medical wellness
preventative healthcare
A groundbreaking programme that aims to prevent the onset of diabetes is being rolled out across the US. Kate Cracknell reports
“I
n the late 1990s, the US federal government invested about US$200m to study whether a drug or a lifestyle
intervention would be more effective in preventing diabetes,” says Jonathan Lever, vice president for health strategy and innovation at YMCA of the US.
“Led by the National Institutes of Health, that study was known as the landmark Diabetes Prevention Programme trial and it ran for seven years, enrolling close to 4,000 people and with a research network comprising 27 different centres across the US. “The study was shut down early
because the lifestyle intervention was clearly so much more effective than the drug. It wouldn’t have been ethical to have continued.” Lever adds: “In that study, the
lifestyle intervention was delivered on a
one-to-one basis, with the researchers authorised to give each patient virtually anything they needed to help them change their lifestyle, whether that was a pair of gym shoes or access to a nutritionist. Because the goal wasn’t to see if this was an effi cient way to do it – it was just to see whether lifestyle was more effective than a drug. “When the results were published in
The New England Journal of Medicine in 2002, it generated a lot of interest, but the problem was that this particular intervention was extremely cost- ineffective – it cost around US$1,400 per person and was simply not scaleable. “One of the original researchers – a
professor at Indiana University School of Medicine – felt that there must be a better way to do it, so in 2005 he approached the YMCA of Greater Indianapolis with a view to doing
about the diabetes prevention programme
overweight and inactive, high blood pressure, family history, and age (‘at risk’ individuals are generally aged 45 years and over). The programme consists of 16 hour-long sessions delivered within
“T
a maximum of 24 weeks, followed by monthly maintenance meetings. Sessions are led by a trained lifestyle coach who facilitates a small group of people (maximum 15 people). The group discusses topics such as healthy eating, with a particular
focus on cutting fat intake. It also looks at increasing physical activity, reducing stress, problem solving and behaviour change strategies in general, coaching people through the barriers that prevent them from making positive lifestyle changes. The ultimate goal for all participants is to lose between 5 and 7 per
cent body weight, as well as gradually increasing physical activity levels to 150 minutes a week. “But there’s a lot of scope to customise within those set goals, working with individuals to determine the exact things they will do to achieve them,” explains Dr Ann Albright of the CDC. “The secret is helping people fi gure out how they’re going to change
their own behaviour, assisted by encouragement from the group,” says the YMCA’s Jonathan Lever. “People generally know what’s good and bad for them – they just don’t know how to make the necessary adjustments.”
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The diabetes prevention programme looks at increasing activity and changing behaviour
april 2012 © cybertrek 2012
he diabetes prevention programme is a 12-month, group-based programme targeting those at high risk of developing Type 2 diabetes. Risk factors include being
essentially the same thing, but in a group-based format. He wanted to see if the same results could be achieved as in the national, one-to-one trial – a minimum fi ve per cent weight loss. “Long story short, the professor’s
group achieved an average six per cent weight loss, in a programme that was delivered at a quarter of the price of the original intervention.”
towards a national programme Lever continues: “It was at this point that the CDC (the US Centers for Disease Control and Prevention) approached the YMCA at a national level. They had been involved in the initial national study, and they wanted to see if our Indianapolis results could be replicated in another centre. They gave us the funding to do that and we achieved similar results in the YMCA of
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