Challenges of diabetes prevention in the real world: results and lessons from the Melbourne Diabetes Prevention Study

James A Dunbar, Andrea L Hernan, Edward D Janus, Erkki Vartiainen, Tiina Laatikainen, Vincent L Versace, John Reynolds, James D Best, Timothy C Skinner, Sharleen L O'Reilly, Kevin P Mc Namara, Elizabeth Stewart, Michael Coates, Catherine M Bennett, Rob Carter, on behalf of the Melbourne Diabetes Prevention Study (MDPS) research group

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Objective To assess effectiveness and implementability of the public health programme Life! Taking action on diabetes in Australian people at risk of developing type 2 diabetes.Research design and methods Melbourne Diabetes Prevention Study (MDPS) was a unique study assessing effectiveness of Life! that used a randomized controlled trial design. Intervention participants with AUSDRISK score ≥15 received 1 individual and 5 structured 90 min group sessions. Controls received usual care. Outcome measures were obtained for all participants at baseline and 12 months and, additionally, for intervention participants at 3 months. Per protocol set (PPS) and intention to treat (ITT) analyses were performed.Results PPS analyses were considered more informative from our study. In PPS analyses, intervention participants significantly improved in weight (−1.13 kg, p=0.016), waist circumference (−1.35 cm, p=0.044), systolic (−5.2 mm Hg, p=0.028) and diastolic blood pressure (−3.2 mm Hg, p=0.030) compared with controls. Based on observed weight change, estimated risk of developing diabetes reduced by 9.6% in the intervention and increased by 3.3% in control participants. Absolute 5-year cardiovascular disease (CVD) risk reduced significantly for intervention participants by 0.97 percentage points from 9.35% (10.4% relative risk reduction). In control participants, the risk increased by 0.11 percentage points (1.3% relative risk increase). The net effect for the change in CVD risk was −1.08 percentage points of absolute risk (p=0.013).Conclusions MDPS effectively reduced the risk of diabetes and CVD, but the intervention effect on weight and waist reduction was modest due to the challenges in recruiting high-risk individuals and the abbreviated intervention.
Original languageEnglish
Article numbere000081
Number of pages13
JournalBMJ Open Diabetes Research & Care
Issue number1
Publication statusPublished - Oct 2015

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