Feasibility of a Type 2 Diabetes Prevention Program at Nationwide Level in General Practice: A Pilot Study in Italy

Abstract

Background: Lifestyle interventions halt the progression of prediabetes to frank type 2 diabetes (T2D). However, the feasibility of a diabetes prevention program promoting tailored interventions on a national scale and conducted by primary care physicians is unclear.

Methods: General practitioners located in ten different regions throughout Italy enrolled random subjects without known metabolic diseases to identify individuals with prediabetes and prescribe them an intervention based on physical activity. Using a simple stepwise approach, people referring to their primary care physician for any reason were screened for their diabetes risk with a web-based app of the Findrisc questionnaire. Those at risk for T2D, i.e., with a Findrisc score >9, were invited to come back after overnight fasting to measure fasting glycaemia (FG). Those with 100 ≤ FG < 126 mg/dL were considered as people with prediabetes and compiled the Physical Activity Readiness Questionnaire (PAR-Q) to then receive a personalised prescription of physical activity.

Results: Overall, 5928 people were enrolled and compiled the questionnaire. Of these, 2895 (48.8%) were at risk for T2D. Among these, FG was measured in 2168 subjects (participation rate 75%). The numbers of individuals with undetected prediabetes and T2D according to FG were 755 and 79 (34.8% and 3.6% of those assessing FG), respectively. Of the 755 subjects in the prediabetes range, 739 compiled the PAR-Q and started a personalised program of physical activity (participation rate 97%). Physicians involved in the study reported a mean of 6 min to perform the screening.

Conclusions: Overall, these data suggest the feasibility of a national diabetes prevention program developed by general practitioners using a simple stepwise approach starting from a web app to intercept individuals with prediabetes.

Keywords: Findrisc; PAR-Q; physical activity; prediabetes; prevention; screening; type 2 diabetes.

Figure 1

Design of the study. Flow for the enrolled individuals (A) and locations of the general practitioners’ associations involved throughout Italy (B).

Figure 2

Results of the screening. Number of individuals enrolled in study (A), number of patients in each diabetes risk category according to Findrisc (B), number of subjects measuring capillary fasting glucose (FG) with the relative participation rate (C), number and percentage of individuals in each stratum of glycemic status according to capillary FG (D), and participation rate to the program of physical activity, along with number and percentage of individuals in each risk category according to PAR-Q (E). Low risk: individuals with no more than one risk factor; Moderate risk: subjects older than 45 years old with ≥2 risk factors; High risk: individuals with known cardiovascular or pulmonary diseases.