Type 2 diabetes prevention programs - from proof-of-concept trials to national intervention and beyond

The prevention of type 2 diabetes (T2D) in high-risk people with lifestyle interventions has been demonstrated by several randomized controlled trials. The intervention effect has sustained up to 20 years in post-trial monitoring of T2D incidence. In 2000, Finland launched the national T2D prevention plan. For screening for high T2D risk, the non-laboratory Finnish Diabetes Risk Score was developed and widely used, also in other countries. The incidence of drug-treated T2D has decreased steadily since 2010. The US congress authorized public funding for a national diabetes prevention program (NDPP) in 2010. It was built around a 16-visit program that relies on referral from primary care and self-referral of persons with either prediabetes or by a diabetes risk test. The program uses a train-the-trainer program. In 2015 the program started the inclusion of online programs. There has been limited implementation of nationwide T2D prevention programs in other countries. Despite the convincing results from RCTs in China and India, no translation to the national level was introduced there. T2D prevention efforts in low-and middle-income countries are still limited, but results have been promising. Barriers to efficient interventions are greater in these countries than in high-income countries, where many barriers also exist. Health disparities by socioeconomic status exist for T2D and its risk factors and form a challenge for preventive interventions. It seems that a stronger commitment to T2D prevention is needed, such as the successful WHO Framework Convention on Tobacco Control, which legally binds the countries to act. </p

Integrated care competencies and their association with cross-cultural competence among registered nurses: A cross-sectional questionnaire survey

Aim: To examine the association between the integrated care competencies and cross-cultural competence of registered nurses prior to the integration of social and healthcare services in Finland. Design: A descriptive correlational cross-sectional questionnaire survey was conducted. Methods: A simple random sample of 10,000 registered nurses was drawn from the Finnish Central Register of Valvira (National Supervisory Authority for Welfare and Health); 7000 of them were sent the online questionnaire, and a total of 1232 registered nurses participated in the study. We collected data using background questions, revised versions of the Competent Workforce for the Future tool in the four domains of client orientation, responsibility for personal or relative's welfare, fluency and clarity of services and access to the services and of the Cross-Cultural Competence of Healthcare Professional tool in the four domains of motivation/curiosity, attitude, skill and emotion/empathy. Results: Participants demonstrated a high level of integrated care competencies (mean = 4.00,SD ± 0.49).Anassociation was observed between integrated care competencies and their domains of skills, motivation/curiosity, emotions/empathy, and cross-cultural competence (p< 0.001). Female sex, older age, more working experience, employment in the private sector, and higher self-rated competence for working in a multicultural environment were positively associated with higher integrated care competencies. Conclusion: It is recommended that nurse managers and nurse educators emphasize the development of registered nurses' cross-cultural competence alongside integrated care competencies to meet the needs of different individuals and communities when providing integrated care. Patient or Public Contribution: Finnish registered nurses including all types of nurses, midwives and paramedics working the public and private healthcare, were involved in this study by responding to the online survey.</p

Mean level and number of measurements of FPG, HbA1c, 1-hour OGTT and 2-h OGTT during the 10-year follow-up.

<p>Mean level and number of measurements of FPG, HbA1c, 1-hour OGTT and 2-h OGTT during the 10-year follow-up.</p

Updated mean and updated value of FPG, 1 hPG, 2 hPG and HbA1c in relation to CVD by 1 unit higher SD of the variable.

<p>Model 1 Covariates: Age, Gender, Smoking.</p><p>Model 2 Covariates: Age, Gender, Smoking, BMI, Physical Activity.</p><p>Model 3 Covariates: Age, Gender, Smoking, BMI, Physical Activity, SBP, HDLC, LDLC.</p><p>Model 4 Covariates: Age, Gender, Smoking, BMI, Physical Activity, SBP, HDLC, LDLC, Previous CVD, Previous Cancer.</p><p>Updated mean and updated value of FPG, 1 hPG, 2 hPG and HbA1c in relation to CVD by 1 unit higher SD of the variable.</p

Hazard ratios of CVD for 1 unit increase in FPG, 1 hPG, 2 hPG and HbA1c.

<p>Model 1 Covariates: Age, Gender, Smoking.</p><p>Model 2 Covariates: Age, Gender, Smoking, BMI, Physical Activity.</p><p>Model 3 Covariates: Age, Gender, Smoking, BMI, Physical Activity, SBP, HDLC, LDLC.</p><p>Model 4 Covariates: Age, Gender, Smoking, BMI, Physical Activity, SBP, HDLC, LDLC, Previous CVD, Previous Cancer.</p><p>Hazard ratios of CVD for 1 unit increase in FPG, 1 hPG, 2 hPG and HbA1c.</p

Telomere length change between the 1^st and 2^nd DNA sampling.

<p>Diabetes Prevention Study sample A) intervention cases and B) controls as a histogram with frequencies of telomere length difference between two time points.</p

<b>The Diabetes Prevention Study sample.</b>

<p>Data are number of individuals, mean ± SD, median (range) or %.</p

Telomere length yearly change as a function of telomere length at the 1^st DNA sampling.

<p>Diabetes Prevention Study sample intervention cases (N = 190) are shown with red dots and controls (N = 188) with blue dots, each dot representing one individual. Regression lines for both groups are shown with the same color coding. Relative telomere length is adjusted for age and sex.</p

Lifestyle changes and lifestyle goals achieved during follow-up (three-year assessment).

<p>Lifestyle changes and lifestyle goals achieved during follow-up (three-year assessment).</p

Waterfall charts of weight changes from baseline to year one of the study participants (n = 105).

<p>Waterfall charts of weight changes from baseline to year one of the study participants (n = 105).</p