title: Challenges of diabetes prevention in the real world: results and lessons from the Melbourne Diabetes Prevention Study.
abstract: OBJECTIVE
  To assess effectiveness and implementability of the public health programme Life! Taking action on diabetes in Australian people at risk of developing type 2 diabetes.
  
  
  METHODS
  Melbourne Diabetes Prevention Study (MDPS) was a unique study assessing effectiveness of Life! that used a randomized controlled trial design. Intervention participants with AUSDRISK score ≥15 received 1 individual and 5 structured 90 min group sessions. Controls received usual care. Outcome measures were obtained for all participants at baseline and 12 months and, additionally, for intervention participants at 3 months. Per protocol set (PPS) and intention to treat (ITT) analyses were performed.
  
  
  RESULTS
  PPS analyses were considered more informative from our study. In PPS analyses, intervention participants significantly improved in weight (-1.13 kg, p=0.016), waist circumference (-1.35 cm, p=0.044), systolic (-5.2 mm Hg, p=0.028) and diastolic blood pressure (-3.2 mm Hg, p=0.030) compared with controls. Based on observed weight change, estimated risk of developing diabetes reduced by 9.6% in the intervention and increased by 3.3% in control participants. Absolute 5-year cardiovascular disease (CVD) risk reduced significantly for intervention participants by 0.97 percentage points from 9.35% (10.4% relative risk reduction). In control participants, the risk increased by 0.11 percentage points (1.3% relative risk increase). The net effect for the change in CVD risk was -1.08 percentage points of absolute risk (p=0.013).
  
  
  CONCLUSIONS
  MDPS effectively reduced the risk of diabetes and CVD, but the intervention effect on weight and waist reduction was modest due to the challenges in recruiting high-risk individuals and the abbreviated intervention.
authors.affiliation: Faculty of Health , Deakin Population Health Strategic Research Centre, Deakin University, Melbourne Burwood Campus , Burwood, Victoria , Australia.
authors.forename: James A
authors.initials: JA
authors.lastname: Dunbar
authors.affiliation: Greater Green Triangle University Department of Rural Health , Flinders and Deakin Universities , Warrnambool, Victoria , Australia.
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Hernan
authors.affiliation: Greater Green Triangle University Department of Rural Health , Flinders and Deakin Universities , Warrnambool, Victoria , Australia ; Western Academic Centre, Western Centre for Health Research and Education, Western Health, University of Melbourne , St. Albans, Victoria , Australia.
authors.forename: Edward D
authors.initials: ED
authors.lastname: Janus
authors.affiliation: Greater Green Triangle University Department of Rural Health , Flinders and Deakin Universities , Warrnambool, Victoria , Australia ; National Institute for Health and Welfare , Helsinki , Finland.
authors.forename: Erkki
authors.initials: E
authors.lastname: Vartiainen
authors.affiliation: Greater Green Triangle University Department of Rural Health , Flinders and Deakin Universities , Warrnambool, Victoria , Australia ; National Institute for Health and Welfare , Helsinki , Finland ; Faculty of Health Sciences , Institute of Public Health and Clinical Nutrition, University of Eastern Finland , Kuopio , Finland.
authors.forename: Tiina
authors.initials: T
authors.lastname: Laatikainen
authors.affiliation: Greater Green Triangle University Department of Rural Health , Flinders and Deakin Universities , Warrnambool, Victoria , Australia.
authors.forename: Vincent L
authors.initials: VL
authors.lastname: Versace
authors.affiliation: Faculty of Medicine, Nursing and Health Sciences , Monash University , Melbourne, Victoria , Australia.
authors.forename: John
authors.initials: J
authors.lastname: Reynolds
authors.affiliation: Lee Kong Chian School of Medicine, Nanyang Technological University and Imperial College London , Singapore , Singapore.
authors.forename: James D
authors.initials: JD
authors.lastname: Best
authors.affiliation: School of Psychological and Clinical Sciences, Charles Darwin University , Darwin, Northern Territory , Australia.
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Skinner
authors.affiliation: Centre for Physical Activity and Nutrition Research, Deakin University, Melbourne Burwood Campus , Burwood, Victoria , Australia.
authors.forename: Sharleen L
authors.initials: SL
authors.lastname: O'Reilly
authors.affiliation: Greater Green Triangle University Department of Rural Health , Flinders and Deakin Universities , Warrnambool, Victoria , Australia ; Faculty of Pharmacy and Pharmaceutical Sciences , Centre for Medicine Use and Safety, Monash University , Parkville, Victoria , Australia.
authors.forename: Kevin P
authors.initials: KP
authors.lastname: Mc Namara
authors.affiliation: Faculty of Health , Deakin Population Health Strategic Research Centre, Deakin University, Melbourne Burwood Campus , Burwood, Victoria , Australia.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Stewart
authors.affiliation: Greater Green Triangle University Department of Rural Health , Flinders and Deakin Universities , Warrnambool, Victoria , Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Coates
authors.affiliation: Faculty of Health , Deakin Population Health Strategic Research Centre, Deakin University, Melbourne Burwood Campus , Burwood, Victoria , Australia.
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Bennett
authors.affiliation: Faculty of Health, Deakin Health Economics , Deakin University, Melbourne Burwood Campus , Burwood, Victoria , Australia.
authors.forename: Rob
authors.initials: R
authors.lastname: Carter
keywords: Cardiovascular Prevention; Intervention; Public Health; Type 2 Diabetes