Skip to main content
Top
Published in: BMC Primary Care 1/2012

Open Access 01-12-2012 | Study protocol

Feasibility and effectiveness of the implementation of a primary prevention programme for type 2 diabetes in routine primary care practice: a phase IV cluster randomised clinical trial

Authors: Alvaro Sanchez, Carmen Silvestre, Regina Sauto, Catalina Martínez, Gonzalo Grandes

Published in: BMC Primary Care | Issue 1/2012

Login to get access

Abstract

Background

The objective of this study is to perform an independent evaluation of the feasibility and effectiveness of an educational programme for the primary prevention of type 2 diabetes (DM2) in high risk populations in primary care settings, implanted within the Basque Health Service - Osakidetza.

Methods/design

This is a prospective phase IV cluster clinical trial conducted under routine conditions in 14 primary health care centres of Osakidetza, randomly assigned to an intervention or control group. We will recruit a total sample of 1089 individuals, aged between 45 and 70 years old, without diabetes but at high risk of developing the condition (Finnish Diabetes Risk Score, FINDRISC ≥ 14) and follow them up for 2 years. Primary health care nursing teams of the intervention centres will implement DE-PLAN, a structured educational intervention program focused on changing healthy lifestyles (diet and physical activity); while the patients in the control centres will receive the usual care for the prevention and treatment of DM2 currently provided in Osakidetza. The effectiveness attributable to the programme will be assessed by comparing the changes observed in patients exposed to the intervention and those in the control group, with respect to the risk of developing DM2 and lifestyle habits. In terms of feasibility, we will assess indicators of population coverage and programme implementation.

Discussion

The aim of this study is to provide the scientific basis for disseminate the programme to the remaining primary health centres in Osakidetza, as a novel way of addressing prevention of DM2. The study design will enable us to gather information on the effectiveness of the intervention as well as the feasibility of implementing it in routine practice.

Trial registration

ClinicalTrials.gov NCT01365013
Appendix
Available only for authorised users
Literature
1.
go back to reference World Health Organization: Diabetes action now: An initiative of the World Health Organization and the International Diabetes Federation. 2004, WHO, Geneva World Health Organization: Diabetes action now: An initiative of the World Health Organization and the International Diabetes Federation. 2004, WHO, Geneva
2.
go back to reference Spanish Ministry for Health and Consumer Affairs: Estrategia en diabetes del Sistema Nacional de Salud. 2007, Centro de publicaciones del Ministerio de Sanidad y Consumo, Madrid Spanish Ministry for Health and Consumer Affairs: Estrategia en diabetes del Sistema Nacional de Salud. 2007, Centro de publicaciones del Ministerio de Sanidad y Consumo, Madrid
3.
go back to reference The DECODE Study Group: Age- and sex-specific prevalences of diabetes and impaired glucose regulation in 13 European cohorts. Diabetes Care. 2003, 26: 61-69. 10.2337/diacare.26.1.61.CrossRef The DECODE Study Group: Age- and sex-specific prevalences of diabetes and impaired glucose regulation in 13 European cohorts. Diabetes Care. 2003, 26: 61-69. 10.2337/diacare.26.1.61.CrossRef
4.
go back to reference Schwarz PE: Congress report from the American Diabetes Association 66th annual scientific sessions in Washington, USA. Exp Clin Endocrinol Diabetes. 2006, 114: 605-610. 10.1055/s-2006-950180.CrossRefPubMed Schwarz PE: Congress report from the American Diabetes Association 66th annual scientific sessions in Washington, USA. Exp Clin Endocrinol Diabetes. 2006, 114: 605-610. 10.1055/s-2006-950180.CrossRefPubMed
5.
go back to reference King H, Aubert RE, Herman WH: Global burden of diabetes, 1995–2025: prevalence, numerical estimates, and projections. Diabetes Care. 1998, 21: 1414-1431. 10.2337/diacare.21.9.1414.CrossRefPubMed King H, Aubert RE, Herman WH: Global burden of diabetes, 1995–2025: prevalence, numerical estimates, and projections. Diabetes Care. 1998, 21: 1414-1431. 10.2337/diacare.21.9.1414.CrossRefPubMed
6.
go back to reference Tuomilehto J, Lindström J, Eriksson J, Valle T, Hämäläinen H, Ilanne-Parikka P, et al: Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med. 2001, 344: 1343-1350. 10.1056/NEJM200105033441801.CrossRefPubMed Tuomilehto J, Lindström J, Eriksson J, Valle T, Hämäläinen H, Ilanne-Parikka P, et al: Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med. 2001, 344: 1343-1350. 10.1056/NEJM200105033441801.CrossRefPubMed
7.
go back to reference The Diabetes Prevention Program Research Group: Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002, 346: 393-403.CrossRef The Diabetes Prevention Program Research Group: Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002, 346: 393-403.CrossRef
8.
go back to reference Pan XR, Li GW, Hu YH, Wang JX, Yang WY, An ZX, et al: Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT and Diabetes Study. Diabetes Care. 1997, 20: 537-544. 10.2337/diacare.20.4.537.CrossRefPubMed Pan XR, Li GW, Hu YH, Wang JX, Yang WY, An ZX, et al: Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT and Diabetes Study. Diabetes Care. 1997, 20: 537-544. 10.2337/diacare.20.4.537.CrossRefPubMed
9.
go back to reference Lindstrom J, Ilanne-Parikka P, Peltonen M, Aunola S, Finnish Diabetes Prevention Study Group, et al: Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: follow-up of the Finnish Diabetes Prevention study. Lancet. 2006, 368: 1673-1679. 10.1016/S0140-6736(06)69701-8.CrossRefPubMed Lindstrom J, Ilanne-Parikka P, Peltonen M, Aunola S, Finnish Diabetes Prevention Study Group, et al: Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: follow-up of the Finnish Diabetes Prevention study. Lancet. 2006, 368: 1673-1679. 10.1016/S0140-6736(06)69701-8.CrossRefPubMed
10.
go back to reference Li G, Zhang P, Wang J, Gregg EW, et al: The long-term effect of lifestyle interventions to prevent diabetes in the China Da Qing Diabetes Prevention Study: a 20-year follow-up study. Lancet. 2008, 371: 1783-1789. 10.1016/S0140-6736(08)60766-7.CrossRefPubMed Li G, Zhang P, Wang J, Gregg EW, et al: The long-term effect of lifestyle interventions to prevent diabetes in the China Da Qing Diabetes Prevention Study: a 20-year follow-up study. Lancet. 2008, 371: 1783-1789. 10.1016/S0140-6736(08)60766-7.CrossRefPubMed
11.
go back to reference Gillies CL, Abrams KR, Lambert PC, Cooper NJ, Sutton AJ, Hsu RT, et al: Pharmacological and lifestyle interventions to prevent or delay type 2 diabetes in people with impaired glucose tolerance: systematic review and meta-analysis. BMJ. 2007, 334: 299-10.1136/bmj.39063.689375.55.CrossRefPubMedPubMedCentral Gillies CL, Abrams KR, Lambert PC, Cooper NJ, Sutton AJ, Hsu RT, et al: Pharmacological and lifestyle interventions to prevent or delay type 2 diabetes in people with impaired glucose tolerance: systematic review and meta-analysis. BMJ. 2007, 334: 299-10.1136/bmj.39063.689375.55.CrossRefPubMedPubMedCentral
12.
go back to reference Simmons RK, Unwin N, Griffin SJ: International Diabetes Federation: An update of the evidence concerning the prevention of type 2 diabetes. Diabetes Res Clin Pract. 2010, 87: 143-149. 10.1016/j.diabres.2009.10.003.CrossRefPubMed Simmons RK, Unwin N, Griffin SJ: International Diabetes Federation: An update of the evidence concerning the prevention of type 2 diabetes. Diabetes Res Clin Pract. 2010, 87: 143-149. 10.1016/j.diabres.2009.10.003.CrossRefPubMed
13.
go back to reference Medical Research Council: A framework for development and evaluation of complex interventions to improve health. 2000, Medical Research Council, London Medical Research Council: A framework for development and evaluation of complex interventions to improve health. 2000, Medical Research Council, London
14.
go back to reference Saaristo T, Moilanen L, Korpi-Hyövälti E, Vanhala M, Saltevo J, Niskanen L, Jokelainen J, Peltonen M, Oksa H, Tuomilehto J, Uusitupa M, Keinänen-Kiukaanniemi S: Lifestyle intervention for prevention of type 2 diabetes in primary health care: one-year follow-up of the Finnish National Diabetes Prevention Program (FIN-D2D). Diabetes Care. 2010, 33: 2146-2151. 10.2337/dc10-0410.CrossRefPubMedPubMedCentral Saaristo T, Moilanen L, Korpi-Hyövälti E, Vanhala M, Saltevo J, Niskanen L, Jokelainen J, Peltonen M, Oksa H, Tuomilehto J, Uusitupa M, Keinänen-Kiukaanniemi S: Lifestyle intervention for prevention of type 2 diabetes in primary health care: one-year follow-up of the Finnish National Diabetes Prevention Program (FIN-D2D). Diabetes Care. 2010, 33: 2146-2151. 10.2337/dc10-0410.CrossRefPubMedPubMedCentral
15.
go back to reference Absetz P, Oldenburg B, Hankonen N, Valve R, Heinonen H, Nissinen A, Fogelholm M, Talja M, Uutela A: Type 2 diabetes prevention in the real world: three-year results of the GOAL lifestyle implementation trial. Diabetes Care. 2009, 32: 11418-11420.CrossRef Absetz P, Oldenburg B, Hankonen N, Valve R, Heinonen H, Nissinen A, Fogelholm M, Talja M, Uutela A: Type 2 diabetes prevention in the real world: three-year results of the GOAL lifestyle implementation trial. Diabetes Care. 2009, 32: 11418-11420.CrossRef
16.
go back to reference Laatikainen T, Dunbar JA, Chapman A, Kilkkinen A, Vartiainen E, Heistaro S, Philpot B, Absetz P, Bunker S, O’Neil A, Reddy P, Best JD, Janus ED: Prevention of type 2 diabetes by lifestyle intervention in an Australian primary health care setting: Greater Green Triangle (GGT) Diabetes Prevention Project. BMC Publ Health. 2007, 7: 249-10.1186/1471-2458-7-249.CrossRef Laatikainen T, Dunbar JA, Chapman A, Kilkkinen A, Vartiainen E, Heistaro S, Philpot B, Absetz P, Bunker S, O’Neil A, Reddy P, Best JD, Janus ED: Prevention of type 2 diabetes by lifestyle intervention in an Australian primary health care setting: Greater Green Triangle (GGT) Diabetes Prevention Project. BMC Publ Health. 2007, 7: 249-10.1186/1471-2458-7-249.CrossRef
17.
go back to reference Vermunt PW, Milder IE, Wielaard F, de Vries JH, van Oers HA, Westert GP: Lifestyle counseling for type 2 diabetes risk reduction in Dutch primary care: results of the APHRODITE study after 0.5 and 1.5 years. Diabetes Care. 2011, 34: 1919-1925. 10.2337/dc10-2293.CrossRefPubMedPubMedCentral Vermunt PW, Milder IE, Wielaard F, de Vries JH, van Oers HA, Westert GP: Lifestyle counseling for type 2 diabetes risk reduction in Dutch primary care: results of the APHRODITE study after 0.5 and 1.5 years. Diabetes Care. 2011, 34: 1919-1925. 10.2337/dc10-2293.CrossRefPubMedPubMedCentral
18.
go back to reference Whittemore R, Melkus G, Wagner J, Dziura J, Northrup V, Grey M: Translating the diabetes prevention program to primary care: a pilot study. Nurs Res. 2009, 58: 2-12. 10.1097/NNR.0b013e31818fcef3.CrossRefPubMedPubMedCentral Whittemore R, Melkus G, Wagner J, Dziura J, Northrup V, Grey M: Translating the diabetes prevention program to primary care: a pilot study. Nurs Res. 2009, 58: 2-12. 10.1097/NNR.0b013e31818fcef3.CrossRefPubMedPubMedCentral
19.
go back to reference Bo S, Ciccone G, Baldi C, Benini L, Dusio F, Forastiere G, Lucia C, Nuti C, Durazzo M, Cassader M, et al: Effectiveness of a lifestyle intervention onmetabolic syndrome. A randomized controlled trial. J Gen Intern Med. 2007, 22 (12): 1695-1703. 10.1007/s11606-007-0399-6.CrossRefPubMedPubMedCentral Bo S, Ciccone G, Baldi C, Benini L, Dusio F, Forastiere G, Lucia C, Nuti C, Durazzo M, Cassader M, et al: Effectiveness of a lifestyle intervention onmetabolic syndrome. A randomized controlled trial. J Gen Intern Med. 2007, 22 (12): 1695-1703. 10.1007/s11606-007-0399-6.CrossRefPubMedPubMedCentral
20.
go back to reference Barclay C, Procter KL, Glendenning R, Marsh P, Freemen J, Mathers N: Can type 2 diabetes be prevented in UK general practice? A lifestyle-change feasibility study (ISAIAH). Br J Gen Pract. 2008, 58 (553): 541-547. 10.3399/bjgp08X319701.CrossRefPubMedPubMedCentral Barclay C, Procter KL, Glendenning R, Marsh P, Freemen J, Mathers N: Can type 2 diabetes be prevented in UK general practice? A lifestyle-change feasibility study (ISAIAH). Br J Gen Pract. 2008, 58 (553): 541-547. 10.3399/bjgp08X319701.CrossRefPubMedPubMedCentral
21.
go back to reference Cardona-Morrell M, Rychetnik L, Morrell SL, Espinel PT, Bauman A: Reduction of diabetes risk in routine clinical practice: are physical activity and nutrition interventions feasible and are the outcomes from reference trials replicable? A systematic review and meta-analysis. BMC Publ Health. 2010, 10: 653-10.1186/1471-2458-10-653.CrossRef Cardona-Morrell M, Rychetnik L, Morrell SL, Espinel PT, Bauman A: Reduction of diabetes risk in routine clinical practice: are physical activity and nutrition interventions feasible and are the outcomes from reference trials replicable? A systematic review and meta-analysis. BMC Publ Health. 2010, 10: 653-10.1186/1471-2458-10-653.CrossRef
22.
go back to reference Schwarz PE, Lindstrom J, Kissimova-Scarbeck K, et al: The European perspective of type 2 diabetes prevention: diabetes in Europe-prevention using lifestyle, physical activity and nutritional intervention (DE-PLAN) project. Exp Clin Endocrinol Diabetes. 2008, 116: 167-172. 10.1055/s-2007-992115.CrossRefPubMed Schwarz PE, Lindstrom J, Kissimova-Scarbeck K, et al: The European perspective of type 2 diabetes prevention: diabetes in Europe-prevention using lifestyle, physical activity and nutritional intervention (DE-PLAN) project. Exp Clin Endocrinol Diabetes. 2008, 116: 167-172. 10.1055/s-2007-992115.CrossRefPubMed
23.
go back to reference Schwarz PEH, Reddy P, Greaves CJ, Dunbar JA, Schwarz J: Diabetes prevention in practice. 2010, TUMAINI Institute for Prevention Management, Dresden, Germany Schwarz PEH, Reddy P, Greaves CJ, Dunbar JA, Schwarz J: Diabetes prevention in practice. 2010, TUMAINI Institute for Prevention Management, Dresden, Germany
24.
go back to reference Costa B, Barrio F, Cabré JJ, Piñol JL, Cos X, Solé C, Bolíbar B, Basora J, Castell C, Solà-Morales O, Salas-Salvadó J, Lindström J, Tuomilehto J, The DE-PLAN-CAT Research Group: Delaying progression to type 2 diabetes among high-risk Spanish individuals is feasible in real-life primary healthcare settings using intensive lifestyle intervention. Diabetologia. 2012, 55: 1319-1328. 10.1007/s00125-012-2492-6.CrossRefPubMed Costa B, Barrio F, Cabré JJ, Piñol JL, Cos X, Solé C, Bolíbar B, Basora J, Castell C, Solà-Morales O, Salas-Salvadó J, Lindström J, Tuomilehto J, The DE-PLAN-CAT Research Group: Delaying progression to type 2 diabetes among high-risk Spanish individuals is feasible in real-life primary healthcare settings using intensive lifestyle intervention. Diabetologia. 2012, 55: 1319-1328. 10.1007/s00125-012-2492-6.CrossRefPubMed
25.
go back to reference Lindström J, Tuomilehto J: The Diabetes Risk Score: a practical tool to predict type 2 diabetes risk. Diabetes Care. 2003, 26: 725-731. 10.2337/diacare.26.3.725.CrossRefPubMed Lindström J, Tuomilehto J: The Diabetes Risk Score: a practical tool to predict type 2 diabetes risk. Diabetes Care. 2003, 26: 725-731. 10.2337/diacare.26.3.725.CrossRefPubMed
26.
go back to reference Basque Government – Department of Health and Consumer Affairs: Strategy for tackling the challenge of chronicity in the Basque country chronicity. 2010, Vitoria-Gazteiz, Spain Basque Government – Department of Health and Consumer Affairs: Strategy for tackling the challenge of chronicity in the Basque country chronicity. 2010, Vitoria-Gazteiz, Spain
27.
go back to reference Grandes G, Sanchez A, Sanchez-Pinilla RO, Torcal J, Montoya I, Lizarraga K, Serra J, PEPAF Group: Effectiveness of physical activity advice and prescription by physicians in routine primary care: a cluster randomized trial. Arch Intern Med. 2009, 169: 694-701. 10.1001/archinternmed.2009.23.CrossRefPubMed Grandes G, Sanchez A, Sanchez-Pinilla RO, Torcal J, Montoya I, Lizarraga K, Serra J, PEPAF Group: Effectiveness of physical activity advice and prescription by physicians in routine primary care: a cluster randomized trial. Arch Intern Med. 2009, 169: 694-701. 10.1001/archinternmed.2009.23.CrossRefPubMed
28.
go back to reference Schröder H, Fitó M, Estruch R, Martínez-González MA, Corella D, Salas-Salvadó J, Lamuela-Raventós R, Ros E, Salaverría I, Fiol M, Lapetra J, Vinyoles E, Gómez-Gracia E, Lahoz C, Serra-Majem L, Pintó X, Ruiz-Gutierrez V, Covas MI: A short screener is valid for assessing Mediterranean diet adherence among older Spanish men and women. J Nutr. 2011, 141: 1140-1145. 10.3945/jn.110.135566.CrossRefPubMed Schröder H, Fitó M, Estruch R, Martínez-González MA, Corella D, Salas-Salvadó J, Lamuela-Raventós R, Ros E, Salaverría I, Fiol M, Lapetra J, Vinyoles E, Gómez-Gracia E, Lahoz C, Serra-Majem L, Pintó X, Ruiz-Gutierrez V, Covas MI: A short screener is valid for assessing Mediterranean diet adherence among older Spanish men and women. J Nutr. 2011, 141: 1140-1145. 10.3945/jn.110.135566.CrossRefPubMed
29.
go back to reference Kottke TE, Solberg LI: Beyond efficacy testing redux. Am J Prev Med. 2004, 27: 104-105. 10.1016/j.amepre.2004.04.027.CrossRefPubMed Kottke TE, Solberg LI: Beyond efficacy testing redux. Am J Prev Med. 2004, 27: 104-105. 10.1016/j.amepre.2004.04.027.CrossRefPubMed
30.
go back to reference Kitson A, Harvey G, McCormack B: Enabling the implementation of evidence based practice: a conceptual framework. Qual Health Care. 1998, 7: 149-159. 10.1136/qshc.7.3.149.CrossRefPubMedPubMedCentral Kitson A, Harvey G, McCormack B: Enabling the implementation of evidence based practice: a conceptual framework. Qual Health Care. 1998, 7: 149-159. 10.1136/qshc.7.3.149.CrossRefPubMedPubMedCentral
31.
go back to reference Grol R, Wensing M, Eccles M: Improving patient care. The implementation of change in clinical practice. 2004, Elsevier, Philadelphia (PA) Grol R, Wensing M, Eccles M: Improving patient care. The implementation of change in clinical practice. 2004, Elsevier, Philadelphia (PA)
32.
go back to reference Wensing M, Bosch M, Grol R: Developing and selecting interventions for translating knowledge to action. CMAJ. 2010, 9: 182(2)- Wensing M, Bosch M, Grol R: Developing and selecting interventions for translating knowledge to action. CMAJ. 2010, 9: 182(2)-
33.
Metadata
Title
Feasibility and effectiveness of the implementation of a primary prevention programme for type 2 diabetes in routine primary care practice: a phase IV cluster randomised clinical trial
Authors
Alvaro Sanchez
Carmen Silvestre
Regina Sauto
Catalina Martínez
Gonzalo Grandes
Publication date
01-12-2012
Publisher
BioMed Central
Published in
BMC Primary Care / Issue 1/2012
Electronic ISSN: 2731-4553
DOI
https://doi.org/10.1186/1471-2296-13-109

Other articles of this Issue 1/2012

BMC Primary Care 1/2012 Go to the issue