Staff Publications

Staff Publications

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    'Staff publications' is the digital repository of Wageningen University & Research

    'Staff publications' contains references to publications authored by Wageningen University staff from 1976 onward.

    Publications authored by the staff of the Research Institutes are available from 1995 onwards.

    Full text documents are added when available. The database is updated daily and currently holds about 240,000 items, of which 72,000 in open access.

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Record number 419387
Title Lifestyle counseling for type 2 diabetes risk reduction in Dutch primary care: results of the APHRODITE study after 0.5 and 1.5 years
Author(s) Vermunt, P.W.; Milder, I.E.J.; Wielaard, F.; Vries, J.H.M. de; Oers, H. van; Westert, G.P.
Source Diabetes Care 34 (2011)9. - ISSN 0149-5992 - p. 1919 - 1925.
Department(s) Chair Nutrition and Disease
Chair Nutrition and Health over the Lifecourse
Publication type Refereed Article in a scientific journal
Publication year 2011
Keyword(s) prevention program - health-care - follow-up - intervention - community - implementation - questionnaire - metaanalysis - validity - outcomes
Abstract OBJECTIVE To study the overall effect of the Active Prevention in High-Risk Individuals of Diabetes Type 2 in and Around Eindhoven (APHRODITE) lifestyle intervention on type 2 diabetes risk reduction in Dutch primary care after 0.5 and 1.5 years and to evaluate the variability between general practices. RESEARCH DESIGN AND METHODS Individuals at high risk for type 2 diabetes (Finnish Diabetes Risk Score =13) were randomly assigned into an intervention group (n = 479) or a usual-care group (n = 446). Comparisons were made between study groups and between general practices regarding changes in clinical and lifestyle measures over 1.5 years. Participant, general practitioner, and nurse practitioner characteristics were compared between individuals who lost weight or maintained a stable weight and individuals who gained weight. RESULTS Both groups showed modest changes in glucose values, weight measures, physical activity, energy intake, and fiber intake. Differences between groups were significant only for total physical activity, saturated fat intake, and fiber intake. Differences between general practices were significant for BMI and 2-h glucose but not for energy intake and physical activity. In the intervention group, the nurse practitioners’ mean years of work experience was significantly longer in individuals who were successful at losing weight or maintaining a stable weight compared with unsuccessful individuals. Furthermore, successful individuals more often had a partner. CONCLUSIONS Risk factors for type 2 diabetes could be significantly reduced by lifestyle counseling in Dutch primary care. The small differences in changes over time between the two study groups suggest that additional intervention effects are modest. In particular, the level of experience of the nurse practitioner and the availability of partner support seem to facilitate intervention success. With a global prevalence of 285 million diagnosed individuals (1), type 2 diabetes poses a major public health concern. Moreover, the prevalence of the disease is estimated to rise to 438 million in 20 years (1). Several studies in experimental settings have shown that type 2 diabetes incidence and risk can be significantly reduced by lifestyle intervention in high-risk individuals (2). Furthermore, the beneficial effect of behavioral change can be sustained long after counseling is stopped (3,4). In daily-life settings, less resources for program implementation and delivery may be available than in experimental settings, which may influence results (5,6). Individual dietary counseling or extensive exercise programs, for example, may be too expensive. Nevertheless, significant reductions in type 2 diabetes risk were found in recent studies in the community and in primary and occupational health care (7–12). However, in most of these studies in daily-life settings, usual-care comparison groups were lacking, and therefore, the additional effectiveness of the interventions could not be determined (5). Furthermore, differences between health care institutions were not reported. The Active Prevention in High-Risk Individuals of Diabetes Type 2 in and Around Eindhoven (APHRODITE) study investigates the effectiveness and feasibility of type 2 diabetes prevention by lifestyle intervention in Dutch general practice. In this article, we report the overall effect of the APHRODITE lifestyle intervention on type 2 diabetes risk reduction in Dutch primary care after 0.5 and 1.5 years. Furthermore, we evaluate differences in risk-factor reduction between practices and investigate the characteristics of participants and health care providers that may facilitate success
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