(13-05-12) A lifestyle intervention to reduce Type 2 diabetes risk in Dutch primary care: 2.5-year results of a randomized controlled trial.

Vermunt PW,?Milder IE,?Wielaard F,?de Vries JH,?Baan CA,?van Oers JA,?Westert GP.
University of Tilburg, Scientific Centre for Transformation in Care and Welfare (Tranzo), Tilburg National Institute for Public Health and the Environment, Centre for Prevention and Health Services Research, Bilthoven Wageningen University, Division of Human Nutrition, Wageningen National Institute for Public Health and the Environment, Department of Public Health Status and Forecasts, Bilthoven Radboud University Nijmegen Medical Centre, Scientific Institute for Quality of Healthcare (IQ Healthcare), Nijmegen, the Netherlands.
Abstract
Aims:  To determine the effectiveness of a 2.5-year lifestyle intervention for Type 2 diabetes prevention in Dutch general practice compared with usual care. Methods:  A randomized controlled trial of 925 individuals at high risk for Type 2 diabetes (FINDRISC-score ≥ 13) in 14 general practices in the Netherlands. Intervention consisted of lifestyle counselling from the nurse practitioner and the general practitioner. Usual care consisted of oral and written information at the start of the study. Study groups were compared over 2.5 years regarding changes in clinical and lifestyle measures. Results:  Both groups showed modest changes in body weight, glucose concentrations, physical activity and dietary intake [weight: intervention group, -0.8 (5.1) kg, usual care group, -0.4 (4.7) kg, (P = 0.69); fasting plasma glucose: intervention group, -0.17 (0.4) mmol/l, usual care group, -0.10 (0.5) mmol/l, (P = 0.10)]. Differences between groups were significant only for total physical activity and fibre intake. In the intervention group, self-efficacy was significantly higher in individuals successful at losing weight compared with unsuccessful individuals. No significant differences in participant weight loss were found between general practitioners and nurse practitioners with different levels of motivation or self-efficacy. Conclusions:  Diabetes risk factors could significantly be reduced by lifestyle counselling in Dutch primary care. However, intervention effects above the effects attributable to usual care were modest. Higher participant self-efficacy seemed to facilitate weight loss. Lack of motivation or self-efficacy of professionals did not negatively influence participant guidance. ? 2012 The Authors. Diabetic Medicine ? 2012 Diabetes UK.

Source: Diabet Med.?2012 Mar 14. doi: 10.1111/j.1464-5491.2012.03648.x. [Epub ahead of print]

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