Dunbar James A
Centre for Population Health Research, Deakin University, Melbourne, Australia.
Diabetes Metab J. 2017 Jun;41(3):160-167. doi: 10.4093/dmj.2017.41.3.160. Epub 2017 Feb 2.
Clinical trials have demonstrated the efficacy of lifestyle modification for the prevention of type 2 diabetes mellitus but it was achieved at higher cost than can be sustained in routine health services. The first clinical trial to report was the Finnish Diabetes Prevention Study. This paper describes how Australia worked with Finnish colleagues to adapt the findings of that study to achieve a statewide diabetes prevention program. Small evaluative, effectiveness trials have been conducted in a number of countries to see if the results of the clinical trials can be replicated in routine health services. The Australian evaluative trial, Greater Green Triangle Diabetes Prevention Program is described in detail to demonstrate the ingredients for success in moving a program from one country to another. Few countries have managed to scale up from evaluative trials to statewide or national programs. The Australian experience is described in detail including lessons learned about what reduced the effectiveness, particularly the need for policy makers in government, people from the implementing organisation and researchers to work together from the start of the evaluative trial and throughout the first 5 years of a national program.
临床试验已证明生活方式改变对预防2型糖尿病有效，但实现这一目标的成本高于常规医疗服务所能承受的范围。首个报告的临床试验是芬兰糖尿病预防研究。本文描述了澳大利亚如何与芬兰同事合作，调整该研究结果以实现一项全州范围的糖尿病预防计划。一些国家已开展小型评估性有效性试验，以探究临床试验结果能否在常规医疗服务中得以复制。文中详细介绍了澳大利亚的评估性试验——大绿三角糖尿病预防计划，以展示将一个项目从一个国家推广到另一个国家的成功要素。很少有国家能够从评估性试验扩大到全州范围或全国性项目。文中详细描述了澳大利亚的经验，包括所吸取的关于降低有效性因素的教训，特别是政府政策制定者、实施机构人员和研究人员需要从评估性试验开始直至国家项目的头5年全程共同合作。
