Gilis-Januszewska Aleksandra, Lindström Jaana, Barengo Noël C, Tuomilehto Jaakko, Schwarz Peter Eh, Wójtowicz Ewa, Piwońska-Solska Beata, Szybiński Zbigniew, Windak Adam, Hubalewska-Dydejczyk Alicja
Department of Endocrinology, Jagiellonian University, Medical College, Kopernika, Krakow, Poland Chronic Disease Prevention Unit, National Institute for Health and Welfare (THL), Helsinki, Finland Department of Medical and Population Health Science, Herbert Wertheim College of Medicine, Florida International University, Miami, USA Dasman Diabetes Institute, Dasman, Kuwait Centre for Vascular Prevention, Danube-University Krems, Krems, Austria Department of Chronic Disease Prevention, National Institute for Health and Welfare Department of Public Health, University of Helsinki, Helsinki, Finland Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia Department for Prevention & Care of Diabetes, Medical Clinic Unit III, University Clinic, Carl Gustav Carus at Technical University Dresden Paul Langerhans Institute Dresden of the Helmholtz Center Munich at University Hospital and Faculty of Medicine, Technical University Dresden, Dresden German Center for Diabetes Research, Neuherberg, Germany Department of Endocrinology Department of Family Medicine, Chair of Medicine and Gerontology, Jagiellonian University, Medical College, Krakow, Poland.
Medicine (Baltimore). 2018 Feb;97(5):e9790. doi: 10.1097/MD.0000000000009790.
It has been shown that real-life implementation studies for the prevention of type 2 diabetes (DM2) performed in different settings and populations can be effective. However, not enough information is available on factors influencing the reach of DM2 prevention programmes. This study examines the predictors of completing an intervention programme targeted at people at high risk of DM2 in Krakow, Poland as part of the DE-PLAN project.A total of 262 middle-aged people, everyday patients of 9 general practitioners' (GP) practices, at high risk of DM2 (Finnish Diabetes Risk Score (FINDRISK) >14) agreed to participate in the lifestyle intervention to prevent DM2. Intervention consisted of 11 lifestyle counseling sessions, organized physical activity sessions followed by motivational phone calls and letters. Measurements were performed at baseline and 1 year after the initiation of the intervention.Seventy percent of the study participants enrolled completed the core curriculum (n = 184), 22% were men. When compared to noncompleters, completers had a healthier baseline diabetes risk profile (P <.05). People who completed the intervention were less frequently employed versus noncompleters (P = .037), less often had hypertension (P = .043), and more frequently consumed vegetables and fruit daily (P = .055).In multiple logistic regression model, employment reduced the likelihood of completing the intervention 2 times (odds ratio [OR] 0.45, 95% confidence interval [CI] 0.25-0.81). Higher glucose 2 hours after glucose load and hypertension were the independent factors decreasing the chance to participate in the intervention (OR 0.79, 95% 0.69-0.92 and OR 0.52, 95% CI 0.27-0.99, respectively). Daily consumption of vegetables and fruits increased the likelihood of completing the intervention (OR 1.86, 95% 1.01-3.41).In conclusion, people with healthier behavior and risk profile are more predisposed to complete diabetes prevention interventions. Male, those who work and those with a worse health profile, are less likely to participate and complete interventions. Targeted strategies are needed in real-life diabetes prevention interventions to improve male participation and to reach those who are working as well as people with a higher risk profile.
研究表明,在不同环境和人群中开展的2型糖尿病(DM2)预防的实际应用研究可能是有效的。然而,关于影响DM2预防项目覆盖范围的因素,目前尚无足够信息。本研究作为DE-PLAN项目的一部分,考察了波兰克拉科夫针对DM2高危人群的干预项目完成情况的预测因素。
共有262名中年DM2高危人群(芬兰糖尿病风险评分(FINDRISK)>14),他们是9名全科医生诊所的日常患者,同意参与预防DM2的生活方式干预。干预包括11次生活方式咨询课程、有组织的体育活动课程,随后是激励性电话和信件。在基线和干预开始1年后进行测量。
70%的参与研究的入组者完成了核心课程(n = 184),其中22%为男性。与未完成者相比,完成者的基线糖尿病风险状况更健康(P <.05)。完成干预的人群与未完成者相比,就业频率较低(P = 0.037),高血压发生率较低(P = 0.043),每天食用蔬菜和水果的频率较高(P = 0.055)。
在多因素逻辑回归模型中,就业使完成干预的可能性降低2倍(比值比[OR] 0.45,95%置信区间[CI] 0.25 - 0.81)。葡萄糖负荷后2小时血糖升高和高血压是降低参与干预机会的独立因素(分别为OR 0.79,95% 0.69 - 0.92和OR 0.52,95% CI 0.27 - 0.99)。每天食用蔬菜和水果增加了完成干预的可能性(OR 1.86,95% 1.01 - 3.41)。
总之,行为和风险状况更健康的人群更倾向于完成糖尿病预防干预。男性、在职人员以及健康状况较差的人群参与并完成干预的可能性较小。在实际的糖尿病预防干预中需要有针对性的策略,以提高男性的参与度,并覆盖在职人员以及风险状况较高的人群。