The Sydney Diabetes Prevention Program: A community-based translational study Translating the Diabetes Prevention Program to Primary Care: A Pilot Study Cost-effectiveness of Community Health Workers in controlling diabetes epidemic on the U.S.-Mexico border. Within-trial cost-effectiveness of lifestyle intervention or metformin for the primary prevention of type 2 diabetes. Implementation of a lifestyle intervention for type 2 diabetes prevention in Dutch primary care: opportunities for intervention delivery Cost-effectiveness of a pragmatic structured education intervention for the prevention of type 2 diabetes: economic evaluation of data from the Let's Prevent Diabetes cluster-randomised controlled trial Lifestyle intervention to prevent diabetes in men and women with impaired glucose tolerance is cost-effective. Cost-effectiveness of a lifestyle intervention in preventing Type 2 diabetes. The cost-effectiveness of diabetes prevention: results from the Diabetes Prevention Program and the Diabetes Prevention Program Outcomes Study A cost effectiveness study of integrated care in health services delivery: a diabetes program in Australia Cost-effectiveness of exercise programs in type 2 diabetes. Controlled trial of a multifaceted intervention for improving quality of care for rural patients with type 2 diabetes. Translating the Diabetes Prevention Program into an Online Social Network Economic evaluation of a lifestyle intervention in primary care to prevent type 2 diabetes mellitus and cardiovascular diseases: a randomized controlled trial Design of a cluster-randomized controlled trial of a diabetes prevention program within African-American churches: The Fit Body and Soul study. A randomized comparative effectiveness trial of using cable television to deliver diabetes prevention programming Focus on health information technology, electronic health records and their financial impact: Cost-effectiveness of a shared computerized decision support system for diabetes linked to electronic medical records
Background Type 2 diabetes is a major public health problem in Australia with prevalence increasing in parallel with increasing obesity . Prevention is an essential component of strategies to reduce the diabetes burden . There is strong and consistent evidence from r and omised controlled trials that type 2 diabetes can be prevented or delayed through lifestyle modification which improves diet , increases physical activity and achieves weight loss in at risk people . The current challenge is to translate this evidence into routine community setting s , determine feasible and effective ways of delivering the intervention and providing on-going support to sustain successful behavioural changes . Methods / Design The Sydney Diabetes Prevention Program ( SDPP ) is a translational study which will be conducted in 1,550 participants aged 50 - 65 years ( including 100 indigenous people aged 18 years and older ) at high risk of future development of diabetes . Participants will be identified through a screening and recruitment program delivered through primary care and will be offered a community-based lifestyle modification intervention . The intervention comprises an initial individual session and three group sessions based on behaviour change principles and focuses on five goals : 5 % weight loss , 210 min/week physical activity ( aerobic and strength training exercise ) , limit dietary fat and saturated fat to less than 30 % and 10 % of energy intake respectively , and at least 15 g/1000 kcal dietary fibre . This is followed by 3-monthly contact with participants to review progress and offer ongoing lifestyle advice for 12 months . The effectiveness and costs of the program on diabetes-related risk factors will be evaluated . Main outcomes include changes in weight , physical activity , and dietary changes ( fat , saturated fat and fibre intake ) . Secondary outcomes include changes in waist circumference , fasting plasma glucose , blood pressure , lipids , quality of life , psychological well being , medication use and health service utilization . Discussion This translational study will ascertain the reach , feasibility , effectiveness and cost-effectiveness of a lifestyle modification program delivered in a community setting through primary health care . If demonstrated to be effective , it will result in recommendations for policy change and practical methods for a wider community program for preventing or delaying the onset of type 2 diabetes in high risk people Background : Research on the translation of efficacious lifestyle change programs to prevent type 2 diabetes into community or clinical setting s is needed . Objective : The objective of this study was to examine the reach , implementation , and efficacy of a 6-month lifestyle program implemented in primary care by nurse practitioners ( NPs ) for adults at risk of type 2 diabetes . Methods : The NP sites ( n = 4 ) were r and omized to an enhanced st and ard care program ( one  NP  and one  nutrition session ) or a lifestyle program ( enhanced st and ard care and six NP sessions ) . These NPs recruited adults at risk of diabetes from their practice ( n = 58 ) , with an acceptance rate of 70 % . Results : The program reached a diverse , obese , and moderately low income sample . The NPs were able to successfully implement the protocol s. The average length of the program was 9.3 months . Attendance was high ( 98 % ) , and attrition was low ( 12 % ) . The NPs were able to adopt the educational , behavioral , and psychosocial strategies of the intervention easily . Motivational interviewing was more difficult for NPs . Mixed-model repeated- measures analysis indicated significant trends or improvement in both groups for nutrition and exercise behavior . Participants of the lifestyle program demonstrated trends for better high-density lipoprotein ( HDL ) and exercise behavior compared with the enhanced st and ard care participants . Twenty-five percent of lifestyle participants met treatment goals of 5 % weight loss compared with 11 % of st and ard care participants . Discussion : A lifestyle program can be implemented in primary care by NPs , reach the targeted population , and be modestly successful . Further research is indicated OBJECTIVES This study attempted to evaluate clinical outcomes and long-term cost-effectiveness of an intervention involving Community Health Workers ( CHW 's , a.k.a . promotoras de salud in Spanish ) in assisting Mexican-American diabetes type-2 patients with controlling their condition . The intervention has been carried out in Hidalgo County , TX which is situated on the U.S.-Mexico border . STUDY DESIGN The design of the study is experimental . The sample ( n = 30 ) was recruited from Mexican-American diabetes patients aged 30 or above . The intervention group received monthly visits from CHW 's , while the control group did not . METHODS Incremental lifetime health outcomes and related expenditures were calculated using the CDC Diabetes Cost-Effectiveness Model ( DCEM ) which is a probabilistic computer simulation model of disease progression and cost-effectiveness for type 2 diabetes patients . The DCEM allows projection of lifetime healthcare costs and Quality -Adjusted Life-Years ( QALYs ) . RESULTS The intervention group showed a significant improvement in glycemic control and cholesterol management after two years of intervention . The intervention is expected to reduce long-term complications , result ing in an increase in residual life-years and quality -adjusted life-years . The incremental cost-effectiveness ratio has been estimated to be $ 13,810 , which is below the level of comparable studies . CONCLUSIONS Intervention has a substantial impact on the medical costs of type 2 diabetes treatment . The estimates presented in this model may be used to analyse the cost-effectiveness of interventions involving CHW 's for type 2 diabetes OBJECTIVE The Diabetes Prevention Program ( DPP ) demonstrated that intensive lifestyle and metformin interventions reduced the incidence of type 2 diabetes compared with a placebo intervention . The aim of this study was to assess the cost-effectiveness of the lifestyle and metformin interventions relative to the placebo intervention . RESEARCH DESIGN AND METHODS Analyses were performed from a health system perspective that considered direct medical costs only and a societal perspective that considered direct medical costs , direct nonmedical costs , and indirect costs . Analyses were performed with the interventions as implemented in the DPP and as they might be implemented in clinical practice . RESULTS The lifestyle and metformin interventions required more re sources than the placebo intervention from a health system perspective , and over 3 years they cost approximately US dollars 2250 more per participant . As implemented in the DPP and from a societal perspective , the lifestyle and metformin interventions cost US dollars 24400 and US dollars 34500 , respectively , per case of diabetes delayed or prevented and US dollars 51600 and US dollars 99200 per quality -adjusted life-year ( QALY ) gained . As the interventions might be implemented in routine clinical practice and from a societal perspective , the lifestyle and metformin interventions cost US dollars 13200 and US dollars 14300 , respectively , per case of diabetes delayed or prevented and US dollars 27100 and US dollars 35000 per QALY gained . From a health system perspective , costs per case of diabetes delayed or prevented and costs per QALY gained tended to be lower . CONCLUSIONS Over 3 years , the lifestyle and metformin interventions were effective and were cost-effective from the perspective of a health system and society . Both interventions are likely to be affordable in routine clinical practice , especially if implemented in a group format and with generic medication pricing Background As in clinical practice re sources may be limited compared to experimental setting s , translation of evidence -based lifestyle interventions into daily life setting s is challenging . In this study we therefore evaluated the implementation of the APHRODITE lifestyle intervention for the prevention of type 2 diabetes in Dutch primary care . Based on this evaluation we discuss opportunities for refining intervention delivery . Methods A 2.5-year intervention was performed in 14 general practice s in the Netherl and s among individuals at high risk for type 2 diabetes ( FINDRISC-score ≥ 13 ) ( n = 479 ) and was compared to usual care ( n = 446 ) . Intervention consisted of individual lifestyle counselling by nurse practitioners ( n = 24 ) and GPs ( n = 48 ) and group-consultations .  Drop-out and attendance were registered during the programme . After the intervention , satisfaction with the programme and perceived implementation barriers were assessed with question naires . Results Drop-out was modest ( intervention : 14.6 % ; usual care : 13.2 % ) and attendance at individual consultations was high ( intervention : 80 - 97 % ; usual care : 86 - 94 % ) . Providers were confident about diabetes prevention by lifestyle intervention in primary care . Participants were more satisfied with counselling from nurse practitioners than from GPs . A major part of the GPs reported low self-efficacy regarding dietary guidance . Lack of counselling time ( 60 % ) , participant motivation ( 12 % ) , and financial reimbursement ( 11 % ) were regarded by providers as important barriers for intervention implementation . Conclusions High participant compliance and a positive attitude of providers make primary care a suitable setting for diabetes prevention by lifestyle counselling . Results support a role for the nurse practitioner as the key player in guiding lifestyle modification . Further research is needed on strategies that could increase cost-effectiveness , such as more stringent criteria for participant inclusion , group-counselling , more tailor-made counselling and integration of screening and / or interventions for different disorders Objectives Prevention of type 2 diabetes mellitus ( TD2 M ) is a priority for healthcare systems . We estimated the cost-effectiveness compared with st and ard care of a structured education programme ( Let 's Prevent ) targeting lifestyle and behaviour change to prevent progression to T2DM in people with prediabetes . Design Cost-effectiveness analysis alongside r and omised controlled trial . Setting 44 general practice s in Leicestershire , Engl and . Participants 880 participants with prediabetes r and omised to receive either st and ard care or a 6-hour group structured education programme with follow-up sessions in a primary care setting . Main outcome measure Incremental cost utility from the UK National Health Service ( NHS ) perspective . Quality of life and re source use measured from baseline and during the 36 months follow-up using the EuroQoL EQ-5D and 15D instruments and an economic question naire . Outcomes measured using quality -adjusted life years ( QALYs ) and healthcare costs calculated in 2012–2013 prices . Results After accounting for clustering and missing data , the intervention group was found to have a net gain of 0.046 ( 95 % CI −0.0171 to 0.109 ) QALYs over 3 years , adjusted for baseline utility , at an additional cost of £ 168 ( 95 % CI −395 to 732 ) per patient compared with the st and ard care group . The incremental cost-effectiveness ratio is £ 3643/QALY with an 86 % probability of being cost-effective at a willingness to pay threshold of £ 20 000/QALY . Conclusions The education programme had higher costs and higher quality of life compared with the st and ard care group . The Let 's Prevent programme is very likely to be cost-effective at a willingness to pay threshold of £ 20 000/QALY gained . Trial registration number IS RCT N80605705 OBJECTIVES The Finnish Diabetes Prevention Study ( DPS ) was a r and omized intervention program that evaluated the effect of intensive lifestyle modification on the development of diabetes mellitus type 2 in patients with impaired glucose tolerance . As such , a program is dem and ing in terms of re sources ; it is necessary to assess whether it would be money well spent . This determination was the purpose of this study . METHODS We developed a simulation model to assess the economic consequences of an intervention like the one studied in DPS in a Swedish setting . The model used data from the trial itself to assess the effect of intervention on the risk of diabetes and on risk factors for cardiovascular disease . Results from the United Kingdom Prospect i ve Diabetes Study were used to estimate the risk of cardiovascular disease and stroke . Cost data were derived from Swedish studies . The intervention was assumed to be applied to eligible patients from a population -based screening program of 60-year-olds in the County of Stockholm from which the baseline characteristics of the patients was used . RESULTS The model predicted that implementing the program would be cost-saving from the healthcare payers ' perspective . Furthermore , it was associated with an increase in estimated survival of .18 years . Taking into consideration the increased consumption by patients due to their longer survival , the predicted cost-effectiveness ratio was 2,363 euro per quality -adjusted life-year gained . CONCLUSIONS Lifestyle intervention directed toward high-risk subjects would be cost-saving for the healthcare payer and highly cost-effective for society as a whole OBJECTIVES Previous research has suggested people with impaired fasting glucose ( IFG ) are less likely to develop Type 2 diabetes ( T2DM ) if they receive prolonged structured diet and exercise advice . This study examined the within-trial cost-effectiveness of such lifestyle interventions . METHODS Screen-detected participants with either newly diagnosed T2DM or IFG were r and omized 2:1 to intervention versus control ( usual care ) between February and December 2009 , in Norfolk ( UK ) . The intervention consisted of group based education , physiotherapy and peer support sessions , plus telephone contacts from T2DM volunteers . We monitored healthcare re source use , intervention costs , and quality of life ( EQ-5D ) . The incremental cost per quality -adjusted life-year ( QALY ) gain ( incremental cost effectiveness ratio [ ICER ] ) , and cost effectiveness acceptability curves ( CEAC ) were estimated . RESULTS In total , 177 participants were recruited ( 118 intervention , 59 controls ) , with a mean follow-up of 7 months . Excluding screening and recruitment costs , the mean cost was estimated to be £ 551 per participant in the intervention arm , compared with £ 325 in the control arm . The QALY gains were -0.001 and -0.004 , respectively . The intervention was estimated to have an ICER of £ 67,184 per QALY ( 16 percent probability of being cost-effective at the £ 20,000/QALY threshold ) . Cost-effectiveness estimates were more favorable for IFG participants and those with longer follow-up ( ≥ 4 months ) ( ICERs of £ 20,620 and £ 17,075 per QALY , respectively ) . CONCLUSIONS Group sessions to prevent T2DM were not estimated to be within current limits of cost-effectiveness . However , there was a large degree of uncertainty surrounding these estimates , suggesting the need for further research Background The Diabetes Prevention Program ( DPP ) was a r and omized , controlled clinical trial . It demonstrated that among high-risk individuals with impaired glucose tolerance , diabetes incidence was reduced by 58 % with lifestyle intervention and 31 % with metformin compared to placebo . During the Diabetes Prevention Program Outcomes Study ( DPPOS ) , all DPP participants were unmasked to their treatment assignments , the original lifestyle intervention group was offered additional lifestyle support , the metformin group continued metformin , and all three groups were offered a group-implemented lifestyle intervention . Over the 10 years of combined DPP/DPPOS follow-up , diabetes incidence was reduced by 34 % in the lifestyle group and 18 % in the metformin group compared to placebo . The purpose of this article is to review and synthesize analyses published by the DPP/DPPOS Research Group that have described the cost-effectiveness of diabetes prevention . Methods We describe the re source utilization and costs of the DPP and DPPOS interventions , the costs of non-intervention-related medical care , the impact of the interventions on diabetes progression and quality -of-life , and the cost-effectiveness of the interventions from health system and societal perspectives . Cost-effectiveness analyses were performed with a 3-year time horizon using DPP data , a lifetime time horizon that simulated 3-year DPP data , and a 10-year time horizon using combined DPP/DPPOS data . Results Although more expensive than the placebo intervention , the greater costs of the lifestyle and metformin interventions were offset by reductions in the costs of nonintervention-related medical care . Every year after r and omization , quality -of-life was better for participants in the lifestyle intervention compared to those in the metformin or placebo intervention . In both the simulated lifetime analysis and the 10-year within trial economic analysis , lifestyle and metformin were extremely cost-effective ( that is , improved outcomes at a low incremental cost ) or even cost-saving ( that is , improved outcomes and reduced total costs ) compared to the placebo intervention . Conclusions The implementation of diabetes prevention programs in high-risk individuals will result in important health benefits and represents a good value for money . Trial registration NCT00004992 ( DPP ) and NCT00038727 ( DPPOS ) Background Type 2 diabetes is rapidly growing as a proportion of the disease burden in Australia as elsewhere . This study addresses the cost effectiveness of an integrated approach to assisting general practitioners ( GPs ) with diabetes management . This approach uses a central ized data base of clinical data of an Australian Division of General Practice ( a network of GPs ) to co-ordinate care according to national guidelines . Methods Long term outcomes for patients in the program were derived using clinical parameters after 5 years of program participation , and the United Kingdom Prospect i ve Diabetes Study ( UKPDS ) Outcomes Model , to project outcomes for 40 years from the time of diagnosis and from 5 years post-diagnosis . Cost information was obtained from a range of sources . While program costs are directly available , and costs of complications can be estimated from the UKPDS model , other costs are estimated by comparing costs in the Division with average costs across the state or the nation . The outcome and cost measures are used derive incremental cost-effectiveness ratios . Results The clinical data show that the program is effective in the short term , with improvement or no statistical difference in most clinical measures over 5 years . Average HbA1c levels increased by less than expected over the 5 year period . While the program is estimated to generate treatment cost savings , overall net costs are positive . However , the program led to projected improvements in expected life years and Quality Adjusted Life Expectancy ( QALE ) , with incremental cost effectiveness ratios of $ A8,106 per life-year saved and $ A9,730 per year of QALE gained . Conclusions The combination of an established model of diabetes progression and generally available data has provided an opportunity to establish robust methods of testing the cost effectiveness of a program for which a formal control group was not available . Based on this methodology , integrated health care delivery provided by a network of GPs improved health outcomes of type 2 diabetics with acceptable cost effectiveness , which suggests that similar outcomes may be obtained elsewhere BACKGROUND A r and omized controlled trial has shown that supervised , facility-based exercise training is effective in improving glycemic control in type 2 diabetes . However , these programs are associated with additional costs . This analysis assessed the cost-effectiveness of such programs . METHODS Analysis used data from the Diabetes Aerobic and Resistance Exercise ( DARE ) clinical trial which compared three different exercise programs ( resistance , aerobic or a combination of both ) of 6 months duration with a control group ( no exercise program ) . Clinical outcomes at 6 months were entered for individual patients into the UKPDS economic model for type 2 diabetes adapted for the Canadian context . From this , expected life-years , quality -adjusted life-years ( QALYs ) and costs were estimated for all patients within the trial . RESULTS The combined exercise program  was the most expensive ( $ 40,050 ) followed by the aerobic program ( $ 39,250 ) , the resistance program ( $ 38,300 ) and no program ( $ 31,075 ) . QALYs were highest for combined ( 8.94 ) , followed by aerobic ( 8.77 ) , resistance ( 8.73 ) and no program ( 8.70 ) . The incremental cost per QALY gained for the combined exercise program was $ 4,792 compared with aerobic alone , $ 8,570 compared with resistance alone , and $ 37,872 compared with no program . The combined exercise program  remained cost-effective for all scenarios considered within sensitivity analysis . CONCLUSIONS A program providing training in both resistance and aerobic exercise was the most cost-effective of the alternatives compared . Based on previous funding decisions , exercise training for individuals with diabetes can be considered an efficient use of re sources OBJECTIVE Despite good evidence and clinical practice guidelines , studies document that treatment of type 2 diabetes is less than optimal . Lack of re sources or limited access may put patients in rural communities at particular risk for suboptimal care . RESEARCH DESIGN AND METHODS We conducted a prospect i ve , before/after study with concurrent controls to assess the effectiveness of a multidisciplinary diabetes outreach service ( intervention ) for improving the quality of care for rural patients with type 2 diabetes . Our intervention consisted of six monthly visits by a traveling team of specialist physicians , nurses , dieticians , and a pharmacist . The core of this service was specialist-to-rural primary care physician academic group detailing . Two comparable regions in Northern Alberta were r and omly allocated to control or intervention . Data were collected before and 6 months after intervention in a representative volunteer sample . The primary outcome was a 10 % improvement in any one of the following : blood pressure , total cholesterol , or HbA(1c ) . RESULTS Our analysis included 200 intervention and 179 control subjects ; 14 subjects were at all three primary outcome targets at baseline . The intervention was associated with a trend toward improvement in primary outcome at 6 months ( 44 % intervention vs. 37 % control ; odds ratio 1.32 , 95 % CI 0.87 - 1.99 ) . The intervention was associated with a significant improvement in blood pressure ( 42 % intervention vs. 25 % control , P = 0.004 ) ; however , there were only small , nonsignificant changes in cholesterol or HbA(1c ) . The intervention was associated with a significant increase in satisfaction with diabetes care . Multivariate adjustment for baseline differences between intervention and control subjects did not affect any of the main results . CONCLUSIONS A diabetes outreach service has the potential to improve the quality of diabetes care for rural patients . Future studies need to involve longer timelines and larger sample sizes Purpose The purpose of this study was to evaluate the efficacy of Prevent , an online social network-based translation of the Diabetes Prevention Program ( DPP ) lifestyle intervention , against the Centers for Disease Control and Prevention ( CDC ) Diabetes Prevention and Recognition Program ( DPRP ) outcome st and ards and weight loss outcomes of other DPP translations . Methods Two hundred twenty participants previously diagnosed with prediabetes were recruited online and enrolled in Prevent , a DPP-based group lifestyle intervention that integrates a private online social network , weekly lessons , health coaching , and a wireless scale and pedometer . Participants underwent a core 16-week intensive lifestyle change intervention and were then offered to continue with a post-core lifestyle change maintenance intervention , with the entire intervention ( core plus post-core ) totaling 12 months . Results One hundred eighty-seven participants met inclusion criteria for the core program and achieved an average of 5.0 % and 4.8 % weight loss at 16 weeks and 12 months , respectively . They also had a 0.37 % reduction in their A1C level at final measurement . One hundred forty-four of these same participants also met inclusion criteria for the post-core program and achieved an average of 5.4 % and 5.2 % weight loss at 16 weeks and 12 months , respectively , and a 0.40 % reduction in A1C at final measurement . Conclusion Results indicate that Prevent meets CDC DPRP outcome st and ards for diabetes prevention programs and performs favorably to other DPP translations . Considering national initiatives to address the obesity and diabetes epidemics , online delivery platforms like Prevent offer an effective and scalable solution Background Cost-effectiveness studies of lifestyle interventions in people at risk for lifestyle-related diseases , addressing ‘ real-world ’ implementation , are needed . This study examines the cost-effectiveness of a primary care intervention from a societal perspective , compared with provision of health brochures , alongside a r and omized controlled trial . Methods Adults aged 30 - 50 years , at risk of type 2 diabetes ( T2DM ) and /or cardiovascular disease ( CVD ) , were recruited from twelve general practice s in The Netherl and s. They were r and omized to the intervention ( n = 314 ) or control group ( n = 308 ) . The intervention consisted of up to six face-to-face counseling sessions with a trained practice nurse , followed by three-monthly sessions by phone . Costs were collected using three-monthly retrospective question naires . Quality of life was measured with the EuroQol-5D-3L , at baseline , 6 , 12 and 24 months . Nine-year risk of developing T2DM and ten-year risk of CVD mortality were estimated using the ARIC and SCORE formulae , respectively , based on measurements at baseline and 24 months while applying a fixed age of 60 years at both time points . Results Small , statistically non-significant differences in effects were found between the intervention and control group with regard to risk scores and Quality Adjusted Life Years ( QALYs ) gained . The mean difference in costs between the intervention and control group was € -866 ( 95 % confidence interval -2372 ; 370 ) . The probability that the intervention was cost-effective varied from 93 % at € 8000/QALY to 88 % at € 80,000/QALY . Conclusion A primary care lifestyle intervention aim ed at adults at increased risk of T2DM and /or CVD  could result in cost savings over a two-year period . However , due to method ological uncertainty no advice can be given regarding the implementation of the intervention in Dutch general practice s . Trial registration Current Controlled Trials IS RCT N59358434 Evidence from varied community setting s has shown that the Group Lifestyle Balance ( GLB ) Program and other adaptations of the Diabetes Prevention Program ( DPP ) intervention are effective in lowering diabetes risk . Most DPP data originated from studies of pre-diabetic whites , with only sparse evidence of the effect of DPP in African Americans ( AAs ) in community setting s. This paper describes the design , methods , baseline characteristics and cost effective measures , of a single-blinded , cluster-r and omized trial of a faith-based adaptation of the GLB program , Fit Body and Soul ( FBAS ) . The major aims are to test efficacy and cost utility of FBAS in twenty AA churches . R and omization occurred at the church level and 604 AA overweight/obese ( BMI ≥25kg/m(2 ) ) adults with fasting plasma glucose range from normal to pre-diabetic received either FBAS or a health-education comparison program . FBAS is a group-based , multi-level intervention delivered by trained church health advisors ( health professionals from within the church ) , with the goal of ≥7 % weight loss , achieved through increasing physical activity , healthy eating and behavior modification . The primary outcome is weight change at 12weeks post intervention . Secondary outcomes include hemoglobin A1C , fasting plasma glucose , waist circumference , blood pressure , physical activity level , quality of life measures , and cost-effectiveness . FBAS is the largest known cohort of AAs enrolled in a faith-based DPP translation . Reliance on health professionals from within the church for program implementation and the cost analysis are unique aspects of this trial . The design provides a model for faith-based DPPs and holds promise for program sustainability and widespread dissemination Objective To evaluate the use and effectiveness of two “ in-home ” strategies for delivering diabetes prevention programming using cable television . Methods An individually r and omized , two-arm intervention trial including adults with diabetes risk factors living in two US cities . Interventions involved a 16-session lifestyle intervention delivered via “ video-on-dem and ” cable television , offered alone versus in combination with web-based lifestyle support tools . Repeated measures longitudinal linear regression with imputation of missing observations was used to compare changes in body weight . Results A total of 306 individuals were r and omized and offered the interventions . After 5 months , 265 ( 87 % ) participants viewed at least 1 , and 110 ( 36 % ) viewed ≥9 of the video episodes . A total of 262 ( 86 % ) participants completed a 5-month weight measurement . In intention-to-treat analysis with imputation of missing observations , mean weight loss at 5 months for both treatment groups combined was 3.3 % ( 95 % CI 0.7 - 5.0 % ) , regardless of intervention participation ( with no differences between r and omized groups ( P = 0.19 ) ) , and was 4.9 % ( 95 % CI 2.1 - 6.5 % ) for participants who viewed ≥9 episodes . Conclusions In-home delivery of evidence -based diabetes prevention programming in a reality television format , offered with or without online behavioral support tools , can achieve modest weight losses consistent with past implementation studies of face-to-face programs using similar content BACKGROUND Computerized decision support systems ( CDSSs ) are believed to enhance patient care and reduce healthcare costs ; however the current evidence is limited and the cost-effectiveness remains unknown . OBJECTIVE To estimate the long-term cost-effectiveness of a CDSS linked to evidence -based treatment recommendations for type 2 diabetes . METHODS Using the Ontario Diabetes Economic Model , changes in factors ( eg , HbA1c ) from a r and omized controlled trial were used to estimate cost-effectiveness . The cost of implementation , development , and maintenance of the core data set , and projected diabetes-related complications were included . The base case assumed a 1-year treatment effect , 5 % discount rate , and 40-year time horizon . Univariate , one-way sensitivity analyses were carried out by altering different parameter values . The perspective was the Ontario Ministry of Health and costs were in 2010 Canadian dollars . RESULTS The cost of implementing the intervention was $ 483,699 . The one-year intervention reduced HbA1c by 0.2 and systolic blood pressure by 3.95 mm Hg , but increased body mass index by 0.02 kg/m² , result ing in a relative risk reduction of 14 % in the occurrence of amputation . The model estimated that the intervention result ed in an additional 0.0117 quality -adjusted life year ; the incremental cost-effectiveness ratio was $ 160,845 per quality -adjusted life-year . CONCLUSION The web-based prototype decision support system slightly improved short-term risk factors . The model predicted moderate improvements in long-term health outcomes . This disease management program will need to develop considerable efficiencies in terms of costs and processes or improved effectiveness to be considered a cost-effective intervention for treating patients with type 2 diabetes
The cost of intervention per participant delivered by dietitians was lower than interventions delivered by non-dietitians , although few studies reported costs .
Lifestyle interventions are effective in reducing body weight and glucose-related outcomes .
Dietitian-delivered interventions , compared with those delivered by other personnel , achieved greater weight reduction .
No consistent trend was identified across different delivery channels
BACKGROUND Type 2 diabetes is a significant public health concern .
With the completion of the Diabetes Prevention Program , there has been a proliferation of studies attempting to translate this evidence base into practice .
However , the cost , effectiveness , and cost-effectiveness of these adapted interventions is unknown .
OBJECTIVE The purpose of this systematic review was to conduct a comprehensive meta- analysis to synthesize the effectiveness , cost , and cost-effectiveness of lifestyle diabetes prevention interventions and compare effects by intervention delivery agent ( dietitian vs non-dietitian ) and channel ( in-person vs technology-delivered ) .