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Stephen Colagiuri - One of the best experts on this subject based on the ideXlab platform.
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Screening for Diabetes Prevention with Diabetes risk scores - A balancing act.
Diabetes research and clinical practice, 2017Co-Authors: Crystal Man Ying Lee, Vincent L. Versace, Jonathan Malo, Jonathan E. Shaw, James Dunbar, Stephen ColagiuriAbstract:Abstract Aims To compare the Diabetes Prevention impact and cost of several screening scenarios for Diabetes Prevention programs with the scenario which included an oral glucose tolerance test (OGTT). Methods We included 4864 participants of the Australian Diabetes, Obesity and Lifestyle study who were aged ≥40 years, did not have known Diabetes at baseline, and attended the five year follow-up. The proportions of participants eligible or ineligible for Diabetes Prevention program were estimated for each scenario. The costs of screening and Diabetes Prevention programs were also estimated. Results Screening with OGTT alone identified 21% of participants as eligible for Diabetes Prevention. While 3.1% of the cohort were identified as high risk and developed Diabetes after five years, 1.0% of the cohort were identified as low risk and developed Diabetes. The population Prevention potential (i.e. sensitivity) for OGTT alone was 76.5%. Screening all Australian adults aged ≥40 years in 2015 by OGTT would have cost a total of AU$2025 million (AU$1031 million on screening and AU$994 million on Prevention programs). The total costs of screening and Prevention were substantially lower when AUSDRISK was used alone or in combination with a blood test. However, the population Prevention potentials were also lower (ranged from 20.1% to 50.7%). Conclusions A blood test post non-invasive risk assessment is a worthwhile step in the process of enrolling participants in a Diabetes Prevention program. Nevertheless, there will be ineligible individuals who proceed to Diabetes.
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Factors influencing participant enrolment in a Diabetes Prevention program in general practice: lessons from the Sydney Diabetes Prevention program
BMC public health, 2012Co-Authors: Rachel Laws, Philip Vita, Kamalesh Venugopal, Chris Rissel, Daniel Davies, Stephen ColagiuriAbstract:The effectiveness of lifestyle interventions in reducing Diabetes incidence has been well established. Little is known, however, about factors influencing the reach of Diabetes Prevention programs. This study examines the predictors of enrolment in the Sydney Diabetes Prevention Program (SDPP), a community-based Diabetes Prevention program conducted in general practice, New South Wales, Australia from 2008–2011.
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Scaling up Type 2 Diabetes Prevention Programs: National and State Interventions in Australia
2010Co-Authors: James Dunbar, Philip Vita, Stephen Colagiuri, Prasuna Reddy, Amy Timoshanko, Ralph Audehm, Andrew MilatAbstract:Policy development for Diabetes Prevention in Australia Australia has one of the world's largest systematic, government-funded Diabetes Prevention programs. This chapter describes a federally-funded national program, a state-funded program in Victoria and an implementation trial in New South Wales. A coincidence of events, influential individuals and policy directions has led to these initiatives. The Federal, State and Territory governments come together as the Council of Australia Governments (COAG) to discuss public policy of national significance, including health care reform. In 2005 at the behest of the Australian Health Ministers’ Advisory Council the National Public Health Partnership undertook economic modelling of Diabetes Prevention and at the same time the Australian Government Productivity Commission and State treasuries undertook analyses of the impact of chronic disease (including Diabetes) on workplace productivity in Australia. Results of these economic analyses, accumulating scientific evidence of effectiveness of Diabetes Prevention internationally and the results of local translation research projects, particularly the Greater Green Triangle Diabetes Prevention Program (GGT DPP), all strengthened the case for a national policy on Diabetes risk reduction. A number of significant individuals, academics and health advocates in the field of Diabetes and obesity also exerted influence on government to take action on preventing Diabetes.
Philip Vita - One of the best experts on this subject based on the ideXlab platform.
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Type 2 Diabetes Prevention in the community: 12-Month outcomes from the Sydney Diabetes Prevention Program
Diabetes research and clinical practice, 2015Co-Authors: Philip Vita, Adrian Bauman, Magnolia Cardona-morrell, Maria A. Fiatarone Singh, Michael Moore, Rene Pennock, Jill Snow, Mandy Williams, Lilian Jackson, Andrew MilatAbstract:Abstract Aims/hypothesis The Sydney Diabetes Prevention Program (SDPP) was a community-based type 2 Diabetes Prevention translational research study with screening and recruitment in the primary health care setting. We aimed to investigate the program's effectiveness in reducing risk factors for Diabetes as well as the program's reach, adoption and implementation. Methods 1238 participants aged 50–65 years at high-risk of developing type 2 Diabetes were recruited by primary care physicians in the greater Sydney region. The intervention, delivered by trained allied health professionals, included an initial consultation, three group sessions/individual sessions, three follow-up phone calls, and a final review at 12 months. Biomarkers and behavioural goals were compared between baseline and 12 months. Results At baseline, the mean age of those who entered the program was 58.8±4.4 years, 63% female, and the mean body mass index was 31.6±5.2kg/m 2 . There was a significant weight reduction of 2±4.3kg ( p p p Conclusions/interpretation This study demonstrates that a community-based lifestyle modification program is effective in reducing important risk factors for Diabetes in individuals at high-risk of developing type 2 Diabetes.
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Factors influencing participant enrolment in a Diabetes Prevention program in general practice: lessons from the Sydney Diabetes Prevention program
BMC public health, 2012Co-Authors: Rachel Laws, Philip Vita, Kamalesh Venugopal, Chris Rissel, Daniel Davies, Stephen ColagiuriAbstract:The effectiveness of lifestyle interventions in reducing Diabetes incidence has been well established. Little is known, however, about factors influencing the reach of Diabetes Prevention programs. This study examines the predictors of enrolment in the Sydney Diabetes Prevention Program (SDPP), a community-based Diabetes Prevention program conducted in general practice, New South Wales, Australia from 2008–2011.
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Scaling up Type 2 Diabetes Prevention Programs: National and State Interventions in Australia
2010Co-Authors: James Dunbar, Philip Vita, Stephen Colagiuri, Prasuna Reddy, Amy Timoshanko, Ralph Audehm, Andrew MilatAbstract:Policy development for Diabetes Prevention in Australia Australia has one of the world's largest systematic, government-funded Diabetes Prevention programs. This chapter describes a federally-funded national program, a state-funded program in Victoria and an implementation trial in New South Wales. A coincidence of events, influential individuals and policy directions has led to these initiatives. The Federal, State and Territory governments come together as the Council of Australia Governments (COAG) to discuss public policy of national significance, including health care reform. In 2005 at the behest of the Australian Health Ministers’ Advisory Council the National Public Health Partnership undertook economic modelling of Diabetes Prevention and at the same time the Australian Government Productivity Commission and State treasuries undertook analyses of the impact of chronic disease (including Diabetes) on workplace productivity in Australia. Results of these economic analyses, accumulating scientific evidence of effectiveness of Diabetes Prevention internationally and the results of local translation research projects, particularly the Greater Green Triangle Diabetes Prevention Program (GGT DPP), all strengthened the case for a national policy on Diabetes risk reduction. A number of significant individuals, academics and health advocates in the field of Diabetes and obesity also exerted influence on government to take action on preventing Diabetes.
Adrian Bauman - One of the best experts on this subject based on the ideXlab platform.
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Type 2 Diabetes Prevention in the community: 12-Month outcomes from the Sydney Diabetes Prevention Program
Diabetes research and clinical practice, 2015Co-Authors: Philip Vita, Adrian Bauman, Magnolia Cardona-morrell, Maria A. Fiatarone Singh, Michael Moore, Rene Pennock, Jill Snow, Mandy Williams, Lilian Jackson, Andrew MilatAbstract:Abstract Aims/hypothesis The Sydney Diabetes Prevention Program (SDPP) was a community-based type 2 Diabetes Prevention translational research study with screening and recruitment in the primary health care setting. We aimed to investigate the program's effectiveness in reducing risk factors for Diabetes as well as the program's reach, adoption and implementation. Methods 1238 participants aged 50–65 years at high-risk of developing type 2 Diabetes were recruited by primary care physicians in the greater Sydney region. The intervention, delivered by trained allied health professionals, included an initial consultation, three group sessions/individual sessions, three follow-up phone calls, and a final review at 12 months. Biomarkers and behavioural goals were compared between baseline and 12 months. Results At baseline, the mean age of those who entered the program was 58.8±4.4 years, 63% female, and the mean body mass index was 31.6±5.2kg/m 2 . There was a significant weight reduction of 2±4.3kg ( p p p Conclusions/interpretation This study demonstrates that a community-based lifestyle modification program is effective in reducing important risk factors for Diabetes in individuals at high-risk of developing type 2 Diabetes.
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Diabetes Prevention research: a systematic review of external validity in lifestyle interventions.
American journal of preventive medicine, 2012Co-Authors: Rachel Laws, Alexis St.george, Lucie Rychetnik, Adrian BaumanAbstract:Context Type 2 Diabetes is a major contributor to disease burden globally. A number of systematic reviews support the efficacy of lifestyle interventions in preventing Type 2 Diabetes in adults; however, relatively little attention has been paid to the generalizability of study findings. This study systematically reviews the reporting of external validity components and generalizability of Diabetes Prevention studies. Evidence acquisition Lifestyle intervention studies for the Prevention of Type 2 Diabetes in adults with at least 6 months' follow-up, published between 1990 and 2011, were identified through searches of major electronic databases. External validity reporting was rated using an assessment tool, and all analysis was undertaken in 2011. Evidence synthesis A total of 31 primary studies ( n =95 papers) met the selection criteria. All studies lacked full reporting on external validity elements. Description of the study sample, intervention, delivery agents, and participant attrition rates were reported by most studies. However, few studies reported on the representativeness of individuals and settings, methods for recruiting settings and delivery agents, costs, and how interventions could be institutionalized into routine service delivery. It is uncertain to what extent the findings of Diabetes Prevention studies apply to men, socioeconomically disadvantaged individuals, those living in rural and remote communities, and to low- and middle-income countries. Conclusions Reporting of external validity components in Diabetes Prevention studies needs to be enhanced to improve the evidence base for the translation and dissemination of these programs into policy and practice.
Andrew Milat - One of the best experts on this subject based on the ideXlab platform.
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Type 2 Diabetes Prevention in the community: 12-Month outcomes from the Sydney Diabetes Prevention Program
Diabetes research and clinical practice, 2015Co-Authors: Philip Vita, Adrian Bauman, Magnolia Cardona-morrell, Maria A. Fiatarone Singh, Michael Moore, Rene Pennock, Jill Snow, Mandy Williams, Lilian Jackson, Andrew MilatAbstract:Abstract Aims/hypothesis The Sydney Diabetes Prevention Program (SDPP) was a community-based type 2 Diabetes Prevention translational research study with screening and recruitment in the primary health care setting. We aimed to investigate the program's effectiveness in reducing risk factors for Diabetes as well as the program's reach, adoption and implementation. Methods 1238 participants aged 50–65 years at high-risk of developing type 2 Diabetes were recruited by primary care physicians in the greater Sydney region. The intervention, delivered by trained allied health professionals, included an initial consultation, three group sessions/individual sessions, three follow-up phone calls, and a final review at 12 months. Biomarkers and behavioural goals were compared between baseline and 12 months. Results At baseline, the mean age of those who entered the program was 58.8±4.4 years, 63% female, and the mean body mass index was 31.6±5.2kg/m 2 . There was a significant weight reduction of 2±4.3kg ( p p p Conclusions/interpretation This study demonstrates that a community-based lifestyle modification program is effective in reducing important risk factors for Diabetes in individuals at high-risk of developing type 2 Diabetes.
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Scaling up Type 2 Diabetes Prevention Programs: National and State Interventions in Australia
2010Co-Authors: James Dunbar, Philip Vita, Stephen Colagiuri, Prasuna Reddy, Amy Timoshanko, Ralph Audehm, Andrew MilatAbstract:Policy development for Diabetes Prevention in Australia Australia has one of the world's largest systematic, government-funded Diabetes Prevention programs. This chapter describes a federally-funded national program, a state-funded program in Victoria and an implementation trial in New South Wales. A coincidence of events, influential individuals and policy directions has led to these initiatives. The Federal, State and Territory governments come together as the Council of Australia Governments (COAG) to discuss public policy of national significance, including health care reform. In 2005 at the behest of the Australian Health Ministers’ Advisory Council the National Public Health Partnership undertook economic modelling of Diabetes Prevention and at the same time the Australian Government Productivity Commission and State treasuries undertook analyses of the impact of chronic disease (including Diabetes) on workplace productivity in Australia. Results of these economic analyses, accumulating scientific evidence of effectiveness of Diabetes Prevention internationally and the results of local translation research projects, particularly the Greater Green Triangle Diabetes Prevention Program (GGT DPP), all strengthened the case for a national policy on Diabetes risk reduction. A number of significant individuals, academics and health advocates in the field of Diabetes and obesity also exerted influence on government to take action on preventing Diabetes.
Robert E. Ratner - One of the best experts on this subject based on the ideXlab platform.
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Effectiveness and Cost-Effectiveness of Diabetes Prevention Among Adherent Participants
The American journal of managed care, 2013Co-Authors: William H. Herman, Robert E. Ratner, Sharon L. Edelstein, Trevor J. Orchard, Maria G. Montez, Christopher D. Saudek, Mary A. Foulkes, Ronald T. Ackermann, Ping Zhang, Morton B. BrownAbstract:Previously, we reported the clinical and economic outcomes of an intent-to-treat analysis of the combined 10 years of the Diabetes Prevention Program/Diabetes Prevention Program Outcomes Study (DPP/DPPOS) (1,2). In that analysis, participants were analysed according to their randomized treatment group whether or not they adhered to their assigned treatment. In this paper, we report the results of an “on treatment” or “per-protocol” analysis of DPP/DPPOS. We assess outcomes by treatment group for participants who were adherent to their randomized assignments and compare the effectiveness and cost-utility of the intensive lifestyle intervention (lifestyle) and the metformin intervention (metformin) to the placebo intervention (placebo). Our previously published 10 year intent-to-treat analysis of DPP/DPPOS used data from all randomized participants including those who did not adhere to their randomized treatments and so, likely underestimated both the effectiveness and the benefits of lifestyle and metformin. In real world clinical practice, neither costs nor benefits are incurred by nonparticipants but among participants, both intervention costs and benefits are likely to be greater. Our goal in this analysis of the DPP/DPPOS is to extend our previous analyses to estimate the clinical effectiveness and cost-effectiveness of Diabetes Prevention among metformin participants who remained on treatment with metformin and lifestyle participants who succeeded in losing weight.
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Long-term effects of the Diabetes Prevention Program interventions on cardiovascular risk factors: a report from the DPP Outcomes Study: Long-term effects of Diabetes Prevention Program interventions
Diabetic medicine : a journal of the British Diabetic Association, 2012Co-Authors: Trevor J. Orchard, Robert E. Ratner, Marinella Temprosa, Elizabeth Barrett-connor, Sarah E. Fowler, Ronald B. Goldberg, Kieren J. Mather, Santica M. Marcovina, Maria G. Montez, Christopher D. SaudekAbstract:Diabet. Med. 30, 46–55 (2013) Abstract Aims Whether long-term cardiovascular risk is reduced by the Diabetes Prevention Program interventions is unknown. The aim of this study was to determine the long-term differences in cardiovascular disease risk factors and the use of lipid and blood pressure medications by the original Diabetes Prevention Program intervention group. Methods This long-term follow-up (median 10 years, interquartile range 9.0–10.5) of the three-arm Diabetes Prevention Program randomized controlled clinical trial (metformin, intensive lifestyle and placebo), performed on 2766 (88%) of the Diabetes Prevention Program participants (who originally had impaired glucose tolerance), comprised a mean of 3.2 years of randomized treatment, approximately 1-year transition (during which all participants were offered intensive lifestyle intervention) and 5 years follow-up (Diabetes Prevention Program Outcomes Study). During the study, participants were followed in their original groups with their clinical care being provided by practitioners outside the research setting. The study determined lipoprotein profiles and blood pressure and medication use annually. Results After 10 years’ follow-up from Diabetes Prevention Program baseline, major reductions were seen for systolic (−2 to −3) and diastolic (−6 to −6.5 mmHg) blood pressure, and for LDL cholesterol (−0.51 to −0.6 mmol/l) and triglycerides (−0.23 to −0.25 mmol/l) in all groups, with no between-group differences. HDL cholesterol also rose significantly (0.14 to 0.15 mmol/l) in all groups. Lipid (P = 0.01) and blood pressure (P = 0.09) medication use, however, were lower for the lifestyle group during the Diabetes Prevention Program Outcomes Study. Conclusion Overall, intensive lifestyle intervention achieved, with less medication, a comparable long-term effect on cardiovascular disease risk factors, to that seen in the metformin and placebo groups.
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Interventional Trials to Prevent Diabetes: Diabetes Prevention Program
Prevention of Type 2 Diabetes, 2012Co-Authors: Vanita R. Aroda, Robert E. RatnerAbstract:The largest randomized controlled clinical trial in Diabetes Prevention is the Diabetes Prevention Program (DPP), funded by the US National Institutes of Health. By design, the DPP is the most diverse prospective study to date in Diabetes Prevention.
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An update on the Diabetes Prevention Program.
Endocrine Practice, 2006Co-Authors: Robert E. RatnerAbstract:Objective: To summarize the results of the Diabetes Prevention Program (DPP) and describe the additional 5-year follow-up study.Methods: The design, implementation, and outcome of the DPP are reviewed, and an economic analysis of the effects of Diabetes Prevention and delay is presented.Results: The DPP, thus far the largest Diabetes Prevention trial with the most ethnically diverse patient population, originally consisted of more than 3,800 subjects with impaired glucose tolerance. These subjects were randomized to receive one of four interventions: intensive lifestyle adjustments or standard lifestyle plus one of the following--placebo, metformin, or troglitazone. In June 1998, the troglitazone treatment was discontinued after a fatal case of liver failure in a study participant, but the subjects in this arm of the study continued to undergo followup. Thus, 3,234 subjects remained in the other three arms of the study. After a mean of 2.8 years of follow-up, the DPP was prematurely terminated because of ...
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An update on the Diabetes Prevention Program.
Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists, 2006Co-Authors: Robert E. RatnerAbstract:To summarize the results of the Diabetes Prevention Program (DPP) and describe the additional 5-year follow-up study. The design, implementation, and outcome of the DPP are reviewed, and an economic analysis of the effects of Diabetes Prevention and delay is presented. The DPP, thus far the largest Diabetes Prevention trial with the most ethnically diverse patient population, originally consisted of more than 3,800 subjects with impaired glucose tolerance. These subjects were randomized to receive one of four interventions: intensive lifestyle adjustments or standard lifestyle plus one of the following--placebo, metformin, or troglitazone. In June 1998, the troglitazone treatment was discontinued after a fatal case of liver failure in a study participant, but the subjects in this arm of the study continued to undergo followup. Thus, 3,234 subjects remained in the other three arms of the study. After a mean of 2.8 years of follow-up, the DPP was prematurely terminated because of an observed significant benefit to the intervention groups. Both metformin therapy and intensive lifestyle intervention reduced the risk of developing Diabetes (by 31% and 58%, respectively, in comparison with placebo), and both interventions were deemed to be cost-effective on the basis of computer projections over a lifetime. Because of the premature discontinuation of the DPP, the durability of the interventions on Diabetes Prevention and the effect on microvascular and macrovascular disease could not be assessed. The subsequent outcomes study will address these issues during a 5-year follow-up period. The DPP showed that both metformin and intensive lifestyle modifications effectively delayed or prevented the development of Diabetes in a cost-effective manner.