TY - JOUR
T1 - Effects of a lifestyle intervention programme after 1 year of follow-up among South Asians at high risk of type 2 diabetes
T2 - A cluster randomised controlled trial
AU - Muilwijk, Mirthe
AU - Loh, Marie
AU - Siddiqui, Samreen
AU - Mahmood, Sara
AU - Palaniswamy, Saranya
AU - Shahzad, Khurram
AU - Athauda, Lathika K.
AU - Jayawardena, Ranil
AU - Batool, Tayyaba
AU - Burney, Saira
AU - Glover, Matthew
AU - Bamunuarachchi, Vodathi
AU - Panda, Manju
AU - Madawanarachchi, Madawa
AU - Rai, Baldeesh
AU - Sattar, Iqra
AU - Silva, Wnurinham
AU - Waghdhare, Swati
AU - Jarvelin, Marjo-Riitta
AU - Rannan-Eliya, Ravindra Prasan
AU - Wijemunige, Nilmini
AU - Gage, Heather M.
AU - Valabhji, Jonathan
AU - Frost, Gary S.
AU - Wickremasinghe, Rajitha
AU - Kasturiratne, Anuradhani
AU - Khawaja, Khadija I.
AU - Ahmad, Sajjad
AU - van Valkengoed, Irene G. M.
AU - Katulanda, Prasad
AU - Jha, Sujeet
AU - Kooner, Jaspal S.
AU - Chambers, John C.
N1 - Funding Information: Funding The iHealth-T2D trial was funded by the European Commission (grant award 643774). Publisher Copyright: © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2021/11/1
Y1 - 2021/11/1
N2 - Introduction South Asians are at high risk of type 2 diabetes (T2D). We assessed whether intensive family-based lifestyle intervention leads to significant weight loss, improved glycaemia and blood pressure in adults at elevated risk for T2D. Methods This cluster randomised controlled trial (iHealth-T2D) was conducted at 120 locations across India, Pakistan, Sri Lanka and the UK. We included 3684 South Asian men and women, aged 40-70 years, without T2D but with raised haemoglobin A1c (HbA1c) and/or waist circumference. Participants were randomly allocated either to the family-based lifestyle intervention or control group by location clusters. Participants in the intervention received 9 visits and 13 telephone contacts by community health workers over 1-year period, and the control group received usual care. Reductions in weight (aim >7% reduction), waist circumference (aim ≥5 cm reduction), blood pressure and HbA1C at 12 months of follow-up were assessed. Our linear mixed-effects regression analysis was based on intention-to-treat principle and adjusted for age, sex and baseline values. Results There were 1846 participants in the control and 1838 in the intervention group. Between baseline and 12 months, mean weight of participants in the intervention group reduced by 1.8 kg compared with 0.4 kg in the control group (adjusted mean difference -1.10 kg (95% CI -1.70 to -1.06), p<0.001). The adjusted mean difference for waist circumference was -1.9 cm (95% CI -2.5; to 1.3), p<0.001). No overall difference was observed for blood pressure or HbA1c. People who attended multiple intervention sessions had a dose-dependent effect on waist circumference, blood pressure and HbA1c, but not on weight. Conclusion An intensive family-based lifestyle intervention adopting low-resource strategies led to effective reduction in weight and waist circumference at 12 months, which has potential long-term benefits for preventing T2D. A higher number of attended sessions increased the effect on waist circumference, blood pressure and HbA1c.
AB - Introduction South Asians are at high risk of type 2 diabetes (T2D). We assessed whether intensive family-based lifestyle intervention leads to significant weight loss, improved glycaemia and blood pressure in adults at elevated risk for T2D. Methods This cluster randomised controlled trial (iHealth-T2D) was conducted at 120 locations across India, Pakistan, Sri Lanka and the UK. We included 3684 South Asian men and women, aged 40-70 years, without T2D but with raised haemoglobin A1c (HbA1c) and/or waist circumference. Participants were randomly allocated either to the family-based lifestyle intervention or control group by location clusters. Participants in the intervention received 9 visits and 13 telephone contacts by community health workers over 1-year period, and the control group received usual care. Reductions in weight (aim >7% reduction), waist circumference (aim ≥5 cm reduction), blood pressure and HbA1C at 12 months of follow-up were assessed. Our linear mixed-effects regression analysis was based on intention-to-treat principle and adjusted for age, sex and baseline values. Results There were 1846 participants in the control and 1838 in the intervention group. Between baseline and 12 months, mean weight of participants in the intervention group reduced by 1.8 kg compared with 0.4 kg in the control group (adjusted mean difference -1.10 kg (95% CI -1.70 to -1.06), p<0.001). The adjusted mean difference for waist circumference was -1.9 cm (95% CI -2.5; to 1.3), p<0.001). No overall difference was observed for blood pressure or HbA1c. People who attended multiple intervention sessions had a dose-dependent effect on waist circumference, blood pressure and HbA1c, but not on weight. Conclusion An intensive family-based lifestyle intervention adopting low-resource strategies led to effective reduction in weight and waist circumference at 12 months, which has potential long-term benefits for preventing T2D. A higher number of attended sessions increased the effect on waist circumference, blood pressure and HbA1c.
KW - cluster randomized trial
KW - diabetes
KW - epidemiology
KW - prevention strategies
KW - public health
UR - http://www.scopus.com/inward/record.url?scp=85119397741&partnerID=8YFLogxK
U2 - https://doi.org/10.1136/bmjgh-2021-006479
DO - https://doi.org/10.1136/bmjgh-2021-006479
M3 - Article
C2 - 34725039
SN - 2059-7908
VL - 6
JO - BMJ global health
JF - BMJ global health
IS - 11
M1 - e006479
ER -