A culturally targeted self-management program for African Americans with type 2 diabetes mellitus. A culturally competent intervention of education and care for black women with type 2 diabetes. A multifaceted school-based intervention to reduce risk for type 2 diabetes in at-risk youth. Nonpharmacological interventions to prevent type 2 diabetes in women diagnosed with gestational diabetes mellitus: a systematic overview Patients' education, and its impact on care outcomes, resource consumption and working conditions: data from the International Diabetes Management Practices Study (IDMPS). Patients with Type 2 Diabetes experiences of making multiple lifestyle changes: a qualitative study. A community based primary prevention programme for type 2 diabetes integrating identification and lifestyle intervention for prevention: the Let's Prevent Diabetes cluster randomised controlled trial. Cluster randomised controlled trial of a peer-led lifestyle intervention program: study protocol for the Kerala diabetes prevention program Effectiveness of a Group-Based Culturally Tailored Lifestyle Intervention Program on Changes in Risk Factors for Type 2 Diabetes among Asian Indians in the United States EMPOWER: a randomized trial using community health workers to deliver a lifestyle intervention program in African American women with Type 2 diabetes: design, rationale, and baseline characteristics. Ngāti and healthy: translating diabetes prevention evidence into community action Engagement, Retention, and Progression to Type 2 Diabetes: A Retrospective Analysis of the Cluster-Randomised "Let's Prevent Diabetes" Trial Prevalence of risk for type 2 diabetes in school children. Effectiveness of A Multifactorial Intervention in Increasing Adherence to the Mediterranean Diet among Patients with Diabetes Mellitus Type 2: A Controlled and Randomized Study (EMID Study) Impact of a Focused Nutrition Educational Intervention Coupled With Improved Access to Fresh Produce on Purchasing Behavior and Consumption of Fruits and Vegetables in Overweight Patients With Diabetes Mellitus A randomized controlled trial of prenatal physical activity to prevent gestational diabetes: design and methods. A prospective study of weight training and risk of type 2 diabetes mellitus in men.
Inadequate knowledge of the influence of lifestyle on clinical outcomes contributes to the difficulties many African Americans experience with type 2 diabetes mellitus ( T2DM ) . This pilot study examined a 12-week church-based culturally targeted diabetes self-management education ( DSME ) intervention for middle-aged and older African Americans with T2DM . Quantitative data were collected at baseline and at 12 weeks and included question naires and anthropometric measures . There were significant increases in medication adherence ( p = .006 ) , healthy eating ( p = .009 ) , and foot care adherence ( p = .003 ) . The intervention had a clinical ly significant effect on systolic blood pressure , blood lipids , physical activity , and waist circumference . Church-based culturally targeted DSME interventions may result in improved outcomes for African-American adults with T2DM . The authors discuss the value of community-based interventions that target behavioural changes in population s of chronically ill patients , particularly those who historically have been disenfranchised and /or underserved This article reports on the development and pilot feasibility testing of a culturally competent intervention of education and care for black women with type 2 diabetes mellitus ( T2DM ) . Using a one group , pretest posttest quasi-experimental design , the intervention was tested with a convenience sample of 25 community black women with T2DM . The conceptual basis , process , and content of the intervention as well as the feasibility and acceptability of study material s and methods are described . Significant improvements from baseline to 3 months were observed in measures of glycemic control , weight , body mass index , and diabetes-related emotional distress . The findings suggest that a culturally sensitive intervention of nurse practitioner diabetes care and education is beneficial for black women with T2DM , result ing in program attendance , kept appointments , improved glycemic control and weight , and decreased diabetes-related emotional distress OBJECTIVE To evaluate the impact of a multifaceted , school-based intervention on inner city youth at high risk for type 2 diabetes mellitus ( T2DM ) and to determine whether the addition of coping skills training ( CST ) and health coaching improves outcomes . METHOD 198 students in New Haven , CT at risk for T2DM ( BMI > 85th percentile and family history of diabetes ) were r and omized by school to an educational intervention with or without the addition of CST and health coaching .  Students were enrolled from 2004 to 2007 and followed for 12 months . RESULTS Students in both groups showed some improvement in anthropometric measures , lipids , and depressive symptoms over 12 months . BMI was not improved by the intervention . Students who received CST showed greater improvement on some indicators of metabolic risk than students who received education only . CONCLUSION A multifaceted , school-based intervention may hold promise for reducing metabolic risk in urban , minority youth This systematic overview summarizes the relevant evidence from multiple systematic review s of the benefits of nonpharmacological interventions for preventing  type 2 diabetes mellitus ( T2MD ) in women diagnosed with gestational diabetes mellitus ( GDM ) . A comprehensive search using the Cochrane Library , CINAHL , EMBASE and MEDLINE via Ovid SP , and PubMed data bases was completed on 18 November 2015 . Any systematic review s that evaluated r and omized controlled trials ( RCTs ) with defined nonpharmacological interventions for preventing T2DM in women diagnosed with GDM were eligible for inclusion . The authors independently performed critical appraisal s and quality assessment s of the included review s using the AMSTAR tool , and extracted data were converted to coherent values for tabular summarization . Six eligible review s of diet and /or exercise , breastfeeding , and reminder interventions were identified ; however , the method ologies of the review s varied greatly , and the majority of the evidence suggested unclear bias . We found inconsistent reporting on the rates at which diet and exercise interventions reduced the risk of T2DM progression , but these interventions were found to be effective at reducing glycemic load . Combined diet , exercise , and breastfeeding interventions proved to be effective at returning women to their postpartum weight . Neither diet alone nor exercise alone proved to be effective at lowering the risk of T2DM . Overall , there was no robust evidence to support the hypothesis that nonpharmacological interventions are effective at lowering the risk of T2DM in women diagnosed with GDM , and there was no consistent evidence showing that these interventions improved the predictor outcomes of T2DM , such as glycemic load or anthropometric changes AIM To evaluate the impact of diabetes education provided to patients with type 2 diabetes mellitus ( T2DM ) in non-controlled studies ( " real-world conditions " ) on quality of care , re source consumption and conditions of employment . METHODS This cross-sectional study and longitudinal follow-up describe the data ( demographic and socioeconomic profiles , clinical characteristics , treatment of hyperglycaemia and associated cardiovascular risk factors , re source consumption ) collected during the second phase ( 2006 ) of the International Diabetes Management Practice s Study ( IDMPS ) . Patients received diabetes education directly from the practice nurse , dietitian or educator , or were referred to ad hoc group-education programmes ; all programmes emphasized healthy lifestyle changes , self-care and active participation in disease control and treatment . Educated vs non-educated T2DM patients ( n=5692 in each group ) , paired by age , gender and diabetes duration , were r and omly recruited for the IDMPS by participating primary -care physicians from 27 countries in Eastern Europe , Asia , Latin America and Africa . Outcome measures included clinical ( body weight , height , waist circumference , blood pressure , foot evaluation ) , metabolic ( HbA(1c ) levels , blood lipid profile ) and biochemical control measures . Treatment goals were defined according to American Diabetes Association guidelines . RESULTS T2DM patients ' education significantly improved the percentage of patients achieving target values set by international guidelines . Educated patients increased their insulin use and self-care performance , had a lower rate of chronic complications and a modest increase in cost of care , and probably higher salaries and slightly better productivity . CONCLUSION Diabetes education is an efficient tool for improving care outcomes without having a major impact on healthcare costs OBJECTIVES To explore patients newly diagnosed with Type 2 Diabetes Mellitus ( T2DM ) experiences of making single ( diet ) or multiple ( diet and physical activity ) changes in order to ( 1 ) assess whether patients experienced increases in physical activity as supporting or hindering dietary changes and vice versa , and ( 2 ) whether patients found making multiple lifestyle changes counterproductive or beneficial . METHODS In-depth interviews with 30 individuals taking part in a r and omised controlled trial that aim ed to determine the effect of diet and physical activity on T2DM . Interviewees had been r and omised to receive usual care , intensive dietary advice , or intensive dietary advice plus information on physical activity . Respondents were interviewed 6 and 9 months post-r and omisation . They were asked about their experiences of making lifestyle changes . Data were analysed thematically . RESULTS Findings suggest providing diet and physical activity information together encourages patients to use physical activity in strategic ways to aid disease management and that most patients find undertaking multiple lifestyle changes helpful . CONCLUSION Increasing physical activity can act as a gateway behaviour , i.e. behaviour that produces positive effects in other behaviours . PRACTICE IMPLICATION S Practitioners should provide diet and physical activity information together to encourage patients to use physical activity strategically to maintain dietary changes OBJECTIVES Prevention of type 2 diabetes ( T2DM ) is a priority in healthcare , but there is a lack of evidence investigating how to effectively translate prevention research into a UK primary care setting . We assessed whether a structured education programme targeting lifestyle and behaviour change was effective at preventing progression to T2DM  in people with pre-diabetes . MATERIAL S AND METHODS Forty-four general practice s were r and omised to receive either st and ard care or a 6hour group structured education programme with an annual refresher course , and regular phone contact . Participants were followed up for 3years . The primary outcome was progression to T2DM . RESULTS Eight hundred and eighty participants were included ( 36 % female , mean age 64years , 16 % ethnic minority group ) ; 131 participants developed T2DM . There was a non-significant 26 % reduced risk of developing T2DM in the intervention arm compared to st and ard care ( HR 0.74 , 95 % CI 0.48 , 1.14 , p=0.18 ) . The reduction in T2DM risk when excluding those who did not attend the initial education session was also non-significant ( HR 0.65 , 0.41 , 1.03 , p=0.07 ) . There were statistically significant improvements in HbA1c ( -0.06 , -0.11 , -0.01 ) , LDL cholesterol ( -0.08 , -0.15 , -0.01 ) , sedentary time ( -26.29 , -45.26 , -7.32 ) and step count ( 498.15 , 162.10 , 834.20 ) when data were analysed across all time points . CONCLUSIONS This study suggests that a relatively low re source , pragmatic diabetes prevention programme result ed in modest benefits to biomedical , lifestyle and psychosocial outcomes , however the reduction to the risk of T2DM did not reach significance . The findings have important implication s for future research and primary care Background India currently has more than 60 million people with Type 2 Diabetes Mellitus ( T2DM ) and this is predicted to increase by nearly two-thirds by 2030 . While management of those with T2DM is important , preventing or delaying the onset of the disease , especially in those individuals at ‘ high risk ’ of developing T2DM , is urgently needed , particularly in re source -constrained setting s. This paper describes the protocol for a cluster r and omised controlled trial of a peer-led lifestyle intervention program to prevent diabetes in Kerala , India . Methods / design A total of 60 polling booths are r and omised to the intervention arm or control arm in rural Kerala , India . Data collection is conducted in two steps . Step 1 ( Home screening ) : Participants aged 30–60 years are administered a screening question naire . Those having no history of T2DM and other chronic illnesses with an Indian Diabetes Risk Score value of ≥60 are invited to attend a mobile clinic ( Step 2 ) . At the mobile clinic , participants complete question naires , undergo physical measurements , and provide blood sample s for biochemical analysis . Participants identified with T2DM at Step 2 are excluded from further study participation . Participants in the control arm are provided with a health education booklet containing information on symptoms , complications , and risk factors of T2DM with the recommended levels for primary prevention . Participants in the intervention arm receive : ( 1 ) eleven peer-led small group sessions to motivate , guide and support in planning , initiation and maintenance of lifestyle changes ; ( 2 ) two diabetes prevention education sessions led by experts to raise awareness on T2DM risk factors , prevention and management ; ( 3 ) a participant h and book containing information primarily on peer support and its role in assisting with lifestyle modification ; ( 4 ) a participant workbook to guide self-monitoring of lifestyle behaviours , goal setting and goal review ; ( 5 ) the health education booklet that is given to the control arm . Follow-up assessment s are conducted at 12 and 24 months . The primary outcome is incidence of T2DM . Secondary outcomes include behavioural , psychosocial , clinical , and biochemical measures . An economic evaluation is planned . Discussion Results from this trial will contribute to improved policy and practice regarding lifestyle intervention programs to prevent diabetes in India and other re source -constrained setting s . Trial registration Australia and New Zeal and Clinical Trials Registry : ACTRN12611000262909 This study used an experimental , pretest-posttest control group repeated measures design to evaluate the effectiveness of a community-based culturally appropriate lifestyle intervention program to reduce the risk for type 2 diabetes ( T2DM ) among Gujarati Asian Indians ( AIs ) in an urban community in the US . Participants included 70 adult AIs in the greater Houston metropolitan area . The primary outcomes were reduction in weight and hemoglobin A1c ( HbA1c ) and improvement in physical activity . Participants were screened for risk factors and r and omly assigned to a 12-week group-based lifestyle intervention program ( n = 34 ) or a control group ( n = 36 ) that received st and ard print material on diabetes prevention . Participants also completed clinical measures and self-reported question naires about physical activity , social , and lifestyle habits at 0 , 3 , and 6 months . No significant baseline differences were noted between groups . While a significant decline in weight and increase in physical activity was observed in all participants , the intervention group lowered their HbA1c ( p < 0.0005 ) and waist circumference ( p = 0.04 ) significantly as compared to the control group . Findings demonstrated that participation in a culturally tailored , lifestyle intervention program in a community setting can effectively reduce weight , waist circumference , and HbA1c among Gujarati AIs living in the US BACKGROUND African American ( AA ) women with Type 2 diabetes mellitus ( T2DM ) in the rural south experience less weight loss and poorer glycemic control in traditional diabetes management programs compared to Caucasians . This paper describes the design , rationale , and baseline characteristics from an innovative community health worker ( CHW ) delivered intervention program in this population . METHODS / DESIGN This prospect i ve trial r and omized rural AA women with uncontrolled T2DM ( HbA1c ≥ 7.0 ) to receive a behaviorally-centered , culturally-tailored lifestyle intervention during 16 contacts  from a trained AA CHW or 16 approved diabetes educational mailings . Changes from baseline in glycosylated hemoglobin levels ( HbA1c ) , blood pressure ( BP ) , weight , body mass index ( BMI ) , self-reported dietary and physical activity patterns , and psychosocial measures including diabetes distress , empowerment , depression , self-care , medication adherence , and life satisfaction will be assessed at 6- and 12-months . BASELINE RESULTS Two hundred AA women ( mean age = 53.09 ± 10.89 years ) with T2DM from impoverished rural communities were enrolled . Baseline data demonstrated profoundly uncontrolled diabetes of long term duration ( mean HbA1c = 9.11 ± 1.82 ; mean BMI = 37.68 ± 8.20 ; mean BP = 134.51 ± 20.39/84.19 ± 11.68 ; 10.5 ± 0.7 years ) . Self-care behavior assessment revealed poor dietary and medication adherence and sedentary lifestyle . Most psychosocial measures ranged within normal limits . CONCLUSION The present sample of AA women from impoverished rural communities exhibited significantly uncontrolled T2DM of long duration with associated obesity and poor lifestyle behaviors . An innovative CHW led lifestyle intervention may lead to more effective strategies for T2DM management in this population Introduction : Type 2 diabetes mellitus ( T2DM ) is a major health issue in New Zeal and Māori . Clinical trials have demonstrated potential for the prevention of T2DM , but whether community public health programmes aim ing to prevent diabetes are effective is untested . Objective : To describe the planning and design of an intervention aim ing to translate T2DM prevention clinical trial evidence into a community-wide population health intervention in a high risk predominantly Māori community . Approach : Community concerns about the diabetes burden were heard by the local diabetes nurse , herself a tribal member , and discussed with a locally raised academic . Project planning ensued . The intervention and its evaluation were design ed using a participatory community development model . The planned intervention had three components : community-wide health promotion initiatives conveying healthy lifestyle messages , community education and monitoring for identified high-risk individuals and their extended families , and a structural strategy aim ed at adapting local environments to support lifestyle changes . The evaluation plan involved interrupted time series surveys coupled with formative and process evaluations rather than a r and omised control trial design . Discussion : Consulting communities , validating community concerns and prioritising cultural and ethical issues were key steps . Time spent developing good relationships amongst the health provider and academic research team members at the outset proved invaluable , as the team were united in addressing the project planning and implementation challenges , such as funding obstacles that arose because of our ethically and culturally appropriate non-r and omised control trial evaluation design . The pre-intervention survey demonstrated high rates of diabetes ( 13 % ) , insulin resistance ( 33 % ) and risk factors , and provided evidence for positive , as opposed to negative , lifestyle intervention messages . Conclusion : Community-wide lifestyle interventions have the potential to reduce rates of type 2 diabetes and other chronic diseases in high-risk communities , but require a high level of commitment from the health sector and buy-in from the community . Adequate commitment , leadership , planning and re sources are essential Background Prevention of  type 2 diabetes mellitus  ( T2DM ) is a global priority . Let ’s Prevent Diabetes is a group-based diabetes prevention programme ; it was evaluated in a cluster-r and omised trial , in which the primary analysis showed a reduction in T2DM ( hazard ratio [ HR ] 0.74 , 95 % CI 0.48–1.14 , p = 0.18 ) . We examined the association of engagement and retention with the Let ’s Prevent Diabetes prevention programme and T2DM incidence . Methods and Findings We used data from a completed cluster-r and omised controlled trial including 43 general practice s r and omised to receive either st and ard care or a 6-h group structured education programme with an annual refresher course for 2 y. The primary outcome was progression to T2DM at 3 y. The characteristics of those who attended the initial education session ( engagers ) versus nonengagers and those who attended all sessions ( retainers ) versus nonretainers were compared . Risk reduction of progression to T2DM by level of attendance was compared to st and ard care . Eight hundred and eighty participants were recruited , with 447 to the intervention arm , of which 346 ( 77.4 % ) were engagers and 130 ( 29.1 % ) were retainers . Retainers and engagers were more likely to be older , leaner , and nonsmokers than nonretainers/nonengagers . Engagers were also more likely to be male and be from less socioeconomically deprived areas than nonengagers . Participants who attended the initial session and at least one refresher session were less likely to develop T2DM compared to those in the control arm ( 30 people of 248 versus 67 people of 433 , HR 0.38 [ 95 % CI 0.24–0.62 ] ) . Participants who were retained in the programme were also less likely to develop T2DM compared to those in the control arm ( 7 people of 130 versus 67 people of 433 , HR 0.12 [ 95 % CI 0.05–0.28 ] ) . Being retained in the programme was also associated with improvements in glucose , glycated haemoglobin ( HbA1c ) , weight , waist circumference , anxiety , quality of life , and daily step count . Given that the data used are from a clinical trial , those taking part might reflect a more motivated sample than the population , which should be taken into account when interpreting the results . Conclusions This study suggests that being retained/engaged in a relatively low-re source , pragmatic diabetes prevention programme for those at high risk is associated with reductions in the progression to T2DM in comparison to those who receive st and ard care . Nonengagers and nonretainers share similar high-risk traits . Service providers of programmes should focus on reaching these hard-to-reach groups . Trial Registration Clinical Trials.gov IS RCT According to the Centers for Disease Control and Prevention , 1 in 3 children born in 2000 in the United States will become diabetic . The odds are higher for African American and Hispanic children as nearly 50 % of them will develop diabetes . R and om screening is not effective in identifying children at risk for type 2 diabetes mellitus ( T2DM )  ; therefore , there is a need to apply screening strategies that guide the development of appropriate primary prevention efforts . To assess the prevalence of risk factors for T2DM , 1066 fifth- grade children were screened using American Diabetes Association guidelines . Overall , 22.6 % were found at risk ; African American and Hispanic children were almost 8 times more likely to be at risk when compared to Caucasians ( odds ratio = 7.41 and 7.87 ) . Children who reported watching TV/playing video games 2 or more hours/day were 73 % more likely to be at risk . Children identified to be at risk were referred to their primary care provider and were invited to participate in a counseling session . The environmental risk factors for T2DM identified in this study are modifiable and should be targeted in preventive interventions at the school and community level to reduce overweight and consequently prevent T2DM in children , especially among minority children The Mediterranean diet ( MD ) is recognized as one of the healthiest dietary patterns and has benefits such as improving glycaemic control among patients with type 2 diabetes ( T2DM ) . Our aim is to assess the effectiveness of a multifactorial intervention to improve adherence to the MD , diet quality and biomedical parameters . The EMID study is a r and omized and controlled clinical trial with two parallel groups and a 12-month follow-up period . The study included 204 subjects between 25–70 years with T2DM . The participants were r and omized into intervention group ( IG ) and control group ( CG ) . Both groups received brief advice about healthy eating and physical activity . The IG participants additionally took part in a food workshop , five walks and received a smartphone application for three months . The population studied had a mean age of 60.6 years . At the 3-month follow-up visit , there were improvements in adherence to the MD and diet quality of 2.2 and 2.5 points , compared to the baseline visit , respectively , in favour of the IG . This tendency of the improvement was maintained , in favour of the IG , at the 12-month follow-up visit . In conclusion , the multifactorial intervention performed could improve adherence to the MD and diet quality among patients with T2DM Purpose The purpose of this study was to test the impact of distributing coupons redeemable at farmers markets plus an educational intervention on fruit and vegetable ( F&V ) purchase and consumption in overweight patients with type 2 diabetes ( T2DM ) . Methods Seventy-eight participants with T2DM being followed at Jacobi Medical Center , a large public hospital in the Bronx , New York , were r and omized to receive the st and ard of care or a 1-hour session focused on benefits of F&V consumption and $ 6 in coupons . Question naires assessed demographics , F&V intake , and farmers market purchasing at baseline and 12 weeks . Clinical parameters were obtained through chart review at baseline and at 12 weeks . Results Participants were predominantly Latino , females , and low income . At 12 weeks , there was a statistically significant increase in the number of participants in the intervention arm who reported purchasing from a farmers market . In addition , there was a minimal increase in fresh fruit intake in the intervention arm at 12 weeks . Conclusion Focused education combined with a small economic incentive result ed in an increase in purchasing behavior and fresh fruit intake per day . A more intense behavioral intervention combined with increased access may result in a significant impact on obesity and diabetes , particularly among low-income and racially diverse communities BACKGROUND Women diagnosed with gestational diabetes mellitus ( GDM ) are at substantially increased risk of developing type 2 diabetes and obesity , currently at epidemic rates in the United States . GDM , therefore , identifies a population of women at high risk of developing type 2 diabetes and provides an opportunity to intervene before the development of this disorder . It is well recognized that acute as well as chronic physical activity improves glucose tolerance in type 2 diabetes . To date , however , primary prevention trials have not been conducted to test whether an increase in physical activity reduces risk of developing GDM among women at high risk of this disorder . METHODS The aims of this study are to investigate the effects of a motivationally targeted , individually tailored 12-week physical activity intervention on ( 1 ) development of GDM , ( 2 ) serum biomarkers associated with insulin resistance , and ( 3 ) the adoption and maintenance of exercise during pregnancy .  Women at high risk of GDM are recruited in early pregnancy and r and omized to either an individually tailored exercise intervention or a comparison health and wellness intervention . RESULTS The overall goal of the exercise intervention is to encourage pregnant women to achieve the American College of Obstetricians and Gynecologists guidelines for physical activity during pregnancy through increasing walking and developing a more active lifestyle . CONCLUSIONS The intervention takes into account the specific social , cultural , economic , and physical environmental challenges faced by pregnant women of diverse socioeconomic and ethnic background BACKGROUND The role of weight training in the primary prevention of  type 2 diabetes mellitus ( T2DM ) is largely unknown . METHODS To examine the association of weight training with  risk of T2DM in US men and to assess the influence of combining weight training and aerobic exercise , we performed a prospect i ve cohort study of 32 002 men from the Health Professionals Follow-up Study observed from 1990 to 2008 . Weekly time spent on weight training and aerobic exercise ( including brisk walking , jogging , running , bicycling , swimming , tennis , squash , and calisthenics/rowing ) was obtained from question naires at baseline and biennially during follow-up . RESULTS During 508 332 person-years of follow-up ( 18 years ) , we documented 2278 new cases of T2DM . In multivariable-adjusted models , we observed a dose-response relationship between an increasing amount of time spent on weight training or aerobic exercise  and lower risk of T2DM ( P < .001 for trend ) . Engaging in weight training or aerobic exercise for at least 150 minutes per week was independently associated with a lower risk of T2DM of 34 % ( 95 % CI , 7%-54 % ) and 52 % ( 95 % CI , 45%-58 % ) , respectively . Men who engaged in aerobic exercise and weight training for at least 150 minutes per week had the greatest reduction in T2DM risk ( 59 % ; 95 % CI , 39%-73 % ) . CONCLUSIONS Weight training was associated with a significantly lower risk of T2DM , independent of aerobic exercise . Combined weight training and aerobic exercise conferred a greater benefit
Conclusion Based on available literature , evidence suggests that community-based interventions may reduce the incidence rate of T2DM and may positively affect anthropometric indices and HbA1C .
Due to the heterogeneity observed between trials we recommend more well- design ed RCTs with longer follow-up duration s be executed , to confirm whether community-based interventions lead to reduced T2DM events in the at-risk population of LMIC setting
Background The increasing prevalence of type 2 diabetes mellitus ( T2DM ) can have a substantial impact in low- and middle-income countries ( LMICs ) .
Community-based programs addressing diet , physical activity , and health behaviors have shown significant benefits on the prevention and management of T2DM , mainly in high-income countries .
However , their effects on preventing T2DM in the at-risk population of LMICs have not been thoroughly evaluated .