Reducing the Incidence of Type 2 Diabetes Mellitus A Healthcare Plan and Program Implementation Perspective

摘要

The evidence base derived from the research literature has clearly established that type 2 diabetes mellitus may be prevented or delayed through pharmacological interventions and, most efficaciously, through lifestyle interventions. Unfortunately, efforts to translate the research results into programs that may be applied to the clinical or healthcare system setting are lacking. The purpose of this article is 3-fold: (i) to briefly review the results of the major trials conducted in the area of type 2 diabetes; (ii) to outline an approach that may guide the design and development of type 2 diabetes prevention programs for clinical care; and (iii) to present a protocol that may support the process of implementation in the practice setting.The literature review clearly delineates critical type 2 diabetes prevention program outcomes, i.e. modest weight loss, dietary changes, an increase in physical activity level and, in the case of pharmacological interventions, good adherence to medication regimens. Guided by evidence-informed approaches to translation, this article outlines a set of critical program design principles that guide the development of type 2 diabetes prevention programs, and are systematically included and recognized in the programs; these principles are termed the '4Ss': (i) effect size; (ii) program scope; (iii) scalability; and (iv) long-term sustainability in the real-world setting.Based on additional literature that addresses operational feasibility and principles of design and evaluation, this paper describes a protocol that may help healthcare systems and care delivery settings design such prevention programs and successfully document desired impacts that are meaningful to their customers. The protocol is designed to include the total membership of a healthcare system and it systematically allows for the identification and stratification of the risk of developing type 2 diabetes. Individuals are assigned to one of three risk strata: (i) low risk of developing type 2 diabetes; (ii) high risk of developing type 2 diabetes; or (iii) active disease (already diagnosed with type 2 diabetes). The high-risk group is subsequently invited to participate in risk-reduction strategies that are designed to reduce the incidence of type 2 diabetes.