Risk perception is not associated with attendance at a preventive intervention for type 2 diabetes mellitus among South Asians at risk of diabetes

To evaluate the association between risk perception and attendance in a diabetes prevention programme among South Asians with a high risk for diabetes. An observational study. We measured risk perception during the baseline interview with causal beliefs, perceived susceptibility and perceived controllability. We used logistic regression to examine the relationship between risk perception and attendance. We adjusted for relevant sociodemographic factors, screening results and psychosocial factors. The Hague, the Netherlands. Five hundred and thirty-five Hindustani Surinamese (South Asians) aged 18-60 years from a lifestyle-versus-control intervention for the prevention of diabetes. In total, 68·2% attended the lifestyle or control intervention. Participants perceived lifestyle and heredity to increase the risk of diabetes and perceived increasing physical activity to decrease it. Only 44·2% of the participants perceived themselves as susceptible to diabetes and only those who perceived a family history of diabetes as a cause of diabetes appeared to be more inclined to attend. However, after adjustment for confounding, the association was not statistically significant. Risk perception was not significantly associated with attendance. The results suggest that increasing the risk perception alone in this South Asian population is unlikely to increase the attendance at a diabetes prevention programm

Estimation of the percentage of the total of cases with type 2 diabetes and prediabetes in the population detected in a 18–60 year old South Asian population in The Hague.

<p>Overall prevalence = prevalence based on combined OGTT and HbA1c measurement. OGTT = oral glucose tolerance test; HbA1c = glycated hemoglobin measurement; CI = 95%- confidence interval.</p

Differences in response and participation between the HbA1c group and the OGTT group.

<p>OGTT group = people offered screening by means of an oral glucose tolerance test; HbA1c group = people offered screening by means of a glycated hemoglobin measurement; Adjusted OR = odds ratio for response or participation, adjusted for age and sex; CI = confidence interval.</p

The Uptake of Screening for Type 2 Diabetes and Prediabetes by Means of Glycated Hemoglobin versus the Oral Glucose Tolerance Test among 18 to 60-Year-Old People of South Asian Origin: A Comparative Study

<div><p>Background</p><p>Direct comparisons of the effect of a glycated haemoglobin measurement or an oral glucose tolerance test on the uptake and yield of screening in people of South Asian origin have not been made. We evaluated this in 18 to 60-year-old South Asian Surinamese.</p><p>Materials and Methods</p><p>We invited 3173 South Asian Surinamese for an oral glucose tolerance test between June 18^th 2009- December 31^st 2009 and 2012 for a glycated hemoglobin measurement between April 19^th 2010-November 11^th, 2010. Participants were selected from 48 general practices in The Hague, The Netherlands. We used mixed models regression to analyse differences in response and participation between the groups. We described differences in characteristics of participants and calculated the yield as the percentage of all cases identified, if all invitees had been offered screening with the specified method.</p><p>Results</p><p>The response and participation in the glycated hemoglobin group was higher than in the group offered an oral glucose tolerance test (participation 23.9 vs. 19.3; OR: 1.30, 95%-confidence interval1.01–1.69). After adjustment for age and sex, characteristics of participants were similar for both groups. Overall, glycated hemoglobin identified a similar percentage of type 2 diabetes cases but a higher percentage of prediabetes cases, in the population than the oral glucose tolerance test.</p><p>Conclusion</p><p>We found that glycated hemoglobin and the oral glucose tolerance test may be equally efficient for identification of type 2 diabetes in populations of South Asian origin. However, for programs aimed at identifying people at high risk of type 2 diabetes (i.e. with prediabetes), the oral glucose tolerance test may be a less efficient choice than glycated hemoglobin.</p></div

Reasons for non-response in the HbA1c group and the OGTT group.

<p>OGTT group = people offered screening by means of an oral glucose tolerance test; HbA1c group = people offered screening by means of a glycated hemoglobin measurement; Not eligible = outside age range, longterm illness, currently pregnant, already participating in other research project(s), moved away from The Hague; Unknown = no contact established or no reason provided during telephone contact or on reply card; OGTT = oral glucose tolerance test.</p

Screening South Asians for type 2 diabetes and prediabetes: (1) comparing oral glucose tolerance and haemoglobin A1c test results and (2) comparing the two sets of metabolic profiles of individuals diagnosed with these two tests

ABSTRACT: BACKGROUND: The glycated haemoglobin A1c (HbA1c) level may be used for screening for type 2 diabetes and prediabetes instead of a more burdensome oral glucose tolerance test (OGTT). However, among the high-risk South Asian population, little is known about the overlap of the methods or about the metabolic profiles of those disconcordantly diagnosed. METHODS: We included 944 South Asians (18--60 years old), whom we screened with the HbA1c level and the OGTT in The Hague, the Netherlands. We calculated the area under the receiver-operator characteristic curve (AUROC) with a 95% confidence interval of HbA1c using the American Diabetes Association classifications, and determined the sensitivity and specificity with 95% confidence intervals at different thresholds. Moreover, we studied differences in metabolic characteristics between those identified by HbA1c and by the OGTT alone. RESULTS: The overlap between HbA1c and OGTT classifications was partial, both for diabetes and prediabetes. The AUROC of HbA1c for OGTT defined diabetes was 0.86 (0.79--0.93). The sensitivity was 0.46 (0.29--0.63); the specificity 0.98 (0.98--0.99). For prediabetes, the AUROC was 0.73 (0.69--0.77). Each of the 31 individuals with diabetes and 353 with prediabetes identified with the HbA1c level had a high body mass index, large waist circumference, high blood pressure, and low insulin sensitivity, all of which were similar to the values shown by those among the 19 with diabetes or 62 with prediabetes who only met the OGTT criteria, but not the HbA1c criteria. CONCLUSIONS: The HbA1c level identified a partially different group than the OGTT did. However, both those identified with the HbA1c level and those identified with the OGTT alone were at increased metabolic risk.Trial registration: Dutch Trial Register: NTR149

By treatment analysis: difference in obesity and metabolic characteristics between those maintaining participation (≥6 sessions attended) in the lifestyle counselling versus those not maintaining participation within the intervention group.

<p>BMI  =  Body mass index, HbA1c  =  haemoglobin A1c, HDL  =  high-density lipoprotein, LDL  =  low-density lipoprotein, 95%CI  = 95% confidence interval.</p>a<p>Maintenance is defined as having attended 6 sessions or more for lifestyle counselling (on top of an initial intake visit).</p>b<p>The differences with corresponding 95%CI's in changes of metabolic characteristics over time between those maintaining and not maintaining participation in the lifestyle counselling, determined with independent sample <i>t</i>-tests for continuous measures and chi-square tests for categorical measures.</p>c<p>P<0.05 for differences between baseline and follow-up measurements of metabolic characteristics determined with paired <i>t</i>-test.</p

Intensive Lifestyle Intervention in General Practice to Prevent Type 2 Diabetes among 18 to 60-Year-Old South Asians: 1-Year Effects on the Weight Status and Metabolic Profile of Participants in a Randomized Controlled Trial

<div><p>Aim</p><p>To study 1-year effectiveness of an intensive, culturally targeted lifestyle intervention in general practice for weight status and metabolic profile of South-Asians at risk of type 2 diabetes.</p><p>Methods</p><p>536 South-Asians at risk of type 2 diabetes were randomized to an intervention (n = 283) or control (n = 253) group. The intervention, which was targeted culturally to the South-Asian population, consisted of individual lifestyle counselling, a family session, cooking classes, and supervised physical activity programme. All components of the intervention were carried out by professionals as part of their daily clinical practice. The control group received generic lifestyle advice. Change in weight status and metabolic profile were assessed after 1 year.</p><p>Results</p><p>After 1 year, 201 participants were lost to follow-up. Remaining participants in intervention (n = 177) and control (n = 158) group had similar baseline characteristics. Weight loss in the intervention group was 0.2±3.3 kg, weight gain in the control group was 0.4±3.1 kg (p = 0.08). Changes in other weight-related measurements did not differ significantly between groups. Furthermore, there were no differences between groups in changes of metabolic profile. All results remained similar after repeating analyses in a multiple imputed dataset.</p><p>Discussion</p><p>An intensive, culturally targeted, lifestyle intervention of 1 year did not improve weight status and metabolic profile of South-Asians at risk of type 2 diabetes. The laborious recruitment, high drop-out, and lack of effectiveness emphasise the difficulty of realising health benefits in practice and suggest that this strategy might not be the optimal approach for this population.</p><p>Trial Registration</p><p>Nederlands Trial Register <a href="http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=1499" target="_blank">NTR1499</a></p></div

Changes after 1 year between the control group and the intervention group.

<p>BMI  =  Body mass index, HbA1c  =  haemoglobin A1c, HDL  =  high-density lipoprotein, LDL  =  low-density lipoprotein, N/A  =  not applicable, 95%CI  = 95% confidence interval, HOMA-IR  =  homeostasis model assessment- insulin resistance.</p><p>Data in parentheses are standard deviations following means.</p>a<p>Any weight loss  =  weight loss >1 kg; weight gain  =  weight gain >1 kg.</p>b<p>The differences with corresponding 95%CI's in changes over time between control group and intervention group were determined with independent sample <i>t</i>-tests for continuous measures and chi-square tests for categorical measures.</p>c<p>P<0.05 for differences between baseline and follow-up measurements of metabolic characteristics determined with paired <i>t</i>-tests.</p>d<p>HOMA-IR was calculated as (fasting plasma glucose * fasting plasma insulin)/22.5 <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0068605#pone.0068605-Matthews1" target="_blank">[26]</a>.</p

By treatment analysis: difference in obesity and metabolic characteristics between those attending the lifestyle counselling (≥2 sessions attended) and those not attending within the intervention group.

<p>BMI  =  Body mass index, HbA1c  =  haemoglobin A1c, HDL  =  high-density lipoprotein, LDL  =  low-density lipoprotein, N/A  =  not applicable, SD  =  standard deviation, 95%CI  = 95% confidence interval.</p>a<p>Attendance is defined as having had two or more sessions of lifestyle counselling on top of an initial intake visit.</p>b<p>The differences with corresponding 95%CI's in changes of metabolic characteristics over time between those attending and not attending the lifestyle counselling were determined with independent sample <i>t</i>-tests for continuous measures and chi-square tests for categorical measures.</p>c<p>P<0.05 for differences between baseline and follow-up measurements of metabolic characteristics determined with paired <i>t</i>-tests.</p