Effects of Diabetes Prevention Education Program for Overweight and Obese Subjects with a Family History of Type 2 Diabetes Mellitus: A Pilot Study from the United Arab Emirates.

OBJECTIVES: The association of obesity and family history of type 2 diabetes mellitus (T2DM) provides an opportunity for risk stratification and prevention, as these two conditions are the most well-known risk factors for T2DM. We aimed to test the feasibility and effects of a diabetes mellitus prevention education program designed for overweight and obese Emirati people with at least one parent with T2DM. METHODS: We conducted a pilot study using a pre-post design without a control arm at the Diabetes Center at Tawam Hospital in Al Ain, UAE. Overweight and obese subjects with at least one parent with T2DM were invited to participate. Three study assessments were conducted at baseline, three months, and six months including a questionnaire, anthropometry, and laboratory assessments. Interventions included three individualized or family-engaged counseling sessions based on the DiAlert protocol. The study outcomes included awareness of risks and prevention opportunities to T2DM, behavior changes in nutrition and exercise, decreased waist-circumference, and clinical/metabolic/inflammatory markers. Pre-post changes were analyzed using repeated-measures analysis of variance. RESULTS: One hundred twenty-two overweight or obese individuals were approached. Forty-four individuals met the eligibility criteria, and 32 individuals (35.0±9.0 years; 75.0% female) completed the study. At six months, there were significant improvements in the glycated hemoglobin levels (p = 0.007), high-density lipoprotein (p < 0.049), serum creatinine (p < 0.025), estimated glomerular filtration rate (p = 0.009), and adiponectin levels (p < 0.024). Sixteen of 32 participants had ≥ 2 cm reduction in waist circumference. They demonstrated notable physical and laboratory improvements in moderate-vigorous activity, average activity counts per day, tumor necrosis factor-alpha, and interleukin-6 total cholesterol, triglyceride, and low-density lipoprotein. CONCLUSIONS: Offering family-oriented diabetes education to people at risk for T2DM is well received and has favorable effects on relevant risk factors. Better testing with large-scale randomized controlled studies is needed, and implementing similar educational programs for the Emirati population seems warranted.

Medication reviews in hospitalized patients: a qualitative study on perceptions of primary and secondary care providers on interprofessional collaboration.

BACKGROUND: In-hospital medication reviews are regularly performed. However, discontinuity in care could occur because secondary care providers lack insight into the outpatient history. Furthermore, for the implementation or follow-up of some medication review-based interventions, the help of primary care providers is essential. This requires interprofessional collaboration between secondary and primary care. Therefore, the aim of this qualitative study was to gain insight into the perceptions of primary and secondary care providers on interprofessional collaboration on medication reviews in hospitalised patients. METHODS: Ten face-to-face semi-structured interviews and three focus group discussions were conducted with 20 healthcare providers from three hospitals and community health services. The interviews were aimed at exploring general practitioners', community pharmacists', geriatricians', and hospital pharmacists' experiences, attitudes, and views of interprofessional collaboration. Focus groups consisted of representatives of all professional groups. Through group discussion, interprofessional collaboration was explored by addressing three main questions: 1) What are the benefits of in-hospital medication reviews? 2) What are the barriers to in-hospital medication reviews from an interprofessional collaboration perspective? 3) Given the barriers mentioned, how should this interprofessional collaboration between primary and secondary care be designed? Data were analysed using a thematic-content approach. RESULTS: The need for in-hospital medication reviews was underlined due to their many benefits, such as reducing potentially preventable re-admissions. Barriers regarding interprofessional collaboration between primary and secondary care can be subdivided into three main themes: 1) defining in-hospital medication reviews (e.g., lack of clear goals), 2) execution of medication reviews (e.g., hospital setting is dynamic), and 3) follow-up after discharge (e.g., unclear instructions). Care providers suggested solutions for each of the barriers mentioned, for example, by using supportive staff in order to overcome the gap between primary and secondary care providers and making clear agreements on proper means of communication. CONCLUSION: Primary and secondary care providers recognise the importance of in-hospital medication reviews and the need for interprofessional collaboration. To create satisfying interprofessional collaboration, conditions should be met on defining in-hospital medication reviews across settings and involving both primary and secondary care providers in implementing medication reviews and organising their follow-up.

Family integrated care in single family rooms for preterm infants and late-onset sepsis: a retrospective study and mediation analysis.

BACKGROUND: During hospital stay after birth, preterm infants are susceptible to late-onset sepsis (LOS). OBJECTIVE: To study the effect of family integrated care in single family rooms (SFRs) compared to standard care in open bay units (OBUs) on LOS. Peripheral or central venous catheters (PVCs/CVCs) and parenteral nutrition (PN) were investigated as potential mediators. Secondary outcomes were length of stay, exclusive breastfeeding at discharge, and weight gain during hospital stay. METHODS: Single-center retrospective before-after study with preterm infants admitted ≥3 days. RESULTS: We studied 1,046 infants (468 in SFRs, 578 in OBUs, median gestational age 35 weeks). SFRs were associated with less LOS (adjusted odds ratio (OR) 0.486, 95% confidence interval (CI): 0.293; 0.807, p = 0.005). PVCs (indirect effect -1.757, 95% CI: -2.738; -1.068), CVCs (indirect effect -1.002, 95% CI: -2.481; 0.092), and PN (indirect effect -1.784, 95% CI: -2.688; -1.114) were possible mediators of the effect. PN was the main mediator of the effect of SFRs on LOS. We found shorter length of stay (median length of stay in SFRs 10 days and in OBUs 12 days, adjusted ß -0.088, 95% CI: -0.159; -0.016, p = 0.016), but no differences in weight gain or exclusive breastfeeding at discharge. CONCLUSIONS: SFRs were associated with decreased incidences of LOS and shorter length of hospital stay. The positive effect of SFRs on LOS was mainly mediated through a decreased use of PN in SFRs. IMPACT: Family integrated care (FICare) in single family rooms for preterm infants was associated with less late-onset sepsis events during hospital stay and a shorter length of hospital stay after birth. FICare in single family rooms was associated with less use of peripheral or central venous catheters and parenteral nutrition. Mediation analysis provided insights into the mechanisms underlying the effect of FICare in single family rooms on late-onset sepsis and helped explain the differences observed in late-onset sepsis between FICare in single family rooms and open bay units. The reduction in late-onset sepsis in FICare in single family rooms was mediated by a reduced use of intravenous catheters and parenteral nutrition.

Hospitalising preterm infants in single family rooms versus open bay units: a systematic review and meta-analysis.

BACKGROUND: The effect of the hospital environment on health and specifically neurodevelopment in preterm infants remains under debate. We assessed outcomes of preterm infants hospitalised in single family rooms compared with common open bay units. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PsycInfo, CENTRAL (the Cochrane Central Register of Controlled Trials), Web of Science, and ClinicalTrials.gov from inception to Aug 13, 2018, using controlled terms (ie, MeSH terms) and text words related to prematurity and neonatal intensive care unit design. We included randomised and non-randomised studies investigating clinical outcomes of preterm infants. We assessed methodological quality using the Cochrane Collaboration's Risk of Bias Tool for randomised controlled trials and the Cochrane Risk of Bias Tool for Non-randomised Studies of Interventions. We calculated summary estimates for meta-analysis using random effects models. The primary outcome was age appropriate long-term neurodevelopment. Secondary outcomes were length of hospital stay, sepsis, breastfeeding, growth, bronchopulmonary dysplasia, intraventricular haemorrhage, retinopathy of prematurity, and mortality. This systematic review is registered with PROSPERO, number CRD42016050643. FINDINGS: We identified 487 records. 13 study populations (n=4793) were included. No difference in cognitive neurodevelopment was found on the Bayley Scales of Infant and Toddler Development-III at 18-24 months of corrected age (680 infants analysed; mean difference 1·04 [95% CI -3·45 to 5·52], p=0·65; I2=42%). The incidence of sepsis was lower (4165 infants analysed; 108 035 days in hospital [hospitalisation days]; risk ratio 0·63 [95% CI 0·50 to 0·78], p<0·0001; I2=0%) and exclusive breastfeeding at discharge was higher (484 infants analysed; 1·31 [1·07 to 1·61], p=0·01; I2=0%) in single family rooms than in open bay units. We found no differences in length of hospital stay, growth, bronchopulmonary dysplasia, intraventricular haemorrhage, retinopathy of prematurity, and mortality. INTERPRETATION: Single family rooms should be considered to hospitalise preterm infants because incidence of sepsis is reduced and exclusive breastfeeding is higher. No difference in long-term neurodevelopment was detected. FUNDING: None.

A Process Evaluation of a Multi-Component Intervention in Dutch Dietetic Treatment to Improve Portion Control Behavior and Decrease Body Mass Index in Overweight and Obese Patients.

The SMARTsize intervention embeds an evidence-based portion control intervention in regular dietetic care. This intervention was evaluated to explore (1) which patients participated, (2) the implementation process, and (3) the outcomes of the intervention. The intervention was evaluated with an observational study design including measures at baseline, and three, six, and nine months after the start of the program. Data concerning the process (participation, dose delivered, dose received, satisfaction) and the outcomes (self-efficacy, intention, portion control strategies, and Body Mass Index (BMI) were collected with forms and questionnaires filled out by dietitians and patients. Descriptive analyses, comparison analyses, and cluster analyses were performed. Patients were mainly obese, moderately to highly educated women of Dutch ethnicity. Use of the intervention components varied from 50% to 100% and satisfaction with the SMARTsize intervention was sufficient to good (grades 7.2⁻8.0). Statistically significant (p < 0.001) improvements were observed for self-efficacy (+0.5), portion control strategies (+0.7), and BMI (-2.2 kg/m²), with no significant differences between patients with or without counselling. Three clusters of patients with different levels of success were identified. To conclude, implementing an evidence-based portion control intervention in real-life dietetic practice is feasible and likely to result in weight loss.

Diabetes risk reduction in overweight first degree relatives of type 2 diabetes patients: effects of a low-intensive lifestyle education program (DiAlert) A randomized controlled trial.

OBJECTIVES: To test the efficacy of a low-intensive lifestyle education program (DiAlert) for overweight first degree relatives of type 2 diabetes patients aimed at reducing diabetes risk. METHODS: Overweight first degree relatives of type 2 diabetes patients were randomly assigned to the DiAlert intervention (N=45) or control group who received leaflets (N=51). DiAlert consists of two group sessions and newsletters. Assessments were scheduled at baseline, three and nine months, with weight loss as primary outcome. Secondary outcomes included anthropometric, metabolic, behavioral and psychological measures. Comparisons were made over time and between groups. RESULTS: Both groups showed modest weight loss with no difference between randomization groups. However, after DiAlert significantly more participants lost 5% of their weight compared to controls (P=0.03). Significant improvement of waist circumference sustained after 9 months in the intervention group (intervention: -4.33cm, P<0.01/control: -1.25cm, P=0.08). Systolic blood pressure improved within the intervention group (intervention: -8.77mmHg, P<0.01/control: -1.03mmHg, P=0.60). No effect was observed for biomedical and psychosocial outcomes. CONCLUSIONS: Our low-intensive structured lifestyle education program helps overweight relatives to improve waist circumference and supports relevant weight loss. PRACTICE IMPLICATIONS: The family approach provides opportunities to reach and engage relatives at risk in diabetes prevention education.

Health care providers' perspective on using family history in the prevention of type 2 diabetes: a qualitative study including different disciplines.

BACKGROUND: Family history (FH) is considered an important factor to detect individuals at increased risk developing type 2 diabetes (T2D). Moreover, FH information could be used to personalise risk messages, which are assumed to increase risk-reducing behaviours. In this study, we aimed to explore Dutch health care professionals' attitudes regarding current or future uptake of a more extensive use of FH information and the family system in diabetes prevention. METHODS: Semi-structured interviews were conducted with nineteen health care professionals from six general practices and four outpatient diabetes clinics. The use of FH information in opportunistic screening for T2D was explored, as well as the usability of a direct versus patient-mediated targeting strategy to reach persons with a FH of T2D. Three researchers analysed the interview transcripts separately. RESULTS: Dutch health care professionals considered FH an important risk factor in opportunistic screening for T2D. However, none of them used FH to promote risk-reducing behaviours. Directly targeting and educating patients known to have a FH of T2D was desirable for most primary care professionals, but not considered feasible. Findings indicated that FH information was not systematically gathered in primary care settings and electronic medical records were not equipped to retrieve persons with T2D running in their family. The idea of asking patients to pass on risk and preventive information was new to all interviewees, but was considered an acceptable strategy to reach persons with a FH of diabetes. Nevertheless, there were concerns about the accuracy of the messages delivered by the patients to their relatives. Practical barriers with regard to time, expertise, and financial reimbursement were also mentioned. CONCLUSIONS: There is great interest among healthcare professionals in primary as well as secondary care about the use of FH to prevent T2D, but there are significant barriers against such use. The removal of these barriers would depend on evidence showing the cost-effectiveness of FH-based strategies designed to prevent T2D.

DiAlert: a prevention program for overweight first degree relatives of type 2 diabetes patients: results of a pilot study to test feasibility and acceptability.

BACKGROUND: Prevalence of type 2 diabetes mellitus is increasing due to lifestyle changes, particularly affecting those genetically at risk. We developed DiAlert as a targeted group-based intervention aimed to promote intrinsic motivation and action planning for lifestyle changes and weight loss in first degree relatives of patients with type 2 diabetes mellitus.The main objective of the pilot of the DiAlert intervention was to assess fidelity, feasibility and acceptability prior to starting the randomized controlled trial. METHODS: Individuals with a family history of type 2 diabetes mellitus were self-identified and screened for eligibility. DiAlert consists of two group sessions. Feasibility, fidelity, acceptability and self-reported perceptions and behavioral determinants were evaluated in a pre-post study using questionnaires and observations. Determinants of behavior change were analyzed using paired-samples t tests and Wilcoxon signed rank tests. RESULTS: DiAlert was delivered to two groups of first degree relatives of patients with type 2 diabetes mellitus (N = 9 and N = 12). Feasibility and fidelity were confirmed. Overall, the DiAlert group sessions were positively evaluated (8.0 on a scale of 1 to 10) by participants. The intervention did not impact perceived susceptibility or worry about personal diabetes risk. Action planning with regard to changing diet and physical activity increased. CONCLUSIONS: DiAlert proved feasible and was well-accepted by participants. Positive trends in action planning indicate increased likelihood of actual behavior change following DiAlert. Testing the effectiveness in a randomized controlled trial is imperative. TRIAL REGISTRATION: Netherlands National Trial Register (NTR): NTR2036.

DiAlert: a lifestyle education programme aimed at people with a positive family history of type 2 diabetes and overweight, study protocol of a randomised controlled trial.

BACKGROUND: Family history is a known risk factor for type 2 diabetes (T2DM), and more so in the presence of overweight. This study aims to develop and evaluate the effectiveness of a new lifestyle education programme 'DiAlert' targeted at 1st degree relatives of people with T2DM and overweight. In view of the high risk for diabetes and cardiovascular disease in immigrants from Turkish origin living in Western Europe, a culturally appropriate Turkish version of DiAlert will be developed and tested. METHODS/DESIGN: In this RCT, 268 (134 Dutch and 134 Turkish) overweight 1st degree relatives of patients with T2DM will be allocated to either the intervention or control group (leaflet). The intervention DiAlert aims to promote intrinsic motivation to change lifestyle, and sustain achieved behaviour changes during follow-up. Primary outcome is weight loss. Secondary outcomes include biological, behavioural and psychological indices, along with process indicators. Measurements will take place at baseline and after 3 and 9 months. Changes in outcomes are tested between intervention and control group at 3 months; effects over time are tested within and between both ethnic groups at 3 and 9 months. DISCUSSION: The DiAlert intervention is expected to be more effective than the control condition in achieving significant weight loss at 3 months, in both Dutch and Turkish Dutch participants. TRIAL REGISTRATION: Netherlands National Trial Register (NTR): NTR2036.

Changing the odds. What do we learn from prevention studies targeted at people with a positive family history of type 2 diabetes?

People with a positive family history of type 2 diabetes (T2DM) are at high risk of developing diabetes. We set out to review the literature reporting on the development and/or evaluation of lifestyle interventions specifically aimed at prevention of T2DM in this group. Targeting people with a positive family history of T2DM seems so far an underutilized prevention strategy. They can and should be approached with the aim to raise risk awareness and promote healthy eating, weight loss and physical activity, thereby reducing their risk of developing diabetes.