Impact of applying a diabetes risk score in primary care on change in physical activity: a pragmatic cluster randomised trial

Esther Seidel-Jacobs, Fiona Kohl, Miguel Tamayo, Joachim Rosenbauer, Matthias B Schulze, Oliver Kuss, Wolfgang Rathmann, Esther Seidel-Jacobs, Fiona Kohl, Miguel Tamayo, Joachim Rosenbauer, Matthias B Schulze, Oliver Kuss, Wolfgang Rathmann

Abstract

Aim: There is little evidence of the impact of diabetes risk scores on individual diabetes risk factors, motivation for behaviour changes and mental health. The aim of this study was to investigate the effect of applying a noninvasive diabetes risk score in primary care as component of routine health checks on physical activity and secondary outcomes.

Methods: Cluster randomised trial, in which primary care physicians (PCPs), randomised (1:1) by minimisation, enrolled participants with statutory health insurance without known diabetes, ≥ 35 years of age with a body mass index ≥ 27.0 kg/m2. The German Diabetes Risk Score was applied as add-on to the standard routine health check, conducted in the controls. Primary outcome was the difference in participants' physical activity (International Physical Activity Questionnaire) after 12 months. Secondary outcomes included body mass index, perceived health, anxiety, depression, and motivation for lifestyle change. Analysis was by intention-to-treat principle using mixed models.

Results: 36 PCPs were randomised; remaining 30 PCPs (intervention: n = 16; control: n = 14) recruited 315 participants (intervention: n = 153; controls: n = 162). A slight increase in physical activity was observed in the intervention group with an adjusted mean change of 388 (95% confidence interval: - 235; 1011) metabolic equivalents minutes per week. There were no relevant changes in secondary outcomes.

Conclusions: The application of a noninvasive diabetes risk score alone is not effective in promoting physical activity in primary care.

Clinical trial registration: ClinicalTrials.gov (NCT03234322, registration date: July 31, 2017).

Keywords: Physical activity; Prevention; Primary care; Risk prediction model; Risk score; Type 2 diabetes.

Conflict of interest statement

WR reported having received consulting fees for attending educational sessions or advisory boards from AstraZeneca, Boehringer Ingelheim and NovoNordisk and institutional research grants from AstraZeneca and NovoNordisk. ES-J, FK, MT, JR, MBS and OK have no financial disclosures.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Flow-chart
Fig. 2
Fig. 2
Odds ratio (OR) on reachability of stages action or maintenance at 12 months follow-up. Results labelled with MI refer to results after multiple across-cluster imputation of missing values

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