The Diabetes Prevention Program in the US - Essay Example

Public Health – Disease Prevention / Health Promotion Intervention Student’s Name: Instructor’s Name: Course Name and Code: University: Date of Submission: The Diabetes Prevention Program in United States of America Introduction Of the non-communicable diseases, diabetes is one of the fastest growing epidemics that is affecting the developed and developing world. Communicable diseases are becoming part of billions of people’s lives. The most effective way to curb the spread of diabetes is preventing it in the first place. The causes of diabetes are complex and often work in combinations. They can be prevented from developing through lifestyle intervention. This intervention will include people modifying or completely taking a different path in their choices of lifestyle. Diet, physical activity and exercise and weight control are examples of lifestyle changes that can be adapted of reinforced in people to stop diabetes (American diabetes association 2003, p.73-77). Type2 diabetes which is sometimes referred to as non insulin dependent diabetes mellitus (NIDDM) is the most common type of diabetes mellitus. It is characterized by the insulin in a person’s body being damaged and the secretion of the same being insufficient. The result of this is metabolic disorders. Numerous comprehensive evaluations have been done on the Diabetes Prevention Program. Some examples of evaluations are Lifestyle Intervention for Type 2 Diabetes Risk Reduction: Using the Diabetes Prevention Program to Inform New Directions in Pediatric Research and Prevention of Type2 Diabetes – Lifestyle Modification with diet and physical activity Vs Physical activity alone. Public Health Problem of Diabetes As the world develops, population increases are experienced in countries and with urbanization, people have gradually adopted a different type of lifestyle. The increase in the number of overweight individuals and lack of adequate physical activity has led to alarming numbers in the prevalence of type2 diabetes. For instance the estimated number of Canadians who have diabetes is two million. Of these 1.8 million of them suffer from type 2 diabetes with 3.6 percent of them being children. Older people are also more susceptible to developing diabetes than younger ones. Estimates show that if the current trend continues, about 82 million people above the age of 64 will have diabetes by 2030 and about 48 million younger people. WHO (2006) published that over one hundred and seventy people have diabetes globally and 3.2 million of them die every year. This would calculate to 6 deaths every minute and 8,700 death a single day. The obvious adverse effects on people’s lives and the high morbidity rates are an obvious concern. This effect on people’s health is accompanied by efforts to manage the condition by individuals and countries as a whole. As a result, the expenditure and health care costs rise. In developed and developing countries, the budget allocated to healthcare concerns sees about 15 % directed towards efforts of managing diabetes mellitus. Numerous cases of type2 diabetes have led to increased incidences of untimely death and illness, especially cardiovascular diseases. Middle aged people are the most common victims ranging between the ages of 35 – 64. By identifying people with the highest risk of developing tupe2 diabetes, prevention efforts can be targeted toward them. For instance, in a Canada, which is one of the countries that evaluated the program, the risk is higher for children of Aboriginal decent and those who are overweight or obese. Diabetes is a chronic condition that can only be managed after being developed. The high levels of prevalence in Canada especially in populations with a higher risk has led to the development of initiatives whose goals are to lessen the burden and healthcare costs that are associated with the condition. The Diabetes Prevention Program (DPP) is one of the preventive and health improving programs that has been implemented in the country.. It employed lifestyle intervention to lower the risk of type 2 diabetes. In cases where there is no developed type 2 diabetes, children are tested for impaired Glucose Tolerance (IGT) which is one of the surest signs of developing type 2 diabetes. By evaluating how the program worked in the America, modifications can be made to studies and areas of focus can be clearly defined for studies in other developed and developing countries. Maintenance of healthy lifestyles is the most basic approach to preventing type 2diabetes (Tuomilehto et al 2001, p. 1343-1350). In addition, maintaining a healthy body mass is another preventive technique. Methods of Evaluation The evaluation of the program was directed by statistics and information that had been summed up from the DPP. The program was targeted at adults in US who had higher chances of developing type2 diabetes through a clinical trial (The Diabetes Prevention Program Research Group 2002, p. 157-171). To the date of the evaluation, it was the largest and most securely controlled clinical trial on the issue of type2 diabetes. By sourcing information from the abstracted findings of the program, data can be looked at as a whole and from the perspective of the program. This, method of evaluation ensures that the correct information is utilized and that one if overlooked. Cardiovascular traits were quantified and calculated in detail. The information obtained aided investigations into the processes and mechanisms that bring about the relationship between change and modification of lifestyle and the prevention of type2 diabetes. The study sample was constituent of people belonging to groups that face higher risk of developing type2 diabetes and have the highest levels of prevalence (Franks et al 2007, pp. 241-251). They included African Americans, Hispanic Americans, American Indians and Asian Americans. The sample size of these minority groups was from North America. By quantifying the cardiovascular traits that were contained in the program, accurate information was obtained for use in the review. Papers that had been published from the DPP were located and identified from or using the National Library of Medicine database. These papers provided the evidence needed for the evaluation and where necessary, corroborating information was sourced from the Finnish Diabetes Prevention Study (DPS). Evidence from DPS is indicated. Another source of the articles was PUBMED. It was searched using various key words like lifestyle, diabetes prevention, non-insulin dependent diabetes mellitus. In May 2002, the main report of outcomes and findings on the DPP was published (The Diabetes Prevention Program Research Group 2002, p. 393-403). Thirty eight more papers were published between May 2002 and August 2007. Out of all the papers that were published, eleven spoke of the issue of the function of lifestyle intervention in preventing type2 diabetes (Kowler et al 2002 p. 393-403). The evidence from the DPP will be utilized to counsel approaches that will utilize lifestyle intervention as a preventive measure. In order to exclude articles and publications that were not as relevant to the subject, various criteria were used. Those that had information on lifestyle modification were used. Among them, those with a direct link to words such as ‘diabetes prevention’ and ‘lifestyle’ were considered most especially when the words are used n combination. In addition, those that had diabetes prevention, exercise and diet were also used. The publications had to have information about controlled trials. The trials had to be on the subject of prevention of diabetes by using the approach of lifestyle modification and change (Biswas 2006, p.3-33). After collecting information from the articles, information was analyzed and the interpretations put in writing and tables for different areas of interest, results were discussed and recommendations made as to the subject of the evaluation. For instance, in the case of Canada, the main aim of the evaluation was to help prevent type 2 diabetes in adults then use the reviews of published literature to identify changes and appropriate approaches that can be utilized in making the focus clear for future approaches to doing the same for children (Biswas 2006, p.3-33). Development and Implementation As a clinical trial, the program was randomized and controlled. By having a randomized trial, th3e sample size was representative of the population that was being sampled. The trials took place in 27 centers in the US (The Diabetes Prevention Program Research Group 2000, p.1619-1629). About 4,000 people participated in the trial. In order to come up with the most comprehensive and sure results, the trial constituted the use of 4 different therapies in the prevention of diabetes with one of them being Lifestyle modification. For this, the sample size of the people who were used were adults who were above or 25 years of age who did not have diabetes. However, they had to have a condition that made them susceptible to developing diabetes. In this case, they had IGT and also some of them had impaired fasting glucose (IFG). One of the therapies used was a placebo on a control group. BID and Metformin 850mg were used for this. Another therapy was lifestyle intervention whose goal was getting the trial individuals to lose 7% of their weight. Another was physical activity and exercise that went to about 150 hours every week accompanied by modifications in the diet and the last one was medication. The medication used was troglitazone 400mg OD. However, the use of this medication was discontinued because of hepatotoxicity (The Diabetes Prevention Program Research Group 2002, p. 393-403). The lifestyle intervention therapy was directed by coaches in lifestyle and professionals in healthcare like doctors, nurses and dietitians. These professionals went through training and also examined feedback from the program and additional support in order to help those participating to achieve the behavior modification goals they had. Additional plans and strategies were also in their possession to help adequately equip them to customize the intervention for every participant. Different material was available so that life coaches could have the material they need to make sure the intervention made since and engaged the differences that the participants had in terms of ethnicity and diverse cultures (The Diabetes Prevention Program Research Group 2000, p.157-171). Other than the individual sessions of counseling that they had with the participants, there were other group discussions that were held too. The group sessions were voluntary. Some of the activities engaged in during group sessions were cooking, attending seminars, exercising and tours. More details about the program were made available online and participants and other people could get more information from there. The participants averaged the age of 51 while the BMI was averaged at thirty four kilograms per meter squared. The participants were subjected to an oral glucose tolerance test (OGIT) whose positive outcome predicted development of type2 diabetes. Some of the participants who were positive after the OGIT also had cardiovascular diseases and / or the risk factors to developing diabetes that accompany it. These risk factors also apply to development of type2 diabetes. From the results, the lifestyle intervention was the most effective in combating the issues that made the participants susceptible to developing type2 diabetes (Franks et al 2007, p. 241-251). The development and implementation of the DPP followed the best practices of prevention of type2 diabetes and health promotion. The participants who went through the program were taught of lifestyle modification skills and counseled in the process. Through exercises and counseling sessions, they were able to go through the program and come out better. In addition, they had voluntary sessions where each of them could engage in activities that helped them. In the case of using medication as a preventive measure, when the medication was deemed harmful, its course of action was discontinued. Also, information about the program was made available to everyone on the internet. Another practice that was engaged in that promoted health was that they were allowed to go out and have fun like on tours and do exercises. The program helped to prevent the participants from developing type2 diabetes by engaging them in the modification the modification of the types of behavior they exhibit every day. In addition, their mental health was addressed in the counseling sessions. Changes in the mental status were reflected in the physical by the participants reinforcing their conviction towards changing their behavior and lifestyles (Franks et al 2007, p. 241-251). Results The results that were obtained from the study showed that the change or modification of lifestyle can lead to prevention of the development of type2 diabetes. This change is in the form of having good diet and exercising regularly which result in weight loss and in turn, eliminate the risks of developing type2 diabetes that accompany weight gain or being overweight. The group that participated in the lifestyle intervention showed reduced rates of risk factors. These reduced rates showed in follow ups of up to 2.8 years. The incidences of those who developed type2 diabetes in the group per every hundred of them was about 4.8 cases. The placebo control group saw 11 cases. The risk of developing diabetes was reduced by 58 percent in the lifestyle group. The higher rate than in the control group shows that lifestyle intervention works better than the other options. Writers of the DPP also predicted that people with the same health and physical characteristics in the control group would get the same results (Franks et al 2007, pp. 241-251). Seven people would have to take part in a similar program to prevent a single case of developing type2 diabetes over a three year follow up. Kitabchi et al (2005) wrote that the lifestyle intervention that was employed in the DPP affected the plasma glucose and reduced the IFG levels (p. 2404-2414). Over a period of about 6 months, the levels reduced in the lifestyle group more than in the control group. Similar results were observed in the FDP (Tuomilehto et al 2001, p. 1343-1350). In the case of genetic factors that make a person more predisposed to developing type2 diabetes, a sub study was done in 2005. TCF7L2, PPARG and KCNJII genes were genotyped since they are the confirmed candidates for development of type2 diabetes (Chanock et al 2007, p.420-426). TCF7L2 is implicated in various diseases and has been the only gene reported to be affected by lifestyle intervention. The modifications that individuals make in their lives and the changes in their bodies interact with the gene and reduce the risk of developing type2 diabetes. Conclusion The results that were obtained from the study can be used to come up with other health promotion and intervention actions. The development, implementation and results of the program can help future studies in terms of choosing the most effective methods of approaching healthcare issues. For instance, the same mode of selecting risk individuals are including them in participations then following up for long term result analysis provides people with enough information to formulate effective programs and policies. In the case Canada, the same program provides the pediatric researches with a model that they can base their own program that is targeted at reducing the risk of developing type2 diabetes in children (Franks et al 2007, pp. 241-251). This is evidence that the intervention can be used in other areas even if for a different target participants. The result of 58% reduction in diabetes cases is worth the effort. However, since people are different and they react differently to changes in their lives and metabolism, the link between the DPP and other programs that involve a different sample cannot be direct. The DPP has informed efforts and it is important that the results are evaluated well before conclusions are made and steps are taken to use the model. Governments and institutions can make use of the program to come up with policies, like those that involve lifestyle modification, to improve people’s health. List of References American diabetes association 2003, Physical activity/exercise and diabetes mellitus, Diabetes Care, 26 (1), 73-77 Baranowski, T. Cooper, D. M. & Harrell, J 2006, Presence of diabetes risk factors in a large U.S. eighth-grade cohort. Diabetes Care. 29 (2), 212-217 Biswas, A 2006, Prevention of Type 2 Diabetes- Life style modification with diet and physical activity Vs physical activity alone, Karolinska Institute, Sweden, p.3-33 Chanock, S. J., Manolio, T., & Boehnke, M 2007, Replicating genotypephenotype associations. Nature, 447 (7145), 655-660. Franks, P. W., Mcphil, M. S., Terry, T. K., & Geoff, D. C 2007, Lifestyle Intervention for Type 2 Diabetes Risk Reduction: Using the Diabetes Prevention Program to Inform New Directions in Pediatric Research, Canadian Journal of Diabetes, 31 (3), 241-251 Grarup, N & Andersen, G 2007, Gene-environment interactions in the pathogenesis of type 2 diabetes and metabolism. Curr Opin Clin Nutr Metab Care, 10:420-426 Hamman, R. F, & Wing, R. R., & Edelstein, S. L 2006, Effect of weight loss with lifestyle intervention on risk of diabetes. Diabetes Care, 29 (9), 2102-2107 Herder, C., Peltonen, M., & Koenig, W, 2006, Systemic immune mediators and lifestyle changes in the prevention of type 2 diabetes: results from the Finnish Diabetes Prevention Study. Diabetes, 55 (8), 2340-2346 Kitabchi, A. E, Temprosa, M., & Knowler, W. C 2005, Role of insulin secretion and sensitivity in the evolution of type 2 diabetes in the Diabetes Prevention Program: effects of lifestyle intervention and metformin. Diabetes, 54 (8), 2404-2414 The Diabetes Prevention Program Research Group 2006, Relationship of body size and shape to the development of diabetes in the diabetes prevention program. 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