Implementation of a new concept for active primary prevention of diabetes type II in a primary care environment
02 / 2007 - unknown
The objective of the project is: - to evaluate the implementation of an established concept for primary prevention of DM II in a Dutch population, 1) in a primary care setting 2) using an active approach (i.e. physician initiated risk assessment)- to demonstrate that -and under what circumstances- the implementation of the prevention and intervention concept will be effective and achievable in the Dutch healthcare system s daily practise. (efficacy will be judged by the parameters reduced total risk score figure, weight loss, reduced waist circumference, improved glucose metabolism, and reduced incidence of diabetes; and also well-being/quality-of-life, compliance).By doing so, we also aim to: -- identify the prevalence of the various risk factors (see FINDRISC scorecard, ref.6. and Appendix); -- identify and characterize patients with pre-diabetes in that population. -- analyse the success and failure factors (such as the degree of participation and compliance for physicians and patients, sustainability of the prevention measures, etc.) for an effective intervention. The proposed project will study the implementation of a concept for active primary prevention of diabetes mellitus type II (DM II) in a primary care setting, which is formed by a group of about 40 primary care physicians in Eindhoven (an association called "De Ondernemende Huisarts", DOH). Impaired glucose tolerance (IGT) and/or Increased Fasting Glucose (IFG) precede the development of full-blown diabetes; at that pre-diabetic stage, reversal of the related insulin resistance is still possible (ref. 10, 11). The intervention concept is based on several studies in e.g. the USA and Finland which have clearly demonstrated that effective prevention of DM II in high-risk individuals is possible (ref.1, 2, 9). Intensive life-style modification programmes were shown to reduce the incidence of DM II by more than 50 %. The focus of the prevention is on individuals with a high risk for developing DM II. As a practical approach, these persons can easily be identified in the general population via a risk assessment "score card" questionnaire (ref. 6). Intervention will imply adjustment of lifestyle and diet, aiming at a moderate weight loss, increased daily physical excercise, and improvements in dietary intake of a/o fats and fibers. The prevention will have an active nature, i.e. potential participants will be selected (based on age) by their family practitioner and will be requested to fill in the risk score questionnaire. When exceeding a certain risk score value they will be invited for additional glucose testing and a confirmatory interview. When confirmed to be high risk, patients will be informed and strongly suggested by their family doctor to participate in the lifestyle adjustment programme. The intervention comprizes intensive counseling, group meetings and regular interviews to promote compliance. The family doctor will play an important role in the efforts to ascertain compliance and sustained participation. The active approach to identify individuals with a high risk for developing diabetes is clearly innovative. The high risk patients will be randomly distributed into an intervention arm (n = 500) and into a control arm (n = 500); participants will be followed/monitored for 2.5 years.The key objective of the project is to evaluate the above concept in a "real life" environment in the Dutch population, using the most recent scientific insights in methods to achieve weight loss, an improved life-style, and a reduction of the known preventable risk factors for DM II. Apart from efficacy and feasibility, other elements such as the factors determining success or failure on individual patient level will be studied. Key endpoints for the study will be the reduction of risk score parameters and the reduction in the incidence of DM II, as compared with the control group.The project will be conducted by a collaboration between the TRANZO foundation of the University of Tilburg and the group DOH in Eindhoven; support on various levels will be provided by the Dutch Institute for Public Health and the Environment (RIVM). The project will evaluate the application some of the findings from the SLIM study (University of Maastricht) in a primary care setting. The Eindhoven project is unique (active prevention, using the authority of the family physician) and will be of significant value for the eventual development of a nationwide prevention program in the Netherlands as it focuses on the practical aspects of implementation of effective prevention strategies.