Abstract
OBJECTIVES: Lifestyle interventions can reduce type 2 diabetes risk. The Primary Care Diabetes Prevention Program (PCDPP) was implemented by the Government of Ontario to lower diabetes risk. This study first evaluated the program, and second used a validated tool to estimate a potential population impact if the program were implemented more broadly in the province.
METHODS: PCDPP was implemented in six primary care settings serving communities with high mortality risk due to chronic diseases. In total, 1916 adults with prediabetes or metabolic syndrome were enrolled from January 2011 to December 2012. Body weight was the primary outcome variable, and was modeled using four time periods (i.e., baseline, 3rd, 6th and 9th month). The intervention effect was estimated using multilevel mixed-effects linear regression, and was stratified by gender and age. In the population impact analysis, a number needed to treat (NNT) for the intervention to prevent one case of diabetes and an absolute number of diabetes cases averted were estimated.
RESULTS: Weight loss over 9 months was 7.5% (or 6.8 kg), with 7.4% (or 6.4 kg) in females and 8.6% (or 8.6 kg) in males. When modeled, changes in weight were all statistically significant. The models for male participants predicted, however, some gains in weight in the last 3 months of the program. Dropout rates were 26.8%, 46.8% and 63.0% at 3rd, 6th and 9th month respectively. Scaling up the program would produce an NNT of approximately 36 and would avert 6401 cases of diabetes in five years.
CONCLUSION: PCDPP may represent a potentially effective tool for population-level diabetes risk reduction.
Key Words: Type 2 diabetes, primary care, prevention
Résumé
OBJECTIFS: Les interventions sur le mode de vie peuvent réduire le risque de diabète de type 2. Le Programme de prévention du diabète en soins primaires (PPDSP) a été mis en œuvre par le gouvernement de l’Ontario pour diminuer le risque de diabète. Premièrement, notre étude a évalué ce programme; deuxièmement, elle a utilisé un outil validé pour estimer l’incidence possible sur la population de l’application du programme à plus grande échelle dans la province.
MÉTHODE: Le PPDSP a été mis en œuvre dans six milieux de soins primaires servant des communautés où le risque de mortalité dû aux maladies chroniques est élevé. En tout, 1 916 adultes atteints de prédiabète ou du syndrome métabolique ont été inscrits entre janvier 2011 et décembre 2012. Le poids était la principale variable de résultat, et nous l’avons modélisé à l’aide de quatre intervalles (base de référence, 3e, 6e et 9e mois). Nous avons estimé l’effet de l’intervention au moyen d’une régression linéaire multiniveau à effets mixtes, et nous l’avons stratifié selon le sexe et l’âge. Dans l’analyse d’incidence sur la population, nous avons estimé le nombre nécessaire pour traiter (NNT) pour que l’intervention prévienne un cas de diabète et le nombre absolu de cas de diabète évités.
RÉSULTATS: La perte de poids sur 9 mois a été de 7,5 % (ou 6,8 kg), soit 7,4 % (ou 6,4 kg) chez les femmes et 8,6 % (ou 8,6 kg) chez les hommes. Avec la modélisation, les changements du poids étaient tous significatifs. Les modèles pour les participants de sexe masculin ont cependant prédit des gains de poids au cours des 3 derniers mois du programme. Les taux d’abandon ont été de 26,8 %, 46,8 % et 63 % au 3e, 6e et 9e mois, respectivement. La mise à l’échelle du programme produirait un NNT d’environ 36 et éviterait 6 401 cas de diabète sur cinq ans.
CONCLUSION: Le PPDSP est un outil potentiellement efficace pour réduire le risque de diabète dans la population.
Mots Clés: diabète de type 2, soins primaires, prévention
Footnotes
Conflict of Interest: All authors except for Laura Rosella either work or worked for the Ontario Ministry of Health and Long-Term Care at the time this program was implemented and/or the review of the program was conducted.
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