A systematic review of real-world diabetes prevention programs: learnings from the last 15 years

Zahra Aziz, Pilvikki Absetz, John Oldroyd, Nicolaas P Pronk, Brian Oldenburg, Zahra Aziz, Pilvikki Absetz, John Oldroyd, Nicolaas P Pronk, Brian Oldenburg

Abstract

Background: The evidence base for the prevention of type 2 diabetes mellitus (T2DM) has progressed rapidly from efficacy trials to real-world translational studies and practical implementation trials over the last 15 years. However, evidence for the effective implementation and translation of diabetes programs and their population impact needs to be established in ways that are different from measuring program effectiveness. We report the findings of a systematic review that focuses on identifying the critical success factors for implementing diabetes prevention programs in real-world settings.

Methods: A systematic review of programs aimed at diabetes prevention was undertaken in order to evaluate their outcomes using the penetration, implementation, participation, and effectiveness (PIPE) impact metric. A search for relevant articles was carried out using PubMed (March 2015) and Web of Science, MEDLINE, CENTRAL, and EMBASE. A quality coding system was developed and included studies were rated independently by three researchers.

Results: Thirty eight studies were included in the review. Almost all (92 %) provided details on participation; however, only 18 % reported the coverage of their target population (penetration). Program intensity or implementation-as measured by frequency of contacts during first year and intervention duration-was identified in all of the reported studies, and 84 % of the studies also reported implementation fidelity; however, only 18 % of studies employed quality assurance measures to assess the extent to which the program was delivered as planned. Sixteen and 26 % of studies reported 'highly' or 'moderately' positive changes (effectiveness) respectively, based on weight loss. Six (16 %) studies reported 'high' diabetes risk reduction but 'low' to 'moderate' weight loss only.

Conclusion: Our findings identify that program intensity plays a major role in weight loss outcomes. However, programs that have high uptake-both in terms of good coverage of invitees and their willingness to accept the invitation-can still have considerable impact in lowering diabetes risk in a population, even with a low intensity intervention that only leads to low or moderate weight loss. From a public health perspective, this is an important finding, especially for resource constrained settings. More use of the PIPE framework components will facilitate increased uptake of T2DM prevention programs around the world.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram

References

    1. International Diabetes Federation . IDF diabetes atlas. 6. Brussels: International Diabetes Federation; 2013.
    1. Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, et al. Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. The New England journal of medicine. 2002;346(6):393–403. doi: 10.1056/NEJMoa012512.
    1. Tuomilehto J, Lindstrom J, Eriksson JG, Valle TT, Hamalainen H, Ilanne-Parikka P, et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. The New England journal of medicine. 2001;344(18):1343–50. doi: 10.1056/NEJM200105033441801.
    1. Pan XR, Li GW, Hu YH, Wang JX, Yang WY, An ZX, et al. Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT and diabetes study. Diabetes care. 1997;20(4):537–44. doi: 10.2337/diacare.20.4.537.
    1. Ramachandran A, Snehalatha C, Mary S, Mukesh B, Bhaskar AD, Vijay V, et al. The Indian diabetes prevention programme shows that lifestyle modification and metformin prevent type 2 diabetes in Asian Indian subjects with impaired glucose tolerance (IDPP-1) Diabetologia. 2006;49(2):289–97. doi: 10.1007/s00125-005-0097-z.
    1. Diabetes Prevention Program Research Group 10-year follow-up of diabetes incidence and weight loss in the diabetes prevention program outcomes study. The Lancet. 2009;374(9702):1677–86. doi: 10.1016/S0140-6736(09)61457-4.
    1. Li G, Zhang P, Wang J, Gregg EW, Yang W, Gong Q, et al. The long-term effect of lifestyle interventions to prevent diabetes in the China Da Qing diabetes prevention study: a 20-year follow-up study. Lancet. 2008;371(9626):1783–9. doi: 10.1016/S0140-6736(08)60766-7.
    1. Peters DH, Adam T, Alonge O, Agyepong IA, Tran N. Implementation research: what it is and how to do it. Bmj. 2013;347:f6753. doi: 10.1136/bmj.f7086.
    1. Jensen D. In: “Transferability.” The SAGE encyclopedia of qualitative research methods. Given LM, editor. Thousand Oaks: SAGE Publications, Inc; 2008. p. 887.
    1. Yates T, Davies M, Khunti K. Preventing type 2 diabetes: can we make the evidence work? Postgraduate medical journal. 2009;85(1007):475–80. doi: 10.1136/pgmj.2008.076166.
    1. Yamaoka K, Tango T. Efficacy of lifestyle education to prevent type 2 diabetes: a meta-analysis of randomized controlled trials. Diabetes care. 2005;28(11):2780–6. doi: 10.2337/diacare.28.11.2780.
    1. Gillies CL, Abrams KR, Lambert PC, Cooper NJ, Sutton AJ, Hsu RT, et al. Pharmacological and lifestyle interventions to prevent or delay type 2 diabetes in people with impaired glucose tolerance: systematic review and meta-analysis. Bmj. 2007;334(7588):299. doi: 10.1136/bmj.39063.689375.55.
    1. Orozco LJ, Buchleitner AM, Gimenez-Perez G, Roque IFM, Richter B, Mauricio D. Exercise or exercise and diet for preventing type 2 diabetes mellitus. The Cochrane database of systematic reviews. 2008;3:CD003054.
    1. Angermayr L, Melchart D, Linde K. Multifactorial lifestyle interventions in the primary and secondary prevention of cardiovascular disease and type 2 diabetes mellitus—a systematic review of randomized controlled trials. Annals of behavioral medicine: a publication of the Society of Behavioral Medicine. 2010;40(1):49–64. doi: 10.1007/s12160-010-9206-4.
    1. Baker MK, Simpson K, Lloyd B, Bauman AE, Singh MA. Behavioral strategies in diabetes prevention programs: a systematic review of randomized controlled trials. Diabetes research and clinical practice. 2011;91(1):1–12. doi: 10.1016/j.diabres.2010.06.030.
    1. Gillett M, Royle P, Snaith A, Scotland G, Poobalan A, Imamura M, et al. Non-pharmacological interventions to reduce the risk of diabetes in people with impaired glucose regulation: a systematic review and economic evaluation. Health technology assessment. 2012;16(33):1–236. doi: 10.3310/hta16330.
    1. Schellenberg ES, Dryden DM, Vandermeer B, Ha C, Korownyk C. Lifestyle interventions for patients with and at risk for type 2 diabetes: a systematic review and meta-analysis. Annals of internal medicine. 2013;159(8):543–51. doi: 10.7326/0003-4819-159-8-201310150-00007.
    1. Terranova CO, Brakenridge CL, Lawler SP, Eakin EG, Reeves MM. Effectiveness of lifestyle-based weight loss interventions for adults with type 2 diabetes: a systematic review and meta-analysis. Diabetes Obes Metab. 2015;17(4):371–8. doi: 10.1111/dom.12430.
    1. Stevens JW, Khunti K, Harvey R, Johnson M, Preston L, Woods HB, et al. Preventing the progression to type 2 diabetes mellitus in adults at high risk: a systematic review and network meta-analysis of lifestyle, pharmacological and surgical interventions. Diabetes Res Clin Pract. 2015;107(3):320–31. doi: 10.1016/j.diabres.2015.01.027.
    1. Yuen A, Sugeng Y, Weiland TJ, Jelinek GA. Lifestyle and medication interventions for the prevention or delay of type 2 diabetes mellitus in prediabetes: a systematic review of randomised controlled trials. Australian and New Zealand journal of public health. 2010;34(2):172–8. doi: 10.1111/j.1753-6405.2010.00503.x.
    1. Cardona-Morrell M, Rychetnik L, Morrell SL, Espinel PT, Bauman A. Reduction of diabetes risk in routine clinical practice: are physical activity and nutrition interventions feasible and are the outcomes from reference trials replicable? A systematic review and meta-analysis. BMC public health. 2010;10:653. doi: 10.1186/1471-2458-10-653.
    1. Taylor J, Cottrell C, Chatterton H, Hill J, Hughes R, Wohlgemuth C, et al. Identifying risk and preventing progression to type 2 diabetes in vulnerable and disadvantaged adults: a pragmatic review. Diabetic medicine : a journal of the British Diabetic Association. 2013;30(1):16–25. doi: 10.1111/dme.12027.
    1. Li R, Zhang P, Barker LE, Chowdhury FM, Zhang X. Cost-effectiveness of interventions to prevent and control diabetes mellitus: a systematic review. Diabetes care. 2010;33(8):1872–94. doi: 10.2337/dc10-0843.
    1. Jackson L. Translating the diabetes prevention program into practice: a review of community interventions. The Diabetes educator. 2009;35(2):309–20. doi: 10.1177/0145721708330153.
    1. Ali MK, Echouffo-Tcheugui J, Williamson DF. How effective were lifestyle interventions in real-world settings that were modeled on the diabetes prevention program? Health affairs. 2012;31(1):67–75. doi: 10.1377/hlthaff.2011.1009.
    1. Johnson M, Jones R, Freeman C, Woods HB, Gillett M, Goyder E, et al. Can diabetes prevention programmes be translated effectively into real-world settings and still deliver improved outcomes? A synthesis of evidence. Diabetic medicine : a journal of the British Diabetic Association. 2013;30(1):3–15. doi: 10.1111/dme.12018.
    1. Dunkley AJ, Bodicoat DH, Greaves CJ, Russell C, Yates T, Davies MJ, et al. Diabetes prevention in the real world: effectiveness of pragmatic lifestyle interventions for the prevention of type 2 diabetes and of the impact of adherence to guideline recommendations: a systematic review and meta-analysis. Diabetes care. 2014;37(4):922–33. doi: 10.2337/dc13-2195.
    1. Pronk NP, Remington PL; Community Preventive Services Task Force. Combined diet and physical activity promotion programs for prevention of diabetes: community preventive services task force recommendation statement. Ann Intern Med. 2015; 163. doi:10.7326/M15-1029.
    1. Whittemore R. A systematic review of the translational research on the diabetes prevention program. Translational behavioral medicine. 2011;1(3):480–91. doi: 10.1007/s13142-011-0062-y.
    1. Glasgow RE. Evaluation of theory-based interventions: the RE-AIM model. In: Glanz K, Lewis FM, Rimer BK, editors. Health behavior and health education. 3. San Francisco: Jossey-Bass; 2002. pp. 531–44.
    1. Laws RA, et al. A systematic review of external validity in lifestyle interventions. Am J Prev Med. 2012;43(2):205–14. doi: 10.1016/j.amepre.2012.04.017.
    1. Green LW, Glasgow RE. Evaluating the relevance, generalization, and applicability of research—issues in external validation and translation methodology. Eval Health Prof. 2006;29(1):126–53. doi: 10.1177/0163278705284445.
    1. Pronk NP. Designing and evaluating health promotion programs: simple rules for a complex issue. Disease Management & Health Outcomes. 2003;11(3):149–57. doi: 10.2165/00115677-200311030-00002.
    1. Zyriax BC, Letsch B, Stock S, Windler E. DELIGHT (delay of impaired glucose tolerance by a healthy lifestyle trial)—a feasibility study on implementing a program of sustainable diabetes prevention in German companies. Experimental and clinical endocrinology & diabetes: official journal, German Society of Endocrinology [and] German Diabetes Association. 2014;122(1):20–6.
    1. Mensink M, Feskens EJ, Saris WH, De Bruin TW, Blaak EE. Study on lifestyle intervention and impaired glucose tolerance Maastricht (SLIM): preliminary results after one year. International journal of obesity and related metabolic disorders: journal of the International Association for the Study of Obesity. 2003;27(3):377–84. doi: 10.1038/sj.ijo.0802249.
    1. Bo S, Ciccone G, Baldi C, Benini L, Dusio F, Forastiere G, et al. Effectiveness of a lifestyle intervention on metabolic syndrome. A randomized controlled trial. J Gen Intern Med. 2007;22(12):1695–703. doi: 10.1007/s11606-007-0399-6.
    1. Lakerveld J, Bot S, Chinapaw M, van Tulder M, Kingo L, Nijpels G. Process evaluation of a lifestyle intervention to prevent diabetes and cardiovascular diseases in primary care. Health promotion practice. 2012;13(5):696–706. doi: 10.1177/1524839912437366.
    1. Ma J, Yank V, Xiao L, Lavori PW, Wilson SR, Rosas LG, et al. Translating the diabetes prevention program lifestyle intervention for weight loss into primary care: a randomized trial. JAMA internal medicine. 2013;173(2):113–21. doi: 10.1001/2013.jamainternmed.987.
    1. Davis-Smith YM, Boltri JM, Seale JP, Shellenberger S, Blalock T, Tobin B. Implementing a diabetes prevention program in a rural African-American church. Journal of the National Medical Association. 2007;99(4):440–6.
    1. Costa B, Barrio F, Cabre JJ, Pinol JL, Cos X, Sole C, et al. Delaying progression to type 2 diabetes among high-risk Spanish individuals is feasible in real-life primary healthcare settings using intensive lifestyle intervention. Diabetologia. 2012;55(5):1319–28. doi: 10.1007/s00125-012-2492-6.
    1. Absetz P, Valve R, Oldenburg B, Heinonen H, Nissinen A, Fogelholm M, et al. Type 2 diabetes prevention in the “real world”: one-year results of the GOAL implementation trial. Diabetes Care. 2007;30(10):2465–70. doi: 10.2337/dc07-0171.
    1. Nilsen V, Bakke PS, Gallefoss F. Effects of lifestyle intervention in persons at risk for type 2 diabetes mellitus—results from a randomised, controlled trial. BMC public health. 2011;11:893. doi: 10.1186/1471-2458-11-893.
    1. Penn L, Lordon J, Lowry R, Smith W, Mathers JC, Walker M, et al. Translating research evidence to service provision for prevention of type 2 diabetes: development and early outcomes of the ‘new life, new you’ intervention. British Journal of Diabetes and Vascular Disease. 2011;11(4):175–81. doi: 10.1177/1474651411401538.
    1. Savas LA, Grady K, Cotterill S, Summers L, Boaden R, Gibson JM. Prioritising prevention: implementation of IGT care call, a telephone based service for people at risk of developing type 2 diabetes. Primary care diabetes. 2015;9(1):3–8. doi: 10.1016/j.pcd.2014.07.003.
    1. Vanderwood KK, Hall TO, Harwell TS, Butcher MK, Helgerson SD, Montana Cardiovascular D, et al. Implementing a state-based cardiovascular disease and diabetes prevention program. Diabetes Care. 2010;33(12):2543–5. doi: 10.2337/dc10-0862.
    1. Janus ED, Best JD, Davis-Lameloise N, Philpot B, Hernan A, Bennett CM, et al. Scaling-up from an implementation trial to state-wide coverage: results from the preliminary Melbourne diabetes prevention study. Trials. 2012;13:152. doi: 10.1186/1745-6215-13-152.
    1. Sepah SC, Jiang L, Peters AL. Translating the diabetes prevention program into an online social network: validation against CDC standards. The Diabetes educator. 2014;40(4):435–43. doi: 10.1177/0145721714531339.
    1. Kumanyika S, Fassbender J, Phipps E, Tan-Torres S, Localio R, Morales KH, et al. Design, recruitment and start up of a primary care weight loss trial targeting African American and Hispanic adults. Contemporary Clinical Trials. 2011;32(2):215–24. doi: 10.1016/j.cct.2010.11.002.
    1. Duijzer G, Haveman-Nies A, Jansen SC, ter Beek J, Hiddink GJ, Feskens EJ. Feasibility and potential impact of the adapted SLIM diabetes prevention intervention in a Dutch real-life setting: the SLIMMER pilot study. Patient education and counseling. 2014;97(1):101–7. doi: 10.1016/j.pec.2014.05.024.
    1. Kanaya AM, Santoyo-Olsson J, Gregorich S, Grossman M, Moore T, Stewart AL. The live well, be well study: a community-based, translational lifestyle program to lower diabetes risk factors in ethnic minority and lower-socioeconomic status adults. Am J Public Health. 2012;102(8):1551–8. doi: 10.2105/AJPH.2011.300456.
    1. Paulweber B, Valensi P, Lindstrom J, et al. A European evidence-based guideline for the prevention of type 2 diabetes. Horm Metab Res. 2010;42(Suppl. 1):S3–36. doi: 10.1055/s-0029-1240928.
    1. National Institute for Health and Clinical Excellence . Preventing type 2 diabetes: risk identification and interventions for individuals at high risk. London: National Institute for Health and Clinical Excellence; 2012.
    1. Balk EM, Earley A, Raman G, Avendano EA, Pittas AG, Remington PL, Task Force on Community Preventive Services Combined diet and physical activity promotion programs to prevent type 2 diabetes among persons at increased risk: a systematic review for the community preventive services task force. Ann Intern Med. 2015;163(6):437–51. doi: 10.7326/M15-0452.
    1. Li R, Qu S, Zhang P, Chattopadhyay S, Gregg EW, Albright A, Hopkins D, Pronk NP, [Task Force on Community Preventive Services]. Economic evaluation of combined diet and physical activity promotion programs to prevent type 2 diabetes among persons at increased risk: a systematic review for the community preventive services task force. Ann Intern Med. 2015; 163. doi:10.7326/M15-0469.
    1. Lindstrom J, Peltonen M, Eriksson JG, Louheranta A, Fogelholm M, Uusitupa M, et al. High-fibre, low-fat diet predicts long-term weight loss and decreased type 2 diabetes risk: the Finnish diabetes prevention study. Diabetologia. 2006;49:912–20. doi: 10.1007/s00125-006-0198-3.
    1. Yajnik CS, Lubree HG, Rege SS, Naik SS, Deshpande JA, Deshpande SS, et al. Adiposity and hyperinsulinemia in Indians are present at birth. The Journal of clinical endocrinology and metabolism. 2002;87(12):5575–80. doi: 10.1210/jc.2002-020434.
    1. Chan JC, Malik V, Jia W, Kadowaki T, Yajnik CS, Yoon KH, et al. Diabetes in Asia: epidemiology, risk factors, and pathophysiology. Jama. 2009;301(20):2129–40. doi: 10.1001/jama.2009.726.
    1. Resnicow K, McMaster F. Motivational interviewing: moving from why to how with autonomy support. The international journal of behavioral nutrition and physical activity. 2012;9:19. doi: 10.1186/1479-5868-9-19.
    1. Spring B, Sohn MW, Locatelli SM, Hadi S, Kahwati L, Weaver FM. Individual, facility, and program factors affecting retention in a national weight management program. BMC public health. 2014;14:363. doi: 10.1186/1471-2458-14-363.
    1. Daivadanam M, Absetz P, Sathish T, Thankappan KR, Fisher EB, Philip NE, et al. Lifestyle change in Kerala, India: needs assessment and planning for a community-based diabetes prevention trial. Bmc Public Health. 2013;13:95. doi: 10.1186/1471-2458-13-95.
    1. Sathish T, Williams ED, Pasricha N, Absetz P, Lorgelly P, Wolfe R, et al. Cluster randomised controlled trial of a peer-led lifestyle intervention program: study protocol for the Kerala diabetes prevention program. BMC public health. 2013;13:1035. doi: 10.1186/1471-2458-13-1035.
    1. Kosaka K, Noda M, Kuzuya T. Prevention of type 2 diabetes by lifestyle intervention: a Japanese trial in IGT males. Diabetes research and clinical practice. 2005;67(2):152–62. doi: 10.1016/j.diabres.2004.06.010.
    1. Oldroyd JC, Unwin NC, White M, Mathers JC, Alberti KG. Randomised controlled trial evaluating lifestyle interventions in people with impaired glucose tolerance. Diabetes Res Clin Pract. 2006;72(2):117–27. doi: 10.1016/j.diabres.2005.09.018.
    1. Laatikainen T, Dunbar JA, Chapman A, Kilkkinen A, Vartiainen E, Heistaro S, et al. Prevention of type 2 diabetes by lifestyle intervention in an Australian primary health care setting: greater green triangle (GGT) diabetes prevention project. Bmc Public Health. 2007;7:249. doi: 10.1186/1471-2458-7-249.
    1. Ackermann RT, Finch EA, Brizendine E, Zhou H, Marrero DG. Translating the diabetes prevention program into the community. The DEPLOY pilot study. American Journal of Preventive Medicine. 2008;35(4):357–63. doi: 10.1016/j.amepre.2008.06.035.
    1. Boltri JM, Davis-Smith YM, Seale JP, Shellenberger S, Okosun IS, Cornelius ME. Diabetes prevention in a faith-based setting: results of translational research. Journal of Public Health Management and Practice. 2008;14(1):29–32. doi: 10.1097/01.PHH.0000303410.66485.91.
    1. Payne WR, Walsh KJ, Harvey JT, Livy MF, McKenzie KJ, Donaldson A, et al. Effect of a low-resource-intensive lifestyle modification program incorporating gymnasium-based and home-based resistance training on type 2 diabetes risk in Australian adults. Diabetes Care. 2008;31(12):2244–50. doi: 10.2337/dc08-0152.
    1. Kramer MK, Kriska AM, Venditti EM, Miller RG, Brooks MM, Burke LE, et al. Translating the diabetes prevention program. A comprehensive model for prevention training and program delivery. American Journal of Preventive Medicine. 2009;37(6):505–11. doi: 10.1016/j.amepre.2009.07.020.
    1. Kulzer B, Hermanns N, Gorges D, Schwarz P, Haak T. Prevention of diabetes self-management program (PREDIAS): effects on weight, metabolic risk factors, and behavioral outcomes. Diabetes Care. 2009;32(7):1143–6. doi: 10.2337/dc08-2141.
    1. Penn L, White M, Oldroyd J, Walker M, Alberti KG, Mathers JC. Prevention of type 2 diabetes in adults with impaired glucose tolerance: the European Diabetes Prevention RCT in Newcastle upon Tyne, UK. BMC Public Health. 2009;9:342. doi: 10.1186/1471-2458-9-342.
    1. Almeida FA, Shetterly S, Smith-Ray RL, Estabrooks PA. Reach and effectiveness of a weight loss intervention in patients with prediabetes in Colorado. Preventing Chronic Disease. 2010;7(5):A103.
    1. Makrilakis K, Liatis S, Grammatikou S, Perrea D, Katsilambros N. Implementation and effectiveness of the first community lifestyle intervention programme to prevent type 2 diabetes in Greece. The DE-PLAN study. Diabetic Medicine. 2010;27(4):459–65. doi: 10.1111/j.1464-5491.2010.02918.x.
    1. Parikh P, Simon EP, Fei K, Looker H, Goytia C, Horowitz CR. Results of a pilot diabetes prevention intervention in East Harlem, New York City: project HEED. American journal of public health. 2010;100(Suppl 1):S232–9. doi: 10.2105/AJPH.2009.170910.
    1. Vermunt PW, Milder IE, Wielaard F, van Oers JA, Westert GP. An active strategy to identify individuals eligible for type 2 diabetes prevention by lifestyle intervention in Dutch primary care: the APHRODITE study. Family practice. 2010;27(3):312–9. doi: 10.1093/fampra/cmp100.
    1. Boltri JM, Davis-Smith M, Okosun IS, Seale JP, Foster B. Translation of the National Institutes of Health diabetes prevention program in African American churches. Journal of the National Medical Association. 2011;103(3):194–202. doi: 10.1016/S0027-9684(15)30301-1.
    1. Gilis-Januszewska A, Szybinski Z, Kissimova-Skarbek K, Piwonska-Solska B, Pach D, Topor-Madry R, et al. Prevention of type 2 diabetes by lifestyle intervention in primary health care setting in Poland: diabetes in Europe prevention using lifestyle, physical activity and nutritional intervention (DE-PLAN) project. Br J Diabetes Vasc Dis. 2011;11(4).
    1. Katula JA, Vitolins MZ, Rosenberger EL, Blackwell CS, Morgan TM, Lawlor MS, et al. One-year results of a community-based translation of the diabetes prevention program: healthy-living partnerships to prevent diabetes (HELP PD) project. Diabetes Care. 2011;34(7):1451–7. doi: 10.2337/dc10-2115.
    1. Ruggiero L, Oros S, Choi YK. Community-based translation of the diabetes prevention program's lifestyle intervention in an underserved Latino population. Diabetes Educator. 2011;37(4):564–72. doi: 10.1177/0145721711411107.
    1. Sakane N, Sato J, Tsushita K, Tsujii S, Kotani K, Tsuzaki K, et al. Prevention of type 2 diabetes in a primary healthcare setting: three-year results of lifestyle intervention in Japanese subjects with impaired glucose tolerance. BMC Public Health. 2011;11(1):40. doi: 10.1186/1471-2458-11-40.
    1. Ockene IS, Tellez TL, Rosal MC, Reed GW, Mordes J, Merriam PA, et al. Outcomes of a Latino community-based intervention for the prevention of diabetes: the Lawrence Latino diabetes prevention project. American Journal of Public Health. 2012;102(2):336–42. doi: 10.2105/AJPH.2011.300357.
    1. Piatt GA, Seidel MC, Chen H-Y, Powell RO, Zgibor JC. Two-year results of translating the diabetes prevention program into an urban, underserved community. Diabetes Educator. 2012;38(6):798–804. doi: 10.1177/0145721712458834.
    1. Jiang LH, Manson SM, Beals J, Henderson WG, Huang HX, Acton KJ, et al. Translating the diabetes prevention program into American Indian and Alaska native communities results from the special diabetes program for Indians diabetes prevention demonstration project. Diabetes Care. 2013;36(7):2027–34. doi: 10.2337/dc12-1250.

Source: PubMed

Sponsors et collaborateurs

Les conditions médicales

Interventions en matière de drogue

3
S'abonner