Structured education, physical activity and the prevention of type 2 diabetes Dr Tom Yates, University of Leicester

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Structured education, physical activity and
the prevention of type 2 diabetesDr Tom Yates,
University of Leicester
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Aims of the presentation

• Overview of type 2 diabetes and why physical
  activity is important in its prevention
• The role of structured education
• The PREPARE programme
• Future work and associated funding structures

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Type 2 diabetes

• Fifth leading cause of mortality globally
• Around 5 of total NHS resources are devoted to
  the care and treatment of type 2 diabetes
• Prevalence set to rise in the future
• Represent a serious clinical and financial
  challenge to the NHS

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Type 2 diabetes

• Type 2 diabetes is primarily a lifestyle related
  disease
• Attributable to modern industrialised
  environments

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The importance of physical activity an
evolutionary perspective
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The importance of physical activity an
evolutionary perspective
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Diabetes prevention

• Intensive one-to-one counselling has proven
  successful at reducing the risk of type 2
  diabetes in at-risk individuals
• However
• Unlikely to be feasible for implementation in a
  primary health care setting
• Failed to demonstrate clinically significant
  increases in physical activity
• Traditional one-to-one counselling strategies are
  unsuccessful at promoting physical activity in a
  primary health care or community setting

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Structured education

• Widely advocated
• Compatible with the infrastructure of many health
  care systems
• Group-based education
• Written, evidence-based curriculum
• Underpinned with appropriate learning and
  health-behaviour theories

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The PREPARE programme

• Single session
• 3 hours long
• Written, evidence-based curriculum
• Person-centred approach

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PREPARE programme

• Patient story
  10
• Professional story
  40
• Health glucose metabolism
• Aetiology of prediabetes
• Risk factors and complications
• Diet
  10
• Physical activity
  40
• Physical activity and glucose control
• Physical activity recommendations
• Physical activity in everyday life
• Barriers
• Action plans and diaries

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Complex interventions
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Randomized controlled trial

• Funded by Diabetes UK
• Three groups
• Control
• PREPARE programme
• PREPARE programme plus pedometers

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Randomized controlled trial

• Participants
• Identified as having impaired glucose tolerance
• Primary outcomes
  Oral glucose tolerance test (2-h glucose)
• Follow-up
• 3, 6 and 12 months

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Baseline characteristics
Number of participants 103
Age (years) 65 9
Sex Female Male 38 (37) 65 (63)
Ethnicity White South Asian 75 (73) 28 (27)
BMI (kg/m2) 29 4
Physical activity (steps per day) 6346 3444
2-hour glucose (mmol/l) 8.8 0.2
Fasting glucose (mmol/l) 5.6 0.1
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Results at 3 months Physical activity
Change in pedometer counts (steps per day)
Change in self-reported physical activity
(MET-minutes/week)
P 0.001
P 0.046
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Results at 3 months Glucose control
Change in 2-hour glucose (mmol/l)
Change in fasting glucose (mmol/l)
P 0.036
P 0.002
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Limitations

• Conducted in a single centre with a detected
  research team
• Multi-centred study needed in a primary health
  care setting

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Next steps - NIHR programme grant

• 2 million
• Multi-factor structured education programme aimed
  at preventing type 2 diabetes
• 800 individuals with IGT
• Recruited from 50 GP practices within the
  Leicester and Northampton region
• 3 year follow-up

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Next steps CLAHRC funding

• 10 million with 10 million in matched funding
• Aimed at developing strategies for identifying,
  preventing and treating chronic diseases using
  methods that are suitable for implementation in a
  primary health care setting
• Has a strong focus on structured education which
  includes testing the PREPARE programme in primary
  care