The online version of this article (https://doi.org/10.1186/s12875-017-0671-8) contains supplementary material, which is available to authorized users.
Primary care nurse-led prediabetes interventions are seldom reported. We examined the implementation and feasibility of a 6-month multilevel primary care nurse-led prediabetes lifestyle intervention compared with current practice in patients with prediabetes, with weight and glycated haemoglobin (HbA1c) as outcomes.
This study used a convergent mixed methods design involving a 6-month pragmatic non-randomised pilot study with a qualitative process evaluation, and was conducted in two neighbouring provincial cities in New Zealand, with indigenous Māori populations comprising 18.2% and 23.0%, respectively. Participants were non-pregnant adults aged ≤ 70 years with newly diagnosed prediabetes (HbA1c 41-49 mmol/mol), body mass index (BMI) ≥ 25 kg/m2 and not prescribed Metformin. A structured dietary intervention tool delivered by primary care nurses with visits at baseline, 2–3 weeks, 3 months and 6 months was implemented in four intervention practices. Four control practices continued to provide usual care. Primary quantitative outcome measures were weight and HbA1c. Linear and quantile regression models were used to compare each outcome between the two groups at follow-up. Qualitative data included: observations of nurse training sessions and steering group meetings; document review; semi-structured interviews with a purposive sample of key informants (n = 17) and intervention patients (n = 20). Thematic analysis was used.
One hundred fifty-seven patients with prediabetes enrolled (85 intervention, 72 control), 47.8% female and 31.2% Māori. Co-morbidities were common, particularly hypertension (49.7%), dyslipidaemia (40.1%) and gout (15.9%). Baseline and 6 month measures were available for 91% control and 79% intervention participants. After adjustment, the intervention group lost a mean 1.3 kg more than the control group (p < 0.001). Mean HbA1c, BMI and waist circumference decreased in the intervention group and increased in the control group, but differences were not statistically significant. Implementation fidelity was high, and it was feasible to implement the intervention in busy general practice settings. The intervention was highly acceptable to both patients and key stakeholders, especially primary care nurses.
Study findings confirm the feasibility and acceptability of primary care nurses providing structured dietary advice to patients with prediabetes in busy general practice settings. The small but potentially beneficial mean weight loss among the intervention group supports further investigation.
ANZCTR ACTRN12615000806561. Registered 3 August 2015 (Retrospectively registered).
Additional file 1: Prediabetes Intervention Package (PIP) in primary care study process evaluation - key informant and intervention patient interview guides. This file contains copies of the process evaluation interview guide for key informants and the interview guide for intervention participants. (PDF 89 kb)
Danaei G, Finucane M, Lu Y, Singh G, Cowan M, Paciorek C, for the Global Burden of Metabolic Risk Factors of Chronic Diseases Collaborating Group (Blood Glucose), et al. National, regional, and global trends in fasting plasma glucose and diabetes prevalence since 1980: systematic analysis of health examination surveys and epidemiological studies with 370 country-years and 2·7 million participants. Lancet. 2011;378:31–40. CrossRefPubMed
Global Burden of Disease Study 2013 Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the global burden of disease study 2013. Lancet. 2015;386:743–800. CrossRefPubMedCentral
Coppell KJ, Mann JI, Williams SM, Jo E, Drury PL, Miller JC, et al. Prevalence of diagnosed and undiagnosed diabetes and prediabetes in New Zealand: findings from the 2008/09 adult nutrition survey. N Z Med J. 2013;126:23–42. PubMed
Ministry of Health. New Zealand primary care handbook 2012 (updated 2013): cardiovascular disease risk assessment. Wellington: Ministry of Health; 2013.
Knowler W, Barrett-Connor E, Fowler S, Hamman R, Lachin J, Walker E, et al. For the diabetes prevention program research group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346:393–403.
Kilkkinen A, Heistaro S, Laatikainen T, Janus E, Chapman A, Absetz P, et al. Prevention of type 2 diabetes in a primary health care setting. Interim results from the Greater Green Triangle (GGT) diabetes prevention project. Diabetes Res Clin Pract. 2007;76:460–2.
Statistics New Zealand, 2013 Census QuickStats about a place. http://archive.stats.govt.nz/Census/2013-census/profile-and-summary-reports/quickstats-about-a-place.aspx?url=/Census/2013-census/profile-and-summary-reports/quickstats-about-a-place.aspx&request_value=14074#14074. Accessed 4 Dec 2017.
Atkinson J, Salmond C, Crampton P. NZDep2013 index of deprivation. Wellington: Department of Public Health. Wellington: University of Otago; 2014.
Coppell K, Kataoka M, Williams S, Chisholm A, Vorgers S, Mann J. Nutritional intervention in patients with type 2 diabetes who are hyperglycaemic despite optimised drug treatment—lifestyle over and above drugs in diabetes (LOADD) study: randomised controlled trial. BMJ. 2010;341:c3337. CrossRefPubMedPubMedCentral
Diabetes New Zealand. Diabetes and healthy food choices. Wellington: Diabetes New Zealand Inc. 2007. https://diabetes.org.nz/pamphlet-order-form/. Accessed 4 Dec 2017.
Ministry of Health. Prediabetes advice. Wellington: Ministry of Health; 2013.
Ministry of Health. Be Active Every Day. Wellington: Ministry of Health; 2010. https://www.healthed.govt.nz/resource/be-active-every-day-physical-activity-adults. Accessed 4 Dec 2017.
University of Otago and Ministry of Health. A focus on nutrition: key findings of the 2008/09 New Zealand adult nutrition survey. Wellington: Ministry of Health; 2011.
Patton MQ. Qualitative evaluation and research methods. 3rd ed. Newbury Park: Sage; 2002.
Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–10. CrossRef
Kris-Etherton PM, Akabas SR, Bales CW, Bistrian B, Braun L, Edwards MS, et al. The need to advance nutrition education in the training of health care professionals and recommended research to evaluate implementation and effectiveness. Am J Clin Nutr. 2014;99(5 Suppl):1153S–66S. https://doi.org/10.3945/ajcn.113.073502. CrossRefPubMedPubMedCentral
Hesselink AE, Rutten GE, Slootmaker SM, de Weerdt I, Raaijmakers LG, Jonkers R, et al. Effects of a lifestyle program in subjects with impaired fasting glucose, a pragmatic cluster-randomized controlled trial. BMC Fam Pract. 2015;16:183. https://doi.org/10.1186/s12875-015-0394-7. CrossRefPubMedPubMedCentral
Gilis-Januszewska A, Lindström J, Tuomilehto J, Piwońska-Solska B, Topór-Mądry R, Szybiński Z, et al. Sustained diabetes risk reduction after real life and primary health care setting implementation of the diabetes in Europe prevention using lifestyle, physical activity and nutritional intervention (DE-PLAN) project. BMC Public Health. 2017;17:198. https://doi.org/10.1186/s12889-017-4104-3. CrossRefPubMedPubMedCentral
Costa B, Barrio F, Cabré JJ, Piñol JL, Cos X, Solé C, DE-PLAN-CAT Research Group, et al. Delaying progression to type 2 diabetes among high-risk Spanish individuals is feasible in real-life primary healthcare settings using intensive lifestyle intervention. Diabetologia. 2012;55:1319–28. https://doi.org/10.1007/s00125-012-2492-6. CrossRefPubMed
Aitaoto N, Campo S, Snetselaar LG, Janz KF, Farris KB, Parker E, et al. Formative Research to Inform Nutrition Interventions in Chuuk and the US Pacific. J Acad Nutr Diet. 2015;115:947–53. https://doi.org/10.1016/j.jand.2014.11.018. CrossRefPubMedPubMedCentral
Belon AP, Nieuwendyk LM, Vallianatos H, Nykiforuk CI. Perceived community environmental influences on eating behaviors: A Photovoice analysis. Soc Sci Med. 2016;171:18–29. https://doi.org/10.1016/j.socscimed.2016.11.004. CrossRefPubMedPubMedCentral
Larson N, Story M. A review of environmental influences on food choices. Ann Behav Med. 2009;38(Suppl 1):S56–73. https://doi.org/ 10.1007/s12160-009-9120-9.
Hempler NF, Nicic S, Ewers B, Willaing I. Dietary education must fit into everyday life: a qualitative study of people with a Pakistani background and type 2 diabetes. Patient Prefer Adherence. 2015;9:347–54. https://doi.org/ 10.2147/PPA.S77380.
Fixsen DL, Naoom SF, Blase KA, Friedman RM, Wallace F. Implementation research: A synthesis of the literature. Tampa: University of South Florida, Louis de la parte Florida Mental Health Institute, The National Implementation Research. Network; 2005.
Whitehead LC, Crowe MT, Carter JD, Maskill VR, Carlyle D, Bugge C, Frampton CM. A nurse-led interdisciplinary approach to promote self-management of type 2 diabetes: A process evaluation of post-intervention experiences. J Eval Clin Pract. 2017;23:264–71. https://doi.org/10.1111/jep.12594. CrossRefPubMed
Maindal HT, Bonde A, Aagaard-Hansen J. Action research led to a feasible lifestyle intervention in general practice for people with prediabetes. Prim Care Diabetes. 2014;8:23–9. https://doi.org/10.1016/j.pcd.2013.11.007. CrossRefPubMed
- The effectiveness of a primary care nursing-led dietary intervention for prediabetes: a mixed methods pilot study
Kirsten J. Coppell
Sally L. Abel
Joanna K. Norton
Lisa C. Whitehead
- BioMed Central
Neu im Fachgebiet Allgemeinmedizin
Meistgelesene Bücher aus dem Fachgebiet
Mail Icon II