Disclosures: Sampson reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
November 03, 2020
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Low-cost intervention nearly halves diabetes risk

Disclosures: Sampson reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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A group-based intervention that cost $153 per participant reduced the 2-year risk for type 2 diabetes by up to 47%, according to results from a randomized clinical trial published in JAMA Internal Medicine.

“This study updates the existing diabetes prevention evidence and brings it into line with current clinical practice,” Michael J. Sampson, MD, a diabetes and endocrinology consultant at the Elsie Bertram Diabetes Centre in England, told Healio Primary Care.

Title: Percentages of participants who progressed to type 2 diabetes in the Norfolk Diabetes Prevention Study: Column 1: 22.8% Usual care Column 2: 13.7% Group-based lifestyle intervention Column 3: 15% Group-based lifestyle intervention with trained volunteers
Reference: Sampson M, et al. JAMA Intern Med. 2020;doi:10.1001/jamainternmed.2020.5938.

In the Norfolk Diabetes Prevention Study, Sampson and colleagues randomly assigned 1,028 participants in a high-risk glycemic category — which meant either an elevated fasting plasma glucose level of 110 mg/dL and higher to less than 126 mg/dL, or an elevated HbA1c level of between 6% and 6.5% with an elevated fasting plasma glucose level between 100 mg/dL and 110 mg/dL — to receive either usual care or a group-based lifestyle intervention with or without trained volunteers with type 2 diabetes.

The intervention consisted of six, 2-hour educational group sessions for 12 weeks, followed by up to 15 maintenance sessions 8 weeks apart (INT). During these sessions, participants received information about the health benefits of losing about 7% of their weight; engaging in 150 minutes weekly of moderately intense physical activity over 5 days or more and weekly muscle-strengthening exercises; and lowering their total and saturated fat consumption. The third study arm received the same intervention plus support from trained mentors and volunteers who had type 2 diabetes (INT-DPM).

The researchers reported that after a mean follow-up of 24.7 months, 39 of 171 (22.8%) participants in the usual care cohort, 55 of 403 (13.7%) in the INT cohort and 62 of 414 (15%) in the INT-DPM cohort progressed to type 2 diabetes. Although there was no significant difference in the odds of developing type 2 diabetes between the two intervention cohorts (OR = 1.14; 95% CI, 0.77-1.7), both groups had significantly lower odds of developing type 2 diabetes (OR = 0.54; 95% CI, 0.34-0.85 for INT; OR = 0.61; 95% CI, 0.39-0.96 for INT-DPM; and combined OR = 0.57; 95% CI, 0.38-0.87). The effect size was similar across groups according to age, glycemic category and social deprivation scores.

According to the researchers, for every 11 participants treated, one diabetes diagnosis was prevented.

Michael J. Sampson

Sampson said “we should be cautious about assuming these results are translatable to all populations,” noting that among all three cohorts more than 95% of the participants were white. He suggested that future studies analyze the intervention’s effect among underserved populations.