Lifestyle Intervention for Pakistani Women in Oslo (InnvaDiab)

Evaluation of a Lifestyle Intervention to Prevent Type 2 Diabetes/Metabolic Syndrome Among Pakistani Immigrants - Focusing on Changes in Diet and Physical Activity

Immigrants from South Asia in Norway have a high prevalence of type 2 diabetes and conditions related to the metabolic syndrome. It has been documented that these conditions may be prevented by changes in lifestyle. No previous intervention studies on immigrants with focus on diet and physical activity have been carried out in Norway. This project concerns a randomized controlled trial with intervention to change diet and physical activity in 200 high risk female Pakistani immigrants living in Oslo. The intervention will be evaluated both in terms of outcome and process.

Study Overview

• Status: Completed
• Conditions: Metabolic Syndrome; Type 2 Diabetes
• Intervention / Treatment: Behavioral: lifestyle intervention (diet and physical activity)

Detailed Description

Objectives:

1. To evaluate the health effects of systematic dietary education and counselling and physical training in a group of Pakistani women with high risk of type 2 diabetes.
2. To evaluate the intervention process in order to identify the most effective methods of intervention in regard to diet and physical activity for immigrant women of Pakistani origin.

Background: Immigrants from South Asia have a high prevalence of type 2 diabetes, which may be prevented by intensive on physical activity and diet. This application concerns intervention with diet and physical activity in female (ongoing study) and male (extended study) Pakistani immigrants living in Oslo to reduce their risk for these diseases.

Intervention design: The subjects will be 200 women randomized into an intervention group and a control group (100 in each). The women are being recruited from a township in Oslo with a high proportion of immigrants by using a network approach. Inclusion criteria is based on a risk score developed by Ramachandran et al for Asian Indians, entailing age, Body Mass Index, waist circumference, family history of diabetes and sedentary physical activity.

The intervention will include a combination of individual counselling and group sessions. The intervention group will be divided into subgroups of 10-12 subjects. Each subgroup will have 10 group sessions on diet/lifestyle in the 6 months the intervention period lasts, and will additionally have the possibility to join a cultural adapted exercise program of low intensity twice a week. This includes indoor activities (exercise with music) and outdoor activities (walking groups).

Evaluation: The main end point of the intervention will be the fasting and 2-h plasma glucose value after an oral glucose tolerance test (OGTT). This will be measured at baseline and after 6 months of intervention.

Secondary end-points will be Serum lipid profile (e.g. triglycerides, High-Density Lipoprotein-cholesterol) ; HbA1c ; C-peptide ; serum insulin; serum albumin; body weight; waist and hip circumference; maximum heart rate on treadmill test; self-reported level of intensity, duration and frequency of physical activity; self-reported level of "Stages of change" in regard to motivation and behavioural change; self- reported subjective health complaints; self-reported coping strategies; self-reported sleeping habits.

Dietary information will be collected by 2 x 48 hours dietary recalls. The intake of energy and nutrients will be calculated from the recalls, as well as the intake of food groups.The diet will also be evaluated by a culturally adapted food frequency questionnaire including 20 food groups (with portion sizes). In addition, the use of cooking oils will be registered by questions about the type and quantity oil used per time unit in the household. Additionally, information on knowledge and perceptions on diet and health before and after the intervention will be registered.

Physical activity will be registered using an advanced continuous body monitor, SenseWear Armband yielding information on total energy expenditure, level of intensity, duration and frequency of physical activity, duration of lying down, duration of sleeping, and sleeping quality.

The completion of the questionnaires will take the form of an interview by Urdu speaking staff.

• Study Type: Interventional
• Enrollment (Actual): 198
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Norway
  • Holmlia, Oslo
    • Oslo, Holmlia, Oslo, Norway, 1255
      • Primary Health Care Health Center

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 25 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: Female

Description

Inclusion Criteria:

• Risk score developed by Ramachandran et al for Asian Indians:

  • BMI, waist circumference, family history of diabetes and sedentary physical activity

Exclusion Criteria:

• Type 1 diabetes.
• Positive auto antibodies.
• Diagnosis of type 2 diabetes more than 6 months.
• Medication for type 2 diabetes.
• Pregnancy at intervention start.
• Suffering from heart attack or stroke the last 3 months.
• Already participating in organised physical exercise.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Intervention; The intervention group was divided into nine subgroups of ten to twelve women who were offered six educational sessions, each lasting 2 h, during a 7 +- 1-month period. The main focus was on the physiological importance of blood glucose and its regulation by diet and physical activity, and on knowledge about the Pakistani lifestyle in Pakistan and Norway	Behavioral: lifestyle intervention (diet and physical activity); The intervention will include a combination of individual counselling group sessions. The intervention groups will be divided into subgroups of 10-12 subjects. Each group will have 10 group sessions on diet/lifestyle in the 6 months the intervention period lasts, and will additionally have the possibility to join a culturally adapted exercise program of low intensity twice a week.
No Intervention: Control; One lesson recieved after post-test

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
The Fasting Plasma Glucose Value, Baseline	baseline
Plasma Glucose 2 h After Oral Glucose Tolerance Test, Baseline	baseline
The Fasting Plasma Glucose, Post-test	post-test
Plasma Glucose, 2-h, Post-test	post-test

Secondary Outcome Measures

Outcome Measure	Time Frame
HbA1c, Baseline	baseline
C-peptide, 0-h, Baseline	baseline
C-peptid, 2-h, Baseline	baseline
Insulin, 0-h, Baseline	baseline
Insulin, 2-h, Baseline	baseline
High-Density Lipoprotein Cholesterol, Baseline	baseline
Triglycerides, Baseline	baseline
Systolic Blood Pressure, Baseline	baseline
Diastolic Blood Pressure, Baseline	baseline
Waist Circumference, Baseline	baseline
Body Mass Index, Baseline	baseline
Intake of Vegetables, Fruit and Fruit Juice, Baseline	baseline
Intake of Soft Drinks With Added Sugar, Baseline	baseline
Intake of Red Meat, Baseline	baseline
Intake of Poultry, Baseline	baseline
Intake of Fish, Baseline	baseline
HbA1C, Post-test	post-test, after completion of all six group sessions
C-peptid, 0-h, Post-test	post-test, after completion of all six group sessions
C-peptid, 2-h, Post-test	post-test, after completion of all six group sessions
Insulin, 0-h, Post-test	post-test, after completion of all six group sessions
Insulin, 2-h, Post-test	post-test, after completion of all six group sessions
High-Density Lipoprotein Cholesterol, Post-test	post-test, after completion of all six group sessions
Triglycerides, Post-test	post-test, after completion of all six group sessions
Systolic Blood Pressure, Post-test	post-test, after completion of all six group sessions
Diastolic Blood Pressure, Post-test	post-test, after completion of all six group sessions
Waist Circumference	post-test, after completion of all six group sessions
Body Mass Index, Post-test	post-test, after completion of all six group sessions
Intake of Vegetables, Fruit and Fruit Juice, Post-test	post-test, after completion of all six group sessions
Intake of Soft Drinks With Added Sugar, Post-test	post-test, after completion of all six group sessions
Intake of Red Meat, Post-test	post-test, after completion of all six group sessions
Intake of Poultry, Post-test	post-test, after completion of all six group sessions
Intake of Fish, Post Test	post-test, after completion of all six group sessions

Collaborators and Investigators

• Sponsor: University of Oslo
• Collaborators: The Research Council of Norway; European Commission
• Investigators: Principal Investigator: Gerd Holmboe-Ottesen, Dr. Philos., University of Oslo

Study record dates

Study Major Dates

• Study Start: April 1, 2006
• Primary Completion (Actual): September 1, 2008
• Study Completion (Actual): September 1, 2008

Study Registration Dates

• First Submitted: January 19, 2007
• First Submitted That Met QC Criteria: January 19, 2007
• First Posted (Estimate): January 22, 2007

Study Record Updates

• Last Update Posted (Estimate): July 21, 2014
• Last Update Submitted That Met QC Criteria: June 24, 2014
• Last Verified: April 1, 2014

More Information

Terms related to this study

• Keywords: Metabolic syndrome; Type 2 Diabetes; Physical activity; lifestyle intervention; Norway; dietary change; Pakistani women
• Additional Relevant MeSH Terms: Pathologic Processes; Glucose Metabolism Disorders; Metabolic Diseases; Endocrine System Diseases; Disease; Diabetes Mellitus; Insulin Resistance; Hyperinsulinism; Diabetes Mellitus, Type 2; Syndrome; Metabolic Syndrome
• Other Study ID Numbers: NFR 166998/166977; EU-DEPLAN 2004310