title: Effects of a Community-Based Healthy Lifestyle Intervention Program (Co-HELP) among Adults with Prediabetes in a Developing Country: A Quasi-Experimental Study.
abstract: BACKGROUND
  The prevalence of type 2 diabetes among Malaysian adults has increased by more than two folds over the past two decades. Strategies to collaborate with the existing community partners may become a promising channel for wide-scale dissemination of diabetes prevention in the country. The objectives of this study were to determine the effects of community-based lifestyle interventions delivered to adults with prediabetes and their health-related quality of life as compared to the usual care group.
  
  
  METHODS
  This was a quasi-experimental study conducted in two sub-urban communities in Seremban, Malaysia. A total of 268 participants with prediabetes aged between 18 to 65 years old were assigned to either the community-based lifestyle intervention (Co-HELP) (n = 122) or the usual care (n = 146) groups. The Co-HELP program was delivered in partnership with the existing community volunteers to incorporate diet, physical activity, and behaviour modification strategies. Participants in the Co-HELP group received twelve group-based sessions and two individual counselling to reinforce behavioural change. Participants in the usual care group received standard health education from primary health providers in the clinic setting. Primary outcomes were fasting blood glucose, 2-hour plasma glucose, and HbA1C. Secondary outcomes included weight, BMI, waist circumference, total cholesterol, triglyceride, LDL cholesterol, HDL cholesterol, systolic and diastolic blood pressure, physical activity, diet, and health-related quality of life (HRQOL).
  
  
  RESULTS
  An intention-to-treat analysis of between-groups at 12-month (mean difference, 95% CI) revealed that the Co-HELP participants' mean fasting plasma glucose reduced by -0.40 mmol/l (-0.51 to -0.28, p<0.001), 2-hour post glucose by -0.58 mmol/l (-0.91 to -0.24, p<0.001), HbA1C by -0.24% (-0.34 to -0.15, p<0.001), diastolic blood pressure by -2.63 mmHg (-3.79 to -1.48, p<0.01), and waist circumference by -2.44 cm (-4.75 to -0.12, p<0.05) whereas HDL cholesterol increased by 0.12 mmol/l (0.05 to 0.13, p<0.01), compared to the usual care group. Significant improvements were also found in HRQOL for both physical component (PCS) by 6.51 points (5.21 to 7.80, p<0.001) and mental component (MCS) by 7.79 points (6.44 to 9.14, p<0.001). Greater proportion of participants from the Co-HELP group met the clinical recommended target of 5% or more weight loss from the initial weight (24.6% vs 3.4%, p<0.001) and physical activity of >600 METS/min/wk (60.7% vs 32.2%, p<0.001) compared to the usual care group.
  
  
  CONCLUSIONS
  This study provides evidence that a culturally adapted diabetes prevention program can be implemented in the community setting, with reduction of several diabetes risk factors and improvement of HRQOL. Collaboration with existing community partners demonstrated a promising channel for the wide-scale dissemination of diabetes prevention at the community level. Further studies are required to determine whether similar outcomes could be achieved in communities with different socioeconomic backgrounds and geographical areas.
  
  
  BACKGROUND
  IRCT201104106163N1.
authors.affiliation: Department of Social and Preventive Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Norliza
authors.identifier: http://orcid.org/0000-0001-7513-4343
authors.initials: N
authors.lastname: Ibrahim
authors.affiliation: Julius Centre University of Malaya, Department of Social and Preventive Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Foong
authors.initials: F
authors.lastname: Ming Moy
authors.affiliation: Department of Dietetic, Hospital Taiping, Perak, Malaysia.
authors.forename: Intan Attikah Nur
authors.initials: IA
authors.lastname: Awalludin
authors.affiliation: State Health Department of Negeri Sembilan, Seremban, Negeri Sembilan, Malaysia.
authors.forename: Zainudin
authors.initials: Z
authors.lastname: Mohd Ali
authors.affiliation: Department of Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia.
authors.forename: Ikram Shah
authors.identifier: http://orcid.org/0000-0001-8796-1936
authors.initials: IS
authors.lastname: Ismail
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001786:Blood Glucose / Q000032:analysis; D001835:Body Weight; D008078:Cholesterol, LDL / Q000097:blood; D055812:Community-Based Participatory Research / Q000706:statistics & numerical data*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000517:prevention & control*; D005260:Female; D006293:Health Promotion / Q000379:methods*; D000070497:Healthy Lifestyle; D006801:Humans; D008019:Life Style; D008296:Malaysia / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data; D011236:Prediabetic State / Q000097:blood / Q000453:epidemiology*; D011788:Quality of Life; D019036:Suburban Health Services / Q000706:statistics & numerical data; D013383:Suburban Population / Q000706:statistics & numerical data; D015431:Weight Loss
chemical_list: D001786:Blood Glucose; D008078:Cholesterol, LDL