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Epidemiology/health services research
Challenges of diabetes prevention in the real world: results and lessons from the Melbourne Diabetes Prevention Study
  1. James A Dunbar1,
  2. Andrea L Hernan2,
  3. Edward D Janus2,3,
  4. Erkki Vartiainen2,4,
  5. Tiina Laatikainen2,4,5,
  6. Vincent L Versace2,
  7. John Reynolds6,
  8. James D Best7,
  9. Timothy C Skinner8,
  10. Sharleen L O'Reilly9,
  11. Kevin P Mc Namara2,10,
  12. Elizabeth Stewart1,
  13. Michael Coates2,
  14. Catherine M Bennett1,
  15. Rob Carter11
  16. on behalf of the Melbourne Diabetes Prevention Study (MDPS) research group
  1. 1Faculty of Health, Deakin Population Health Strategic Research Centre, Deakin University, Melbourne Burwood Campus, Burwood, Victoria, Australia
  2. 2Greater Green Triangle University Department of Rural Health, Flinders and Deakin Universities, Warrnambool, Victoria, Australia
  3. 3Western Academic Centre, Western Centre for Health Research and Education, Western Health, University of Melbourne, St. Albans, Victoria, Australia
  4. 4National Institute for Health and Welfare, Helsinki, Finland
  5. 5Faculty of Health Sciences, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
  6. 6Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
  7. 7Lee Kong Chian School of Medicine, Nanyang Technological University and Imperial College London, Singapore, Singapore
  8. 8School of Psychological and Clinical Sciences, Charles Darwin University, Darwin, Northern Territory, Australia
  9. 9Centre for Physical Activity and Nutrition Research, Deakin University, Melbourne Burwood Campus, Burwood, Victoria, Australia
  10. 10Faculty of Pharmacy and Pharmaceutical Sciences, Centre for Medicine Use and Safety, Monash University, Parkville, Victoria, Australia
  11. 11Faculty of Health, Deakin Health Economics, Deakin University, Melbourne Burwood Campus, Burwood, Victoria, Australia
  1. Correspondence to Dr James A Dunbar; james.dunbar{at}deakin.edu.au

Abstract

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.

  • Type 2 Diabetes
  • Cardiovascular Prevention
  • Intervention
  • Public Health

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjdrc-2015-000131

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