Behavioral strategies in diabetes prevention programs: A systematic review of randomized controlled trials

Boden Institute of Obesity, Nutrition and Exercise, Sydney Medical School, The University of Sydney, Sydney, NSW 2006, Australia.
Diabetes research and clinical practice (Impact Factor: 2.54). 01/2011; 91(1):1-12. DOI: 10.1016/j.diabres.2010.06.030
Source: PubMed


The worldwide epidemic of type 2 diabetes (T2D) emphasizes the need for guidelines regarding community implementation of lifestyle modification prevention programs. An understanding of effective behavioral strategies is needed if evidence translation is to be realized. The aim of this paper is to systematically review the behavioral change strategies for lifestyle T2D prevention programs.
randomized controlled trials (RCTs) of lifestyle interventions for the prevention of T2D were reviewed with a systematic literature search. Data relating to the behavioral strategies and trial outcomes were extracted.
overall, lifestyle interventions were successful in reducing the incidence of T2D. The behavioral strategies utilized in these interventions were drawn from a variety of theoretical backgrounds. All RCTs utilized intensive modes of delivery and were associated with low dropout rates of 5.5-13.4%.
the available evidence shows that a robust behavioral change strategy is an essential part of an effective lifestyle modification program, as the absence of intensive individualized advice or "information only" more closely resembles the control group interventions used in these RCTs.

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Available from: Kylie Simpson, Feb 24, 2014
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    • "Contrary to one of the major assumptions motivating this study, the most commonly reported barriers to adherence with lifestyle goals for those who finished the LIB Program—family, work, social obligations, time, money—are not unique to urban American Indians. Worldwide meta-analyses of compliance issues in type 2 diabetes intervention programs report strikingly similar issues [16,17]. For example, one of the most widely reported factors that helped participants in this study adhere to dietary goals—“Knowledge about nutrition facts”—has been shown in numerous studies to be a critical factor for improving health outcomes in pre-diabetic subjects worldwide [18,19]. "
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    ABSTRACT: Objective The Life in BALANCE (LIB) study is a pilot translational study modeling the Diabetes Prevention Program (DPP) intensive lifestyle coaching intervention among an underserved, high-risk population: American Indians/Alaska Natives (AI/ANs) living in a large urban setting (Las Vegas, Nevada). Research Design and Methods A total of 22 overweight/obese AI/ANs (age, 39.6 ± 10.4 years; BMI, 34.1 ± 6.3 kg/m2) at increased risk for developing type 2 diabetes (HbA1c > 5.4 (36 mmol/mol) < 6.4 percent (46 mmol/mol) participated in the program between April and December, 2011. Study participants completed a 16 week intensive lifestyle coaching intervention. In addition to obtaining qualitative data regarding opportunities and challenges of applying the lifestyle intervention for AI/AN participants in an urban setting, clinical data, including BMI, waist circumference, blood pressure, fasting blood glucose, and blood lipids (HDL, LDL and Triglycerides), were collected. Results Only 12 of the 22 participants remained in the LIB program at the final post-program follow-up. Participants demonstrated significant decreased waist circumference and elevated HDL cholesterol. Triglycerides manifested the highest percentage change without statistical significance. No significant change was observed in blood pressure or fasting blood glucose. Conclusions LIB participants’ improvements in BMI, waist circumference, HDL cholesterol and triglycerides suggests type 2 diabetes prevention programs aimed at urban AI/ANs show significant potential for reducing the risk of developing type 2 diabetes among this underserved and high risk community. Qualitative data suggest the main challenge for type 2 diabetes prevention specific to this population is a need for improved community outreach strategies.
    Journal of Diabetes Mellitus 10/2013; 3(4):184-191. DOI:10.4236/jdm.2013.34028
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    • "Several randomised controlled trials have demonstrated that the onset of type 2 diabetes can be prevented or delayed by lifestyle modification programs [1-3]. Building on this body of evidence to translate small scale successes into ‘real-world’ practice, the Greater Green Triangle implemented a diabetes prevention program (GGT DPP) in the primary health care setting of South-West Victoria and South East South Australia in 2004–2006 [4,5]. "
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    ABSTRACT: Background The Greater Green Triangle diabetes prevention program was conducted in primary health care setting of Victoria and South Australia in 2004–2006. This program demonstrated significant reductions in diabetes risk factors which were largely sustained at 18 month follow-up. The theoretical model utilised in this program achieved its outcomes through improvements in coping self-efficacy and planning. Previous evaluations have concentrated on the behavioural components of the intervention. Other variables external to the main research design may have contributed to the success factors but have yet to be identified. The objective of this evaluation was to identify the extent to which participants in a diabetes prevention program sustained lifestyle changes several years after completing the program and to identify contextual factors that contributed to sustaining changes. Methods A qualitative evaluation was conducted. Five focus groups were held with people who had completed a diabetes prevention program, several years later to assess the degree to which they had sustained program strategies and to identify contributing factors. Results Participants value the recruitment strategy. Involvement in their own risk assessment was a strong motivator. Learning new skills gave participants a sense of empowerment. Receiving regular pathology reports was a means of self-assessment and a motivator to continue. Strong family and community support contributed to personal motivation and sustained practice. Conclusions Family and local community supports constitute the contextual variables reported to contribute to sustained motivation after the program was completed. Behaviour modification programs can incorporate strategies to ensure these factors are recognised and if necessary, strengthened at the local level.
    BMC Health Services Research 12/2012; 12(1):460. DOI:10.1186/1472-6963-12-460 · 1.71 Impact Factor
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    ABSTRACT: Unchecked, the increasing prevalence of prediabetes can be predicted to only expand the numbers of people developing type 2 diabetes and all its associated health ramifications. People with obesity and prediabetes who are able to manage their body weight are known to decrease their risk of developing diabetes. However, making the changes to diet and levels of physical activity is a difficult proposition for many people. Diabetes educators are a group of healthcare professionals trained to work with people who have diabetes on appropriate goal-setting around self-care behaviors including healthy eating and physical activity to better enable them to accomplish the changes needed for better health outcomes. Applying this same skill set to people with prediabetes provides a ready means for addressing the needs of this population to help diminish their risk of developing diabetes.
    American journal of preventive medicine 11/2012; 44(4):S390–S393. DOI:10.1016/j.amepre.2012.12.013 · 4.53 Impact Factor
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