenge of community-based participatory research (CBPR) has been to anchor evaluation and practice in a relevant theoretical framework of community change, which articulates specific and concrete evaluative benchmarks. Social movement theories provide a broad range of theoretical tools to understand and facilitate social change processes, such as those involved in CBPR. Social movement theories have the potential to provide a coherent representation of how mobilization and collective action is gradually developed and leads to systemic change in the context of CBPR. The current study builds on a social movement perspective to assess the processes and intermediate outcomes of a longstanding health promotion CBPR project with an Indigenous community, the Kahnawake Schools Diabetes Prevention Project (KDSPP).

Background: Telemedicine has been promoted as an economical and effective way to enhance patient care, but the
experience and its outcome in the diabetes management are not well understood. Thus, this study aims to assess the
experiences and outcomes of diabetes management by tele-consultation.
Methods: A comparative study included 958 patients with T2DM attending the clinics for diabetes management. Of
them 467 (48.75%) patients consulted the endocrinologists through telemedicine and 491 (51.25%) patients attended
the clinics physically during the study period.
Results: The mean age was 58.5±4.3 years in telemedicine group and 55.8±5.1 years in the physically attending group.
Male patients comprised about half [46.03% in telemedicine group; 51.32% in physically attending group)] of the study
population and around half [55.46% in telemedicine, 44.54% in physically attending group] of them came from urban
areas. The majority of patients were on MNT along with 2 or more OADs [42.18% versus 40.53%; p 0.90]. Among
telemedicine users, 59.74% visited the clinic as regular follow up visits and the highest number of patients [49.67%
(232)] used video calling, apps, WhatsApp. About 62.21% (291) of the telemedicine users did not face any difficulties
in communication. Two-fifths of the participants (40.02%) required assistance for communication; 74.09% of the
patients could understand the advices and instructions of the physicians and 76.45% found it cost effective and more
than four-fifths of them admitted that telemedicine could save time. The majority of patients with T2DM (91.43%) were
satisfied with telemedicine service.
Conclusions: For most patients with T2DM, telemedicine can be as good, or even better than, in-person care, especially
for those who face geographical and time barriers to access during COVID-19 pandemic and may be afterword.
population.

Background: Primary care nurse-led prediabetes interventions are seldom reported. We examined the implementation and feasibility of a 6-month multilevel primary care nurse-led prediabetes lifestyle intervention compared with current practice in patients with prediabetes, with weight and glycated haemoglobin (HbA1c) as outcomes. Methods: This study used a convergent mixed methods design involving a 6-month pragmatic non-randomised pilot study with a qualitative process evaluation, and was conducted in two neighbouring provincial cities in New Zealand, with indigenous Māori populations comprising 18.2% and 23.0%, respectively. Participants were non-pregnant adults aged ≤ 70 years with newly diagnosed prediabetes (HbA1c 41-49 mmol/mol), body mass index (BMI) ≥ 25 kg/m 2 and not prescribed Metformin. A structured dietary intervention tool delivered by primary care nurses with visits at baseline, 2-3 weeks, 3 months and 6 months was implemented in four intervention practices. Four control practices continued to provide usual care. Primary quantitative outcome measures were weight and HbA1c. Linear and quantile regression models were used to compare each outcome between the two groups at follow-up. Qualitative data included: observations of nurse training sessions and steering group meetings; document review; semi-structured interviews with a purposive sample of key informants (n = 17) and intervention patients (n = 20). Thematic analysis was used. Results: One hundred fifty-seven patients with prediabetes enrolled (85 intervention, 72 control), 47.8% female and 31.2% Māori. Co-morbidities were common, particularly hypertension (49.7%), dyslipidaemia (40.1%) and gout (15.9%). Baseline and 6 month measures were available for 91% control and 79% intervention participants. After adjustment, the intervention group lost a mean 1.3 kg more than the control group (p < 0.001). Mean HbA1c, BMI and waist circumference decreased in the intervention group and increased in the control group, but differences were not statistically significant. Implementation fidelity was high, and it was feasible to implement the intervention in busy general practice settings. The intervention was highly acceptable to both patients and key stakeholders, especially primary care nurses.

Diabetes adalah penyakit metabolik kronis yang dikenali dengan peningkatan kadar gula darah. Penyakit ini akan mengakibatkan kerusakan jantung, pembuluh darah, mata, ginjal, dan syaraf. Jenis yang paling banyak muncul di masyarakat adalah diabetes tipe 2 dimana tubuh menjadi resisten terhadap insulin atau tidak dapat membuat insulin dalam jumlah yang cukup. Faktor resiko untuk diabetes  tipe 2 diantaranya adalah (1) kurangnya aktivitas fisik; (2) keturunan langsung dari keluarga pengidap diabetes; (3) etnis/ ras yang beresiko tinggi diabetes; (4) wanita yang melahirkan anak dengan berat lahir lebih dari 4 kg; (5) hipertensi (tekanan darah lebih dari 140/90 mmHg atau sedang dalam pengobatan hipertensi); (6) kondisi yang berhubungan dengan resistensi insulin, misalnya obesitas; dan (7) riwayat penyakit kardiovaskular.1
Terdapat peningkatan prevalensi Diabetes di Indonesia dari 5,55% pada tahun 2013 menjadi 6,2% di tahun 2015. Selain itu angka kematian karena Diabetes juga menunjukkan peningkatan yang signifikan dari  172.601 orang pada tahun 2013 menjadi 184.985 orang pada tahun 2015.

Purpose: To evaluate the feasibility of translating the Diabetes Prevention Program (DPP) lifestyle intervention into practice in a rural community.Methods: In 2008, the Montana Diabetes Control Program worked collaboratively with Holy Rosary Healthcare to implement an adapted group-based DPP lifestyle intervention. Adults at high risk for diabetes and cardiovascular disease were recruited and enrolled (N = 101). Participants set targets to reduce fat intake and increase physical activity (≥150 mins/week) in order to achieve a 7% weight loss goal.Findings: Eighty-three percent (n = 84) of participants completed the 16-session core program and 65 (64%) participated in 1 or more after-core sessions. Of those completing the core program, the mean participation was 14.4 ± 1.6 and 3.9 ± 1.6 sessions during the core and after core, respectively. Sixty-five percent of participants met the 150-min-per-week physical activity goal during the core program. Sixty-two percent achieved the 7% weight loss goal and 78% achieved at least a 5% weight loss during the core program. The average weight loss per participant was 7.5 kg (range, 0 to 19.7 kg), which was 7.5% of initial body weight. At the last recorded weight in the after core, 52% of participants had met the 7% weight loss goal and 66% had achieved at least a 5% weight loss.Conclusion: Our findings suggest that it is feasible to implement a group-based DPP in a rural community and achieve weight loss and physical goals that are comparable to those achieved in the DPP.

Background: The evidence base for the prevention of type 2 diabetes mellitus (T2DM) has progressed rapidly from efficacy trials to real-world translational studies and practical implementation trials over the last 15 years. However, evidence for the effective implementation and translation of diabetes programs and their population impact needs to be established in ways that are different from measuring program  effectiveness. We report the findings of a systematic review that focuses on identifying the critical success factors for implementing diabetes prevention programs in real-world settings.

Methods: A systematic review of programs aimed at diabetes prevention was undertaken in order to evaluate their outcomes using the penetration, implementation, participation, and effectiveness (PIPE) impact metric. A search for relevant articles was carried out using PubMed (March 2015) and Web of Science, MEDLINE, CENTRAL, and EMBASE.
A quality coding system was developed and included studies were rated independently by three researchers.

Results: Thirty eight studies were included in the review. Almost all (92 %) provided details on participation; however,
only 18 % reported the coverage of their target population (penetration). Program intensity or implementation—as
measured by frequency of contacts during first year and intervention duration—was identified in all of the reported
studies, and 84 % of the studies also reported implementation fidelity; however, only 18 % of studies employed quality
assurance measures to assess the extent to which the program was delivered as planned. Sixteen and 26 % of studies
reported ‘highly’ or ‘moderately’ positive changes (effectiveness) respectively, based on weight loss. Six (16 %) studies reported ‘high’ diabetes risk reduction but ‘low’ to ‘moderate’ weight loss only.

Conclusion: Our findings identify that program intensity plays a major role in weight loss outcomes. However, programs that have high uptake—both in terms of good coverage of invitees and their willingness to accept the invitation—can still have considerable impact in lowering diabetes risk in a population, even with a low intensity intervention that only leads to low or moderate weight loss. From a public health perspective, this is an important finding, especially for resource constrained settings. More use of the PIPE framework components will facilitate increased uptake of T2DM prevention programs around the world.

Keywords: Implementation, Translational research, Diabetes prevention, Penetration, Implementation, Participation,
Effectiveness (PIPE) impact metric, Systematic review, Resource allocation

A longstanding challenge of community-based participatory research (CBPR) has been to anchor evaluation and practice in a relevant theoretical framework of community change, which articulates specific and concrete evaluative benchmarks. Social movement theories provide a broad range of theoretical tools to understand and facilitate social change processes, such as those involved in CBPR. Social movement theories have the potential to provide a coherent representation of how mobilization and collective action is gradually developed and leads to systemic change in the context of CBPR. The current study builds on a social movement perspective to assess the processes and intermediate outcomes of a longstanding health promotion CBPR project with an Indigenous community, the Kahnawake Schools Diabetes Prevention Project (KDSPP). This research uses a case study design layered on a movement-building evaluation framework, which allows progress to be tracked over time. Data collection strateg...

We are experiencing a pandemic in metabolic syndrome and in particular diabetes and obesity, with an expected doubling of prevalence by 2025 – 2030 to between 366 - 380 million cases worldwide, and with over 8.3% of adults being affected in the United States alone. But even more concerning is the fact that over 79 million American adults have a condition of “prediabetes,” with either impaired glucose tolerance (IGT) or impaired fasting glucose (IFG) or elevated A1C, putting them at significantly increased 5 - to 15-fold higher risk of progression to frank diabetes compared to people with normal blood glucose. This is an especially grave problem since treatment only prevents some of the dire complications of diabetes, usually failing to restore normal blood glucose levels or to eliminate all of the adverse events associated with diabetes, entailing enormous and accelerating national and global economic and social costs. Most regrettably the burden of diabetes continues to shift toward low and middle-income countries where almost 80% of diabetes deaths occur, precisely where there is limited access to affordable treatment, and often insufficient education /awareness of the magnitude and fundamentals of the problem. We here review and critically appraised the diabetes prevention research to date, restricting attention to predominantly Level I (RCT, systematic review and meta-analyses) data, exposing certain misperceptions in our understanding of the problem and suggesting some ways forward.

Type 2 diabetes is a lifelong metabolic disorder caused by high levels of glucose in the blood which can result in serious health conditions such as neuro-, nephro-, retinoand cardio-pathy. Enormous on-going research efforts and interventions are focussed on diabetes management but less on prediabetes which is associated with the prevention of or progression to Type 2 diabetes. Health behavioural change theories are important contributors to the effectiveness of interventions. However, they are rarely integrated systematically in the design of self-care applications for empowerment. In this paper, a Systematic Literature Review (SLR) is presented to evaluate the effectiveness of existing health behavioural change theories in managing prediabetes and to determine the effectiveness of self-care applications that incorporates these theories in their design. A total of four hundred and thirty-six papers were found in this regard. After careful study and the removal of duplicate papers a...

Diabetes Prevention Programs (DPPs) have shown that healthy eating and moderate physical activity are effective ways of delaying and preventing type 2 diabetes in people with impaired glucose tolerance. We assessed willingness to pay for DPPs from the perspective of potential recipients and the cost of providing these programs from the perspective of community health centers and local health departments in North Carolina. We used contingent valuation to determine how much potential recipients would be willing to pay to participate in DPPs under 3 different models: delivered by registered professionals (traditional model), by community health workers, or online. By using information on the minimum reimbursement rate at which public health agencies would be prepared to provide the 3 models, we estimated the marginal costs per person of supplying the programs. Matching supply and demand, we estimated the degree of cost sharing between recipients and providers. Potential program recipie...

A longstanding challenge of community-based participatory research (CBPR) has been to anchor evaluation and practice in a relevant theoretical framework of community change, which articulates specific and concrete evaluative benchmarks. Social movement theories provide a broad range of theoretical tools to understand and facilitate social change processes, such as those involved in CBPR. Social movement theories have the potential to provide a coherent representation of how mobilization and collective action is gradually developed and leads to systemic change in the context of CBPR. The current study builds on a social movement perspective to assess the processes and intermediate outcomes of a longstanding health promotion CBPR project with an Indigenous community, the Kahnawake Schools Diabetes Prevention Project (KDSPP). This research uses a case study design layered on a movement-building evaluation framework, which allows progress to be tracked over time. Data collection strateg...

Problem considered: Type 2 diabetes mellitus (T2DM) is a global pandemic with increasing prevalence worldwide.
Hearsay, or reported speech, is an important contributor to diabetes care related behavior and may influence the
outcomes of diabetes treatment. An emerging concept in preventive medicine is Quinary prevention which aims
at preventing health-related hearsay or misinformation.
Methods: A group of international clinical experts comprising endocrinologists, diabetologists, cardiologists and
community medicine specialists gathered in India and discussed ways to restrain the menace of de-hearsay in
diabetes care

The Eagle Adventure program was designed as a semester-long, SNAP-Ed program to address food and physical activity choices important for prevention of type 2 diabetes, obesity, and other chronic diseases. The program was developed for implementation in Grades 1-3. This article presents findings from two participating grade centers inclusive of Grades1-2. The elementary school-based program not only addresses health-related behaviors in a culturally relevant and responsive way, but also serves as a potential model for promoting diversity inclusion in Extension programming.