title: Effect of lifestyle intervention for people with diabetes or prediabetes in real-world primary care: propensity score analysis.
abstract: BACKGROUND
  Many lifestyle interventions for patients with prediabetes or type 2 diabetes mellitus (T2DM) have been investigated in randomised clinical trial settings. However, the translation of these programmes into primary care seems challenging and the prevalence of T2DM is increasing. Therefore, there is an urgent need for lifestyle programmes, developed and shown to be effective in real-world primary care. We evaluated a lifestyle programme, commissioned by the Dutch government, for patients with prediabetes or type 2 diabetes in primary care.
  
  
  METHODS
  We performed a retrospective comparative medical records analysis using propensity score matching. Patients with prediabetes or T2DM were selected from ten primary healthcare centres. Patients who received the lifestyle intervention (n = 186) were compared with a matched group of patients who received usual care (n = 2632). Data were extracted from the electronic primary care records. Propensity score matching was used to control for confounding by indication. Outcome measures were exercise level, BMI, HbA1c, fasting glucose, systolic and diastolic blood pressure, total cholesterol, HDL and LDL cholesterol and triglycerides and the follow-up period was one year.
  
  
  RESULTS
  There was no significant difference at follow-up in any outcome measure between either group. The reduction at one year follow-up of HbA1c and fasting glucose was positive in the intervention group compared with controls, although not statistically significant (-0.12%, P = 0.07 and -0.17 mmol/l, P = 0.08 respectively).
  
  
  CONCLUSIONS
  The effects of the lifestyle programme in real-world primary care for patients with prediabetes or T2DM were small and not statistically significant. The attention of governments for lifestyle interventions is important, but from the available literature and the results of this study, it must be concluded that improving lifestyle in real-world primary care is still challenging.
authors.affiliation: Maastricht University, CAPHRI, Department of General Practice, The Netherlands. joris.linmans@maastrichtuniversity.nl
authors.forename: Joris J
authors.initials: JJ
authors.lastname: Linmans
authors.forename: Mark G
authors.initials: MG
authors.lastname: Spigt
authors.forename: Linda
authors.initials: L
authors.lastname: Deneer
authors.forename: Annelies E M
authors.initials: AE
authors.lastname: Lucas
authors.forename: Marlies
authors.initials: M
authors.lastname: de Bakker
authors.forename: Luc G
authors.initials: LG
authors.lastname: Gidding
authors.forename: Rik
authors.initials: R
authors.lastname: Linssen
authors.forename: J André
authors.initials: JA
authors.lastname: Knottnerus
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000517:prevention & control* / Q000628:therapy; D057286:Electronic Health Records / Q000706:statistics & numerical data; D015444:Exercise; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011236:Prediabetic State / Q000097:blood / Q000628:therapy*; D011320:Primary Health Care / Q000379:methods / Q000706:statistics & numerical data*; D015397:Program Evaluation; D012189:Retrospective Studies
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin