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
- Associate Professor 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
- Associate Professor 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.