An international panel of diabetes prevention researchers shared lessons learned from the implementation of type 2 diabetes prevention programs around the world during a morning symposium on Monday, June 28.
Diabetes Prevention—Addressing Implementation Challenges can be viewed by registered meeting attendees at ADA2021.org through September 29, 2021. If you haven’t registered for the Virtual 81st Scientific Sessions, register today to access all of the valuable meeting content.
Mike Sampson, MD, Professor and Consultant in the Department of Diabetes and Endocrinology, Norfolk and Norwich University Hospitals NHS Foundation Trust, opened the session with a discussion of the Norfolk Diabetes Prevention Study (NDPS), a type 2 diabetes prevention program that ran from 2010 and 2019 in three counties in England. Results from the NDPS main trial were published earlier this year in JAMA Internal Medicine.
“We found that the weight loss in NDPS was broadly similar to that seen in observational trials,” Dr. Sampson said. “We also found that this type 2 diabetes prevention intervention improved glycemic control at 12 months in people with screen-detected type 2 diabetes. So this is one of the few lifestyle interventions that has diabetes prevention benefit and also has value as a lifestyle management program in people with type 2 diabetes.”
One of the major challenges NDPS investigators faced was short-term regression to normoglycemia at baseline, he added.
“We think better risk-stratification at entry to prevention programs would have real value to disentangle who’s at genuinely high risk of progressing and who’s likely to regress,” Dr. Sampson said.
Kerri Lynn Knippen, PhD, MPH, RDN, LD, BC-ADM, a registered dietitian and Assistant Professor in the Department of Public and Allied Health, Bowling Green State University, discussed strategies to prevent progression to type 2 diabetes in women who have gestational diabetes (GDM).
“A meta-analysis of 20 studies found that women with GDM history had nearly a 10 times greater risk for developing type 2 diabetes compared to women without that history,” she said.
Provider-patient communication and interdisciplinary care coordination are among the keys to developing effective prevention programs and interventions for this patient population, she added.
“Access to primary care and improving communication across the transitions from pregnancy to the postpartum period and beyond have the potential to increase long-term behavior to prevent type 2 diabetes,” Dr. Knippen said. “System-based and interdisciplinary interventions focused on care coordination would have value for this population. When care is disjointed, as it can be with GDM, care coordination can improve processes, including information sharing and fragmentation.”
Pilvikki Absetz, PhD, Research Director, University of Eastern Finland, and Professor of Health Promotion, Tampere University, discussed the unique challenges of implementing and maintaining diabetes prevention programs in low- and middle-income countries.
Because the vast majority of published literature on the efficacy and real-world effectiveness of diabetes prevention programs comes from studies conducted in high-income countries, Dr. Absetz said it’s important to ensure the “cultural fit” of programs and intervention models in low- and middle-income countries. She reviewed some of the lessons learned from the Kerala Diabetes Prevention Program (KDPP) in India.
“This was a type 2 diabetes prevention study, an RCT (randomized controlled clinical trial), that aimed to translate findings from our previous studies in high-income countries to India in a setting that was much more constrained in terms of resources, and also very different culturally from the individualistic cultures that we have in the Western world,” she explained.
Dr. Absetz said that engagement of family and community support were identified as key success factors in a comprehensive evaluation of the KDDP. Since the completion of the initial trial, more than 15,000 peer leaders have been trained and nearly 400,000 women and their family members have been introduced to the KDPP.
Anne M. Wolf, MS, RDN, Director of the Virginia Center for Diabetes Prevention and Education, University of Virginia, discussed the use of digital technologies in diabetes prevention. Studies suggest that using technology to provide self-monitoring, counselor feedback, and personalized messages is effective and supports weight loss, while general communication and non-personalized group support is not as effective, she said.
“Results are better if a personalized component or personalized information is added, such as personalized text messages or food tracking with personalized review and messaging,” Wolf said.