SLIMMER diabetes voorkomen in de eerste lijn

De prevalentie van diabetes is de afgelopen jaren flink gestegen. Onderzoek toont aan dat leefstijlverandering diabetes mellitus type 2 bij hoogrisicopatiënten kan uitstellen of voorkomen. De implementatie en effectiviteit van preventieprogramma’s in de praktijk blijft echter een uitdaging vanwege de noodzakelijke aanpassing aan de lokale context en beperkte (financiële) middelen. Omdat in Nederland nog geen effectief diabetespreventieprogramma voor de eerste lijn bestond, is het SLIMMER-programma ontwikkeld. SLIMMER is een gecombineerde leefstijlinterventie waarbij mensen gedurende tien maanden begeleid worden om gezonder te gaan eten en meer te bewegen. In deze beschouwing bespreken we de effectiviteit van het SLIMMER-programma in de eerste lijn en vergelijken we die met de bevindingen van andere implementatieonderzoeken op dit terrein. We hebben de effectiviteit van het SLIMMER-programma onderzocht door middel van een gerandomiseerd gecontroleerd onderzoek. SLIMMER blijkt te leiden tot verbeteringen in klinische en metabole risicofactoren, voedinginname, beweging en kwaliteit van leven. Daarbij waren klinische effecten van ons programma groter dan die van de meeste andere preventieprogramma’s. Dit kan komen door de gedegen voorbereiding, het intensieve programma, het onderhoudsprogramma en aansluiting bij de reguliere werkwijze van eerstelijnszorgverleners. De resultaten van dit onderzoek bieden waardevolle inzichten die kunnen bijdragen aan structurele verankering en financiering van effectieve diabetespreventieprogramma’s in de Nederlandse eerste lijn

Samen in Beweging met kwetsbare bewoners: Tussenrapportage van fase 1 – projectjaar 1: Inzicht in motieven en behoeften van kwetsbare groepen om ‘in beweging’ te komen en de kansen voor integraal samenwerken rondom dit vraagstuk

In dit rapport worden de bevindingen weergegeven van het eerste projectjaar van het project ‘Samen in Beweging met kwetsbare inwoners’. In dit project ontwikkelen zorg-, welzijn- en sportprofessionals, gemeenten en inwoners met elkaar een goede praktijk waarbinnen inwoners gestimuleerd worden om in beweging te komen. In lijn met de theorie van Positieve Gezondheid, wordt bewegen, om de gezondheid te stimuleren, binnen het project breed opgevat. Enerzijds gaat het om bewegen in lichamelijke zin. Anderzijds wordt bewegen binnen dit project meer figuurlijk gezien. Deelname aan activiteiten zorgt ook voor sociale beweging en vergroot het gevoel van onderlinge betrokkenheid van inwoners en mentaal welbevinden. Het onderliggende doel is om inclusie, gezondheid en welzijn van de inwoners te stimuleren

Samen in beweging met kwetsbare inwoners: Slotrapportage van het vierjarige project in de gemeenten Kampen, Hardenberg, Oost Gelre, Steenwijkerland, Winterswijk en Zwartewaterland

In dit rapport wordt het proces en de resultaten beschreven van fase 2 – projectjaar 2 tot en met 4 - van het project ‘Samen in Beweging met kwetsbare inwoners’. Het project is uitgevoerd door het consortium ‘Samen in beweging’ dat bestaat uit GGD IJsselland, GGD Noord- en Oost-Gelderland, Wageningen Universiteit (Academische Werkplaats AGORA),Hogeschool Viaa (Werkplaats Sociaal Domein Regio Zwolle) en de zes deelnemende gemeenten: Kampen, Zwartewaterland. Het vierjarige project is mede mogelijk gemaakt door ZonMw vanuit het preventieprogramma ‘Aan de slag met preventie in uw gemeente’

Using the intervention mapping protocol to develop a maintenance programme for the SLIMMER diabetes prevention intervention

Background: Although lifestyle interventions have shown to be effective in reducing the risk for type 2 diabetes mellitus, maintenance of achieved results is difficult, as participants often experience relapse after the intervention has ended. This paper describes the systematic development of a maintenance programme for the extensive SLIMMER intervention, an existing diabetes prevention intervention for high-risk individuals, implemented in a real-life setting in the Netherlands. Methods: The maintenance programme was developed using the Intervention Mapping protocol. Programme development was informed by a literature study supplemented by various focus group discussions and feedback from implementers of the extensive SLIMMER intervention. Results: The maintenance programme was designed to sustain a healthy diet and physical activity pattern by targeting knowledge, attitudes, subjective norms and perceived behavioural control of the SLIMMER participants. Practical applications were clustered into nine programme components, including sports clinics at local sports clubs, a concluding meeting with the physiotherapist and dietician, and a return session with the physiotherapist, dietician and physical activity group. Manuals were developed for the implementers and included a detailed time table and step-by-step instructions on how to implement the maintenance programme. Conclusions: The Intervention Mapping protocol provided a useful framework to systematically plan a maintenance programme for the extensive SLIMMER intervention. The study showed that planning a maintenance programme can build on existing implementation structures of the extensive programme. Future research is needed to determine to what extent the maintenance programme contributes to sustained effects in participants of lifestyle interventions

Cost-effectiveness of the SLIMMER diabetes prevention intervention in Dutch primary health care : economic evaluation from a randomised controlled trial

Background: Although evidence is accumulating that lifestyle modification may be cost-effective in patients with prediabetes, information is limited on the cost-effectiveness of interventions implemented in public health and primary health care settings. Evidence from well-conducted pragmatic trials is needed to gain insight into the realistic cost-effectiveness of diabetes prevention interventions in real-world settings. The aim of this study is to assess the cost-effectiveness of the SLIMMER lifestyle intervention targeted at patients at high risk of developing type 2 diabetes compared with usual health care in a primary care setting in the Netherlands. Methods: Three hundred and sixteen high-risk subjects were randomly assigned to the SLIMMER lifestyle intervention or to usual health care. Costs and outcome assessments were performed at the end of the intervention (12 months) and six months thereafter (18 months). Costs were assessed from a societal perspective. Patients completed questionnaires to assess health care utilisation, participant out-of-pocket costs, and productivity losses. Quality Adjusted Life Years (QALY) were calculated based on the SF-36 questionnaire. Cost-effectiveness planes and acceptability curves were generated using bootstrap analyses. Results: The cost-effectiveness analysis showed that the incremental costs of the SLIMMER lifestyle intervention were €547 and that the incremental effect was 0.02 QALY, resulting in an incremental cost-effectiveness ratio (ICER) of €28,094/QALY. When cost-effectiveness was calculated from a health care perspective, the ICER decreased to €13,605/QALY, with a moderate probability of being cost-effective (56% at a willingness to pay, WTP, of €20,000/QALY and 81% at a WTP of €80,000/QALY). Conclusions: The SLIMMER lifestyle intervention to prevent type 2 diabetes had a low to moderate probability of being cost-effective, depending on the perspective taken

Cost-effectiveness of the SLIMMER diabetes prevention intervention in Dutch primary health care: economic evaluation from a randomised controlled trial.

Background: Although evidence is accumulating that lifestyle modification may be cost-effective in patients with prediabetes, information is limited on the cost-effectiveness of interventions implemented in public health and primary health care settings. Evidence from well-conducted pragmatic trials is needed to gain insight into the realistic cost-effectiveness of diabetes prevention interventions in real-world settings. The aim of this study is to assess the cost-effectiveness of the SLIMMER lifestyle intervention targeted at patients at high risk of developing type 2 diabetes compared with usual health care in a primary care setting in the Netherlands. Methods: Three hundred and sixteen high-risk subjects were randomly assigned to the SLIMMER lifestyle intervention or to usual health care. Costs and outcome assessments were performed at the end of the intervention (12 months) and six months thereafter (18 months). Costs were assessed from a societal perspective. Patients completed questionnaires to assess health care utilisation, participant out-of-pocket costs, and productivity losses. Quality Adjusted Life Years (QALY) were calculated based on the SF-36 questionnaire. Cost-effectiveness planes and acceptability curves were generated using bootstrap analyses. Results: The cost-effectiveness analysis showed that the incremental costs of the SLIMMER lifestyle intervention were €547 and that the incremental effect was 0.02 QALY, resulting in an incremental cost-effectiveness ratio (ICER) of €28,094/QALY. When cost-effectiveness was calculated from a health care perspective, the ICER decreased to €13,605/QALY, with a moderate probability of being cost-effective (56% at a willingness to pay, WTP, of €20,000/QALY and 81% at a WTP of €80,000/QALY). Conclusions: The SLIMMER lifestyle intervention to prevent type 2 diabetes had a low to moderate probability of being cost-effective, depending on the perspective taken