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Diabetes and large-scale prevention programs

Rapid review: Prevention of type 2 diabetes and the implementation of large-scale prevention programs

July 2015

The authors

The Australian Prevention Partnership Centre
  • Professor Andrew Wilson
  • Dr Jo-An Atkinson
  • Emily Morrice
  • Eloise O’Donnell
The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders
  • Dr Crystal Lee
  • Professor Stephen Colagiuri

Background

  • Diabetes is a crucial health issue for Australia. More than 10% of Australians have diabetes or are at high risk.
  • The burden of diabetes is compounded because many complications of diabetes can be debilitating or life threatening, such as cardiovascular disease, end-stage kidney disease, loss of vision, amputations and mental health issues.
  • This review collates the evidence on diabetes prevention, highlights the key modifiable risk factors to target, and analyses what system-level changes are needed to successfully implement a population-wide diabetes prevention program.

Key findings

  • There is substantial evidence that type 2 diabetes can be prevented and delayed, particularly in certain high-risk groups, and this has been successfully demonstrated in prevention programs in a range of settings.
  • There is also evidence of type 2 diabetes prevention interventions being successfully scaled up and implemented population-wide.
  • The system-level factors needed to successfully scale up an intervention are known and should be considered when planning large-scale diabetes prevention programs.
  • However, while it is clear that large-scale prevention interventions can be effective, further research is needed to determine which characteristics are needed to maximise the efficacy of an intervention.

Evidence brief: What large-scale lifestyle interventions work to prevent type 2 diabetes?

July 2015

The authors

The Australian Prevention Partnership Centre
  • Professor Andrew Wilson
  • Dr Jo-An Atkinson
  • Emily Morrice

Background

  • Progression to diabetes can be prevented or delayed. Modifiable risk/protective factors for diabetes include body mass index, physical activity, smoking status and early life factors such as birthweight.
  • Many lifestyle interventions for diabetes prevention help to prevent other chronic diseases such as cardiovascular disease.
  • Delaying the onset and severity of diabetes is important because it can prevent diabetes-related complications.
  • This review aimed to:
    • Summarise the evidence regarding type 2 diabetes prevention interventions, focusing on lifestyle interventions
    • Assess the effect size of different lifestyle interventions, and to consider the potential for scalability
    • Identify research gaps and areas of most potential to inform future research investment.

Key findings include:

  • While not lifestyle interventions, bariatric surgery and medications were included as comparators in many studies assessing lifestyle interventions so were included in this review.
  • Bariatric surgery was the only intervention with a large effect size, but the studies only assessed participants who were obese and at high risk. Bariatric surgery is likely to be inapplicable and unfeasible at the general population level.
  • Interventions with a medium effect size were: diet and/or exercise; diet and exercise and an additional component such as education; and exercise and/or education.
  • Not all existing lifestyle intervention studies were included in this review as they did not meet the inclusion criteria. Many population-level interventions measured weight loss or other clinical indicators as a proxy for impact on diabetes risk.
  • Many study participants had successful and sustained weight loss, suggesting reduced diabetes risk. However, this information was inadequate to confidently calculate effect size.