Original Title: Prevención de la Diabetes Mellitus Tipo 2 en Atención Primaria de salud mediante estilos de vida saludables: cuidados e intervención clínica recomendada

Authors' objectives: The aim of this work is to provide a reference document to help optimize the clinical practice of Type 2 Diabetes Mellitus (T2DM) prevention in the routine context of primary health care (PHC), by means of a thorough assessment of the results related to the feasibility and effectiveness of the DEPLAN Euskadi project and its interpretation based on the state of scientific evidence and clinical practice guidelines (CPG) on T2DM primary prevention in the routine clinical context.

Authors' results and conclusions: 31.4% of the general practitioners and 57.6% of the nurses from the collaborating centers participated in the study, whilst 4,170 (6.2%) of the 67,293 patients who visited the centers during the execution period were addressed by identifying their T2DM risk. Around half the patients selected were identified as high risk (FINDRISC score ≥14). Apart from observing significant variability in the majority of the process indicators at center level, the participation rejection rate and the proportion of women was greater in the IG. Of the 634 and 454 non-diabetic patients aged 45 to 70 included in the IG and CG, 545 (85.9%) and 411 (90.5%) finished the 24-month follow-up measurements. Of these, 77 CG patients and 38 GI patients developed DM2. The incidence rate of DM2, considering that the patients lost in the monitoring did not develop DM2, was 12.6% (77/634) and 8.4% (38/454) in the CG and IG. The absolute risk difference was 3.8% (0.18%-7.4%) in favor of the IG, with a relative risk reduction of 34% (RR: 0.66; 0.44-0.99). Despite having a potentially effective intervention to prevent T2DM in PHC, the «passive» implementation strategy, focused on providing training and tools, executed to facilitate the transfer and adoption of this intervention by our professionals in the routine clinical context, has not achieved a feasible or sustainable implementation: low adoption level among professionals, limited coverage in the population, non-integration in practice, discontinuity at the end of the project, etc. The factors identified by professionals as main barriers affecting the implementation of the intervention at the centers were lack of time, prevailing excess work load in the PHC center context, low motivation of the users to cope with their pre-diabetic condition, and difficulties in the organization of the operational aspects of launching the program and its components. CONCLUSIONS Results show that a T2DM primary prevention program implemented in routine PHC conditions is effective in reducing the development of T2DM among high-risk patients. However, the limited feasibility of the program does not guarantee its transfer and integration into daily practice. Based on the results of the DEPLAN Euskadi project and the recommendations based on scientific evidence and on the main CPGs, clinical care is proposed in order to launch a feasible and effective T2DM primary prevention program in the PHC clinical context. To maximize this feasible transfer and integration by our professionals and centers, it is advisable to apply implementation strategies that facilitate the generalized adoption of this type of interventions with proven effectiveness.

Authors' methods: The DEPLAN Euskadi project is a phase IV clinical trial performed at 14 PHC centers of Osakidetza (Basque Health Service), randomly assigned to intervention group (IG) or control group (CG). All participating centers implemented the same T2DM risk identification system, based on the administration of the FINDRISC scale among all non-diabetic consulters aged between 45 and 70. Those identified with a high T2DM risk (FINDRISC>= 14 points), were invited to take part in the study. The IG implemented the DE-PLAN, a structured educational healthy lifestyle promotion intervention program. The CG patients received standard T2DM prevention care. The population coverage of the program was assessed, as well as other indicators related to the recruitment of patients, the reception of the different intervention components in those exposed, and their variability between comparison groups and centers. Effectiveness attributable to the program was determined by comparing the accumulated incidence of T2DM after 24 months in patients exposed to the intervention and patients belonging to the control centers. In addition, the potential effectiveness in changing healthy lifestyles (physical activity and diet) after 12 months was explored in a sub-sample of patients included, by means of telephone interviews carried out by trained interviewers. Finally, a qualitative study was carried out with professionals from the intervention centers to identify the main factors that determined the launch of the program. With the aim of interpreting the results obtained in light of the current state of knowledge regarding T2DM prevention, experimental scientific evidence and evidence of transferring T2DM primary prevention intervention programs to the clinical context, as well as the main CPGs were reviewed.

Project Status: Completed

Year Published: 2016

URL for published report: https://www.ogasun.ejgv.euskadi.eus/r51-catpub/es/k75aWebPublicacionesWar/k75aObtenerPublicacionDigitalServlet?R01HNoPortal=true&N_LIBR=051917&N_EDIC=0001&C_IDIOM=es&FORMATO=.pdf

English language abstract: An English language summary is available

Publication Type: Other

Country: Spain

Organisation Name: Basque Office for Health Technology Assessment

Contact Address: C/ Donostia – San Sebastián, 1 (Edificio Lakua II, 4ª planta) 01010 Vitoria - Gasteiz

Contact Name: Lorea Galnares-Cordero

Contact Email: lgalnares@bioef.eus

Copyright: <p>Osteba (Basque Office for Health Technology Assessment) Health Department of the Basque Government</p>