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In 2017, 1.2 million people in the Netherlands have diabetes, in about 90% of the cases type 2. This number increases by 1200 every week. Among the working population data indicates that about 2% has diabetes. This prevalence differs by socioeconomic position (SEP). In 2015 an estimated 2,6% of low SEP workers had diabetes compared to 1,4% of the intermediate and high educated workers combined. Diabetes is associated with cardiovascular, eye, kidney and nerve diseases as well as depression which leads to higher sickness absence and reduced productivity. All in all diabetes does not only cause human suffering but also has profound financial consequences for individuals, companies and society. The latter could ultimately lead to increasing socioeconomic health inequalities.


An important factor increasing the risk of the onset of type 2 diabetes (T2D) is shiftwork on which low SEP workers often depend given the financial compensation. Through a disturbed circadian rhythm and sleep deprivation the metabolic system is dysregulated as is the glucose response. Shiftwork is also related to an unhealthy lifestyle. By 2016, 14% of the Dutch workforce is engaged in shiftwork and this percentage is on the rise. Given these numbers, there is a high need for effective (preventive) T2D interventions.


Over the past 20 years, T2D interventions focused on lifestyle instead of pharmacotherapy, targeting the metabolic dysregulation instead of the symptoms. Already in 2002, positive effects of lifestyle interventions were found. Not all participants benefit equally from the current ‘one-size-fits all’ interventions. Recent insights showed various T2D subtypes based on specific organ dysfunction. Lifestyle interventions tailoring these subtypes could increase the effectiveness for all participants. In a previous study called P4@Hillegom such a personalized lifestyle intervention was developed and offered by health care professionals. Based on the Oral Glucose Tolerance Test individuals were divided into one of six subtypes. Additionally, individuals were appointed to a 13 week personalized lifestyle intervention, that matched their subtype, focusing on either nutritional advice, an exercise program or a combination. Preliminary results of 60 participants showed strong significant improvements (10%) in fasting plasma glucose level over time, an indication of glucose efficiency regulation of the body.


Despite the high prevalence of T2D in low SEP workers and the negative influence of shiftwork, T2D lifestyle interventions targeting low SEP (shift)workers are lacking. Therefore we aim to adapt the P4@Hillegom approach to this specific population. The content of the lifestyle intervention (the diet and the exercise program) will be adapted to work demands and working condition of the target group. Behavioral Change Techniques used will be adjusted to fit low SEP workers. The intervention will be developed in close collaboration with KLM and KLM Health Services, and the target group. Since we address Theme 1a of the call “research addressing (further) development of interventions”, the focus of this project will be on development and feasibility.


The project is divided in five work packages:

(1) In work package 1 we install an advisory board including relevant stakeholders representing KLM HS, KLM work council, KLM shift workers, KLM management and primary care professionals.

(2) In work package 2 we will develop a first prototype of the intervention, called P4@Work, by:

a. describing the core components of the P4@Hillegom approach

b. study behavioral change techniques targeting low SEP individuals, the physical workload and food preferences of the workers and KLM’s infrastructure, and adjusting the original intervention to fit.

We will discuss this prototype in two focus group meetings with the target population and the advisory board.

(3) We will test the prototype in the third work package in a pilot study resulting in a proof of principle.

(4) The feasibility of this proof of principle will be tested in work package 4 in a small scale study with 16 participants. Within this work package the implementation process will be systematically evaluated because thorough knowledge on factors stimulating or hindering successful implementation is important for generalization.

(5) The generalization of the intervention is the main topic of work package 5 in which we will write a detailed description of P4@Work, the adjustments made and the lessons learned. All results will be presented in a final focus group meeting with KLM HS company doctors who play a role in further dissemination.


We share results through presentations at (inter)national conferences, two scientific papers published in international peer reviewed journals, an article in a Dutch journal for Occupation Medicine Experiences and testimonials of participants will be captured in short video’s, to share with other health care professionals, employers and low SEP workers.

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