Prevention of type 2 diabetes by lifestyle intervention in an Australian primary health care setting: Greater Green Triangle (GGT) Diabetes Prevention Project.
BACKGROUND
Randomised controlled trials demonstrate a 60% reduction in type 2 diabetes incidence through lifestyle modification programmes. The aim of this study is to determine whether such programmes are feasible in primary health care.


METHODS
An intervention study including 237 individuals 40-75 years of age with moderate or high risk of developing type 2 diabetes. A structured group programme with six 90 minute sessions delivered during an eight month period by trained nurses in Australian primary health care in 2004-2006. Main outcome measures taken at baseline, three, and 12 months included weight, height, waist circumference, fasting plasma glucose and lipids, plasma glucose two hours after oral glucose challenge, blood pressure, measures of psychological distress and general health outcomes. To test differences between baseline and follow-up, paired t-tests and Wilcoxon rank sum tests were performed.


RESULTS
At twelve months participants' mean weight reduced by 2.52 kg (95% confidence interval 1.85 to 3.19) and waist circumference by 4.17 cm (3.48 to 4.87). Mean fasting glucose reduced by 0.14 mmol/l (0.07 to 0.20), plasma glucose two hours after oral glucose challenge by 0.58 mmol/l (0.36 to 0.79), total cholesterol by 0.29 mmol/l (0.18 to 0.40), low density lipoprotein cholesterol by 0.25 mmol/l (0.16 to 0.34), triglycerides by 0.15 mmol/l (0.05 to 0.24) and diastolic blood pressure by 2.14 mmHg (0.94 to 3.33). Significant improvements were also found in most psychological measures.


CONCLUSIONS
This study provides evidence that a type 2 diabetes prevention programme using lifestyle intervention is feasible in primary health care settings, with reductions in risk factors approaching those observed in clinical trials.
Laatikainen
Tiina
T
Greater Green Triangle University Department of Rural Health, Flinders and Deakin Universities, PO Box 423, Warrnambool, Victoria, 3280, Australia. tiina.laatikainen@ktl.fi
Dunbar
James A
JA
Chapman
Anna
A
Kilkkinen
Annamari
A
Vartiainen
Erkki
E
Heistaro
Sami
S
Philpot
Ben
B
Absetz
Pilvikki
P
Bunker
Stephen
S
O'Neil
Adrienne
A
Reddy
Prasuna
P
Best
James D
JD
Janus
Edward D
ED
D000328:Adult; D000368:Aged; D001315:Australia; D001794:Blood Pressure; D015992:Body Mass Index; D002784:Cholesterol / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D003376:Counseling; D003924:Diabetes Mellitus, Type 2 / Q000517:prevention & control*; D005240:Feasibility Studies; D005260:Female; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000379:methods*; D011321:Primary Nursing / Q000379:methods*; D040242:Risk Reduction Behavior; D019035:Rural Health Services
D008078:Cholesterol, LDL; D002784:Cholesterol