Costa Bernardo, Castell Conxa, Cos Xavier, Solé Claustre, Mestre Santiago, Canela Marta, Boquet Antoni, Cabré Joan-Josep, Barrio Francisco, Flores-Mateo Gemma, Ferrer-Vidal Daniel, Lindström Jaana
Jordi Gol Primary Care Research Institute, Reus-Tarragona Diabetes Research Group, Catalan Health Institute, Primary Health Care Division, Camí de Riudoms 53-55, 43202, Reus-Barcelona, Spain.
Public Health Division, Departament of Health, Generalitat de Catalunya, Barcelona, Spain.
J Transl Med. 2016 Apr 27;14(1):103. doi: 10.1186/s12967-016-0867-z.
Compelling evidence has been accumulated to support the effectiveness of intensive lifestyle intervention in delaying progression to Type 2 diabetes even in people identified as being at high risk determined by the Finnish diabetes risk score. The DE-PLAN-CAT project (diabetes in Europe-prevention using lifestyle, physical activity and nutritional intervention-Catalonia) evidenced that intensive lifestyle intervention was feasible and cost-effective on a short scale in real-life primary care settings, at least over 4 years. However, transferring such lifestyle interventions to society remains the major challenge of research in the field of diabetes prevention.
METHODS/DESIGN: The derived DP-TRANSFERS (diabetes prevention-transferring findings from European research to society) is a large scale national programme aimed at translating a tailored lifestyle intervention to the maximum of primary care centres where feasible through a core proposal agreed with all the partners. The method is built upon a 3-step (screening, intervention and follow-up) real-life, community-wide structure on the basis of a dual intensity lifestyle intervention (basic and continuity modules) and supported by a 4-channel transfer strategy (institutional relationships, facilitators' workshops, collaborative groupware and programme WEB page). Participation will initially cover nine health departments (7 million inhabitants) through nine coordinating centres located in metropolitan (3.2 million), semi-urban (2.9 million) and rural (0.9 million) areas from which it is expected accessing 25 % of all primary care settings, equivalent to 90 associated centres (1.6-1.8 million people) with an estimate of 0.32 million participants aged 45-75 years at high risk of future development of diabetes. To ascertain sustainability, effect, satisfaction and quality of the translation programme statistical analyses will be performed from both the entire population (facilitators and participants) and a stratified representative sample obtained by collecting data from at least 920 participants.
The DP-TRANSFERS will use a strategy of approach to society consistent with the impact of the disease and the fast accessibility provided by primary care settings in Catalonia. Both the widespread effect of the lifestyle intervention and the translational process itself could be assessed.
已有确凿证据支持强化生活方式干预在延缓2型糖尿病进展方面的有效性，即便对于那些根据芬兰糖尿病风险评分被认定为高危人群亦是如此。DE-PLAN-CAT项目（欧洲糖尿病——利用生活方式、体育活动和营养干预进行预防——加泰罗尼亚）证明，强化生活方式干预在现实生活中的初级保健机构短期实施是可行且具有成本效益的，至少在4年期间如此。然而，将此类生活方式干预推广至社会仍是糖尿病预防领域研究的主要挑战。
方法/设计：衍生的DP-TRANSFERS（糖尿病预防——将欧洲研究成果转化至社会）是一项大规模国家计划，旨在通过与所有合作伙伴商定的核心方案，在可行的情况下将量身定制的生活方式干预推广至尽可能多的初级保健中心。该方法基于一个三步（筛查、干预和随访）的现实生活、社区范围结构，以双重强度生活方式干预（基础模块和持续模块）为基础，并由一个四渠道推广策略（机构关系、促进者研讨会、协作组件和项目网页）提供支持。参与最初将覆盖九个卫生部门（700万居民），通过位于大都市（320万）、半城市（290万）和农村（90万）地区的九个协调中心进行，预计可覆盖所有初级保健机构的25%，即90个相关中心（160万至180万人），估计有32万年龄在45至75岁、未来患糖尿病风险高的参与者。为确定推广项目的可持续性、效果、满意度和质量，将对全体人群（促进者和参与者）以及通过收集至少920名参与者的数据获得的分层代表性样本进行统计分析。
DP-TRANSFERS将采用一种与疾病影响以及加泰罗尼亚初级保健机构提供的快速可及性相一致的面向社会的策略。生活方式干预的广泛效果以及转化过程本身均可得到评估。
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