title: Diabetes prevention program in a Mediterranean environment: individual or group therapy? An effectiveness evaluation.
abstract: BACKGROUND
  Diabetes as a multifactorial disorder requires prevention measures based upon the modification of several risk factors simultaneously; otherwise, there is insufficient potential for prevention. Following the success of the American Diabetes Prevention Program (DPP), we implemented an intervention program in a large Israeli healthcare organization with an emphasize on Mediterranean Diet (MedDiet) and physical activity. The objective was to evaluate the effectiveness of two types of intervention, individual and group therapies, in reducing risk factors and in preventing or delaying the development of type 2 diabetes.
  
  
  METHODS
  Out of 180 primary care physicians, 85 who agreed to participate, were randomly assigned, between the years 2005 and 2006, into two groups: those who would refer pre-diabetes adult patients for individual therapy and those who would refer for group therapy. The two groups of patients consisted of 111 and 112 in each group. The intervention lasted for 6 months and discussed: the benefits of MedDiet, planning nutritional behavior and mindful eating, and the importance of physical activity. All patients were invited to participate in walking groups. Follow up lasted for 24 months and logistic, mixed models, and Cox regressions were employed.
  
  
  RESULTS
  No statistically significant differences were detected between the two intervention groups in age; gender and clinical measurements at recruitment. Thirty nine percent of both groups developed diabetes (entered the DR by 2012), including 38.7% from the individual therapy and 39.3% from the group therapy (P=0.933). The mean time from 2005 until entry to the Diabetes Registry (DR) was 2.9 and 2.5 years for the individual and group therapy respectively (P=0.542).
  
  
  CONCLUSIONS
  Both interventions were equally effective in achieving the desired outcomes and time until entry to the DR. For large health organizations with a high number of pre-diabetes patients and scarce resources, group therapy, where 12 people are reached out by one team member are preferable and more costly effective, than a one on one therapy.
authors.affiliation: Health Promotion and Preventive Medicine, Maccabi Health Organization, Israel; School of Public Health, Haifa University, Haifa, Israel.
authors.forename: R
authors.initials: R
authors.lastname: Endevelt
authors.affiliation: Health Systems Management, Ben Gurion University of the Negev, Beer Sheva, Israel. Electronic address: ronitpeled@yahoo.com.
authors.forename: R
authors.initials: R
authors.lastname: Peled
authors.affiliation: Health Promotion and Preventive Medicine, Maccabi Health Organization, Israel.
authors.forename: A
authors.initials: A
authors.lastname: Azrad
authors.affiliation: Health Promotion and Preventive Medicine, Maccabi Health Organization, Israel.
authors.forename: G
authors.initials: G
authors.lastname: Kowen
authors.affiliation: Department of Clinical Quality, Meuhedet Health Organization, Tel Aviv, Israel.
authors.forename: L
authors.initials: L
authors.lastname: Valinsky
authors.affiliation: Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: A D
authors.initials: AD
authors.lastname: Heymann
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D008076:Cholesterol, HDL / Q000097:blood; D057186:Comparative Effectiveness Research; D003920:Diabetes Mellitus / Q000517:prevention & control*; D038441:Diet, Mediterranean; D018450:Disease Progression; D004777:Environment; D005081:Exercise Therapy; D005247:Feeding Behavior; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007557:Israel; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011236:Prediabetic State / Q000097:blood / Q000175:diagnosis / Q000178:diet therapy* / Q000523:psychology; D011322:Primary Prevention / Q000379:methods*; D016016:Proportional Hazards Models; D011615:Psychotherapy, Group; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014280:Triglycerides / Q000097:blood
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D008076:Cholesterol, HDL; D014280:Triglycerides
keywords: Diabetes prevention; Group therapy; Individual therapy; Pre diabetes intervention