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The effectiveness of a targeted diabetes prevention programme for Hindustani Surinamese, consisting of screening followed by a lifestyle intervention

Projectomschrijving

Diabetes (suikerziekte) komt veel voor bij Hindoestaanse Surinamers. Een van de oorzaken van diabetes is een ongezonde leefstijl. Het risico op diabetes kan mogelijk verkleind worden door gezond(er) te eten en te bewegen. Dit onderzoek kijkt of een bevolkingsonderzoek en een leefstijlprogramma diabetes kunnen uitstellen of voorkomen bij Hindoestaanse Surinamers.

In het bevolkingsonderzoek werd onder meer het bloedsuikergehalte bepaald. Een verstoord bloedsuikergehalte kan leiden tot diabetes en komt viermaal vaker voor bij deze groep dan bij autochtone Nederlanders. Mensen wiens bloedsuikergehalte was verstoord, werden uitgenodigd voor een leefstijlprogramma en verdeeld in twee groepen. Een daarvan krijgt intensieve leefstijladviezen en de andere groep meer algemene. In het begin en na afloop van het onderzoek (na 1 en 3 jaar) krijgen de deelnemers een interview, een bloedsuikertest en een lichamelijk onderzoek. Zo wordt gemeten of het risico op diabetes in beide groepen is verlaagd.

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Samenvatting van de aanvraag

Type 2 diabetes mellitus (DM) is one of the most common chronic diseases and is associated with long-term morbidity, such as retinopathy, renal failure and, in particular, cardiovascular disease. Prevention of new DM cases and DM-related morbidity could lead to important health gain. In the Netherlands, a particularly high prevalence of DM is found among Hindustani: the prevalence among the Hindustani is four times as high as that among the ethnic Dutch in the same age group. In accordance, studies have shown that the prevalence of pre-diabetes, characterised by impaired fasting glucose (5.6-7.0 mmol/l) or impaired glucose tolerance (2-h OGTT value 7.8 -11.1 mmol/l), is also high in the Hindustani populations. Persons with pre-diabetes are at high risk of developing DM and DM-related morbidity. Previous studies have convincingly shown that intensive lifestyle interventions prevent the onset of DM among persons with pre-diabetes. However, the effectiveness of interventions depends on the characteristics of the population studied and the strategy used. In general, interventions aimed at the general (white) population are less effective in specific migrant groups, such as the Hindustani. Therefore, prevention programmes for DM among the Hindustani population should be targeted to the characteristics of that population. In a recent feasibility study, we have developed such a prevention programme for the Hindustani population, which consists of a targeted screening and a targeted lifestyle intervention [(Zonmw project 6130.0034), unpublished]. The design of this programme takes the specific epidemiological and cultural characteristics of the Hindustani population into account. An initial evaluation showed that the intensive, targeted approach used is successful: 43% of all eligible persons were screened. Of those, 40% had pre-diabetes and were eligible for the lifestyle intervention. However, prior to further implementation of this programme, insight into the effectiveness is needed. Specifically, what is the effectiveness of a targeted prevention programme with regard to the prevention of DM and –in the long-term- DM-related morbidity, what are the costs vs. benefits, and what are the side-effects of the prevention programme? To investigate these issues, we will invite approximately 6000 Hindustani Surinamese men and women aged 18-60 to be screened by means of a fasting plasma glucose measurement and oral glucose tolerance test. Participants with pre-diabetes (n=500) will subsequently be invited for a randomised controlled trial in which a group receiving the intensive lifestyle intervention will be compared with a control group receiving simple, generic lifestyle advice. In case of suspected DM, participants will be referred to their GP for care. Moreover, a sample of those with normoglycemia at baseline will be invited for re-screening after 3 years. The lifestyle intervention consists of individual dietary counselling, supplemented with group sessions aimed at the social environment and a supervised exercise programme. The content of the intervention has been adjusted to reflect prevalent dietary behaviours (e.g. irregular meal pattern), physical activity preferences (e.g. fitness and dancing), motivational factors (e.g. sessions to decrease the (perceived) social pressure) and barriers (e.g. women-only facilities). To evaluate the effectiveness of the intervention, data will be collected on fasting glucose, HbA1c, insulin and post-load glucose concentrations at baseline and at 12, 24 and 36 months. Moreover, changes in physical fitness and cardiovascular risk profile will be measured. In addition, data on self-reported physical activity, dietary behaviour, motivational factors, quality of life and other measures will be collected using structured interviews. Furthermore, each patient will be asked to record the direct costs, including for example the costs of transportation and the purchase of sports gear, in a diary. The direct non-medical costs, the indirect costs and the time investment of professionals in the programme will also be determined. The design and data collection procedures for this study have been developed in the aforementioned feasibility study. Therefore, the proposed study, which matches several priorities of the ZonMW Prevention Programme, will be able to benefit from the knowledge gained and the organisational arrangements that were already made. In conclusion, this study will provide an important contribution to preventive strategies and guidelines aimed at reducing the burden of DM and DM-related morbidity. On the basis of the information obtained on the effectiveness and costs, recommendations will be made for the wider implementation of the prevention programme in the Hindustani Surinamese population in the Netherlands.

Onderwerpen

Kenmerken

Projectnummer:
120620023
Looptijd: 100%
Looptijd: 100 %
2008
2012
Onderdeel van programma:
Projectleider en penvoerder:
Prof. dr. K. Stronks
Verantwoordelijke organisatie:
Amsterdam UMC - locatie AMC