Cost-effectiveness of the SLIMMER diabetes prevention intervention in Dutch primary health care: economic evaluation from a randomised controlled trial
Duijzer, Geerke ; Bukman, Andrea J. ; Meints-Groenveld, Aafke ; Haveman-Nies, Annemien ; Jansen, Sophia C. ; Heinrich, Judith ; Hiddink, Gerrit J. ; Feskens, Edith J.M. ; Wit, G.A. de - \ 2019
BMC Health services research 19 (2019)1. - ISSN 1472-6963 - 1 p.
Cost-effectiveness - Diabetes - Economic evaluation - Lifestyle intervention - Prevention
BACKGROUND: Although evidence is accumulating that lifestyle modification may be cost-effective in patients with prediabetes, information is limited on the cost-effectiveness of interventions implemented in public health and primary health care settings. Evidence from well-conducted pragmatic trials is needed to gain insight into the realistic cost-effectiveness of diabetes prevention interventions in real-world settings. The aim of this study is to assess the cost-effectiveness of the SLIMMER lifestyle intervention targeted at patients at high risk of developing type 2 diabetes compared with usual health care in a primary care setting in the Netherlands. METHODS: Three hundred and sixteen high-risk subjects were randomly assigned to the SLIMMER lifestyle intervention or to usual health care. Costs and outcome assessments were performed at the end of the intervention (12 months) and six months thereafter (18 months). Costs were assessed from a societal perspective. Patients completed questionnaires to assess health care utilisation, participant out-of-pocket costs, and productivity losses. Quality Adjusted Life Years (QALY) were calculated based on the SF-36 questionnaire. Cost-effectiveness planes and acceptability curves were generated using bootstrap analyses. RESULTS: The cost-effectiveness analysis showed that the incremental costs of the SLIMMER lifestyle intervention were €547 and that the incremental effect was 0.02 QALY, resulting in an incremental cost-effectiveness ratio (ICER) of €28,094/QALY. When cost-effectiveness was calculated from a health care perspective, the ICER decreased to €13,605/QALY, with a moderate probability of being cost-effective (56% at a willingness to pay, WTP, of €20,000/QALY and 81% at a WTP of €80,000/QALY). CONCLUSIONS: The SLIMMER lifestyle intervention to prevent type 2 diabetes had a low to moderate probability of being cost-effective, depending on the perspective taken. TRIAL REGISTRATION: The SLIMMER study is retrospectively registered with ClinicalTrials.gov (Identifier NCT02094911) since March 19, 2014.
Determinants of successful lifestyle change during a 6-month preconception lifestyle intervention in women with obesity and infertility
Karsten, Matty D.A. ; Oers, Anne M. van; Groen, Henk ; Mutsaerts, Meike A.Q. ; Poppel, Mireille N.M. van; Geelen, Anouk ; Beek, Cornelieke van de; Painter, Rebecca C. ; Mol, Ben W.J. ; Roseboom, Tessa J. ; Hoek, Annemieke ; Burggraaff, J.M. ; Kuchenbecker, W.K.H. ; Perquin, D.A.M. ; Koks, C.A.M. ; Golde, R. van; Kaaijk, E.M. ; Schierbeek, J.M. ; Oosterhuis, G.J.E. ; Broekmans, F.J. ; Vogel, N.E.A. ; Lambalk, C.B. ; Veen, F. van der; Klijn, N.F. ; Mercelina, P.E.A.M. ; Kasteren, Y.M. van; Nap, A.W. ; Mulder, R.J.A.B. ; Gondrie, E.T.C.M. ; Bruin, J.P. de - \ 2019
European Journal of Nutrition 58 (2019)6. - ISSN 1436-6207 - p. 2463 - 2475.
Determinants - Lifestyle intervention - Obesity - Preconception
Purpose: To identify demographic, (bio)physical, behavioral, and psychological determinants of successful lifestyle change and program completion by performing a secondary analysis of the intervention arm of a randomized-controlled trial, investigating a preconception lifestyle intervention. Methods: The 6-month lifestyle intervention consisted of dietary counseling, physical activity, and behavioral modification, and was aimed at 5–10% weight loss. We operationalized successful lifestyle change as successful weight loss (≥ 5% weight/BMI ≤ 29 kg/m2), weight loss in kilograms, a reduction in energy intake, and an increase in physical activity during the intervention program. We performed logistic and mixed-effect regression analyses to identify baseline factors that were associated with successful change or program completion. Results: Women with higher external eating behavior scores had higher odds of successful weight loss (OR 1.10, 95% CI 1.05–1.16). Women with the previous dietetic support lost 0.94 kg less during the intervention period (95% CI 0.01–1.87 kg). Women with higher self-efficacy reduced energy intake more than women with lower self-efficacy (p < 0.01). Women with an older partner had an increased energy intake (6 kcal/year older, 95% CI 3–13). A high stage of change towards physical activity was associated with a higher number of daily steps (p = 0.03). A high stage of change towards weight loss was associated with completion of the intervention (p = 0.04). Conclusions: Determinants of lifestyle change and program completion were: higher external eating behavior, not having received previous dietetic support, high stage of change. This knowledge can be used to identify women likely to benefit from lifestyle interventions and develop new interventions for women requiring alternative support. Trial registration: The LIFEstyle study was registered at the Dutch trial registry (NTR 1530; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=1530).
Demographic and Social-Cognitive Factors Associated with Weight Loss in Overweight, Pre-diabetic Participants of the PREVIEW Study
Hansen, Sylvia ; Huttunen-Lenz, Maija ; Sluik, Diewertje ; Brand-Miller, Jennie ; Drummen, Mathijs ; Fogelholm, Mikael ; Handjieva-Darlenska, Teodora ; Macdonald, Ian ; Martinez, Alfredo J. ; Larsen, Thomas Meinert ; Poppitt, Sally ; Raben, Anne ; Schlicht, Wolfgang - \ 2018
International Journal of Behavioral Medicine 25 (2018)6. - ISSN 1070-5503 - p. 682 - 692.
Behavioral determination - Lifestyle intervention - Social-cognitive factors - Weight loss
Purpose: Weight loss has been demonstrated to be a successful strategy in diabetes prevention. Although weight loss is greatly influenced by dietary behaviors, social-cognitive factors play an important role in behavioral determination. This study aimed to identify demographic and social-cognitive factors (intention, self-efficacy, outcome expectancies, social support, and motivation with regard to dietary behavior and goal adjustment) associated with weight loss in overweight and obese participants from the PREVIEW study who had pre-diabetes. Method: Prospective correlational data from 1973 adult participants were analyzed. The participants completed psychological questionnaires that assessed social-cognitive variables with regard to dietary behavior. Stepwise multiple regression analyses were performed to identify baseline demographic and social-cognitive factors associated with weight loss. Results: Overall, being male, having a higher baseline BMI, having a higher income, perceiving fewer disadvantages of a healthy diet (outcome expectancies), experiencing less discouragement for healthy eating by family and friends (social support), and lower education were independently linked to greater weight loss. When evaluating females and males separately, education was no longer associated with weight loss. Conclusion: The results indicate that a supportive environment in which family members and friends avoid discouraging healthy eating, with the application of a strategy that uses specific behavior change techniques to emphasize the benefits of outcomes, i.e., the benefits of a healthy diet, may support weight loss efforts. Weight loss programs should therefore always address the social environment of persons who try to lose body weight because family members and friends can be important supporters in reaching a weight loss goal.
A lifestyle intervention study targeting individuals with low socioeconomic status of different ethnic origins : Important aspects for successful implementation
Teuscher, Dorit ; Bukman, Andrea J. ; Baak, Marleen A. van; Feskens, Edith J.M. ; Renes, Reint Jan ; Meershoek, Agnes - \ 2017
BMC Public Health 18 (2017). - ISSN 1471-2458
Adaptation - Ethnic minorities - Fidelity - Implementation - Lifestyle intervention - Qualitative methods - Socioeconomic status
Background: Evaluation of the implementation process of trials is important, because the way a study is implemented modifies its outcomes. Furthermore, lessons learned during implementation can inform other researchers on factors that play a role when implementing interventions described in research. This study evaluates the implementation of the MetSLIM study, targeting individuals with low socioeconomic status of different ethnic origins. The MetSLIM study was set up to evaluate the effectiveness of a lifestyle programme on waist circumference and other cardio-metabolic risk factors. The objective of this evaluation was to identify components that were essential for the implementation of the MetSLIM study and to inform other researchers on methodological aspects when working with inadequately reached populations in health research. Methods: In this evaluation study the experiences of health professionals, study assistants, a community worker and regional research coordinators involved in the MetSLIM study were explored using semi-structured interviews. Questionnaires were used to evaluate participants' satisfaction with the lifestyle intervention. Results: Our analyses show that a flexible recruitment protocol eventually leads to recruitment of sufficient participants; that trust in the recruiter is an important factor in the recruitment of individuals with low socioeconomic status of different ethnic origins; and that health professionals will unavoidably shape the form of intervention activities. Furthermore, our evaluation shows that daily practice and research mutually influence each other and that the results of an intervention are a product of this interaction. Conclusions: Health promotion research would benefit from a perspective that sees intervention activities not as fixed entities but rather as social interaction that can take on numerous forms. Analysing and reporting the implementation process of studies, like in this evaluation, will allow readers to get a detailed view on the appropriateness of the (intended) study design and intervention for the targeted population. Evaluation studies that shed light on the reasons for adaptations, rather than describing them as deviation from the original plan, would point out methodological aspects important for a study's replication. Furthermore, they would show how various factors can influence the implementation, and therewith initiate a learning cycle for the development of future intervention studies. Trial registration: Netherlands Trial Register NTR3721 (since November 27, 2012).
Effectiveness of the MetSLIM lifestyle intervention targeting individuals of low socio-economic status and different ethnic origins with elevated waist-to-height ratio
Bukman, Andrea J. ; Teuscher, Dorit ; Meershoek, Agnes ; Renes, Reint Jan ; Baak, Marleen A. van; Feskens, Edith J.M. - \ 2017
Public Health Nutrition 20 (2017)14. - ISSN 1368-9800 - p. 2617 - 2628.
Effectiveness - Ethnic groups - Health promotion - Lifestyle intervention - Socio-economic status
Objective: To evaluate whether the lifestyle intervention MetSLIM targeting individuals of low socio-economic status of Turkish, Moroccan and Dutch origin was successful in improving waist circumference and other cardiometabolic risk factors, lifestyle behaviour and quality of life. Design: A quasi-experimental intervention study (Netherlands Trial Register NTR3721). The intervention group participated in a 12-month combined dietary and physical activity programme. Examinations were performed at baseline and after 12 months. Participants underwent anthropometric measurements and blood withdrawal, and completed questionnaires on dietary intake, physical activity and quality of life. Setting: Socio-economically deprived neighbourhoods in two Dutch cities, involving non-blinded ethnicity-matched and gender-matched research assistants, dietitians and sports instructors. Subjects: Mainly Turkish (49 %) and Dutch (36 %) subjects, aged 30–70 years, with a waist-to-height ratio of >0·5 (intervention, n 117; control, n 103). Dropout was 31 %. Results: At 12 months, the intervention group showed greater improvements than the control group in waist circumference (β=−3·3 cm, 95 % CI −4·7, −1·8, P<0·001) and other obesity measures. Additionally, greater reductions were observed for total cholesterol (β=−0·33 mmol/l, 95 % CI −0·56, −0·10, P=0·005) and LDL cholesterol (β=−0·35 mmol/l, 95 % CI −0·56, −0·14, P=0·001). Dietary changes were significant for fibre intake (β=1·5 g/4184 kJ (1000 kcal), 95 % CI 0·3, 2·7, P=0·016). Compared with the control group, the intervention group reported a decrease in total minutes of physical activity (β=−573 min/week, 95 % CI −1126, −21, P=0·042) and showed improvements in the quality-of-life domains ‘health transition’ and ‘general health’. Conclusions: MetSLIM was shown to be effective in improving waist circumference, total and LDL cholesterol, and quality of life among Dutch and Turkish individuals living in deprived neighbourhoods.
Skeletal muscle uncoupling protein-3 restores upon intervention in the prediabetic and diabetic state: Implications for diabetes pathogenesis?
Mensink, Marco ; Hesselink, M.K.C. ; Borghouts, L.B. ; Keizer, H. ; Moonen-Kornips, E. ; Schaart, G. ; Blaak, E.E. ; Schrauwen, P. - \ 2007
Diabetes, Obesity & Metabolism 9 (2007)4. - ISSN 1462-8902 - p. 594 - 596.
Exercise - Impaired glucose tolerance - Lifestyle intervention - Skeletal muscle - Type 2 diabetes mellitus - Uncoupling protein-3
Aim: Skeletal muscle uncoupling protein-3 (UCP3) is reduced in type 2 diabetes, and in the pre-diabetic condition of impaired glucose tolerance (IGT). Here we examined whether intervention programs known to improve insulin sensitivity are paralleled by an increase in skeletal muscle UCP3 protein levels. Methods: Skeletal muscle UCP3 protein content was measured before and after one year of an exercise intervention in muscle biopsies of eight diabetic subjects. In addition, UCP3 was measured in IGT subjects before and after 1 year of following a lifestyle-intervention program or serving as control. Results: In the diabetic patients a significant increase of ∼75% in UCP3 protein was found after 1 year of exercise training (P < 0.05). In IGT subjects UCP3 protein increased in the intervention group (P = 0.02), while UCP3 remained unaltered in the control group (P = 0.64). Conclusion: Both, exercise training and a lifestyle-intervention program increase UCP3 protein content in skeletal muscle of subjects with reduced glycaemic control, indicating a restoration towards normal UCP3 levels. These data support the idea that UCP3 has a role in the aetiology of type 2 diabetes mellitus.
Study on lifestyle intervention and impaired glucose tolerance Maastricht (SLIM): Preliminary results after one year
Mensink, M. ; Feskens, E.J.M. ; Saris, W.H.M. ; Bruin, T.W.A. De; Blaak, E.E. - \ 2003
International Journal of Obesity 27 (2003)3. - ISSN 0307-0565 - p. 377 - 384.
Diet - Impaired glucose tolerance - Lifestyle intervention - Physical activity - Type II diabetes mellitus
AIMS: Important risk factors for the progression from impaired glucose tolerance to type II diabetes mellitus are obesity, diet and physical inactivity. The aim of this study is to evaluate the effect of a lifestyle-intervention programme on glucose tolerance in Dutch subjects with impaired glucose tolerance (IGT). METHODS: A total of 102 subjects were studied, randomised into two groups. Subjects in the intervention group received regular dietary advice, and were stimulated to lose weight and to increase their physical activity. The control group received only brief information about the beneficial effects of a healthy diet and increased physical activity. Before and after the first year, glucose tolerance was measured and several other measurements were done. RESULTS: Body weight loss after 1 y was higher in the intervention group. The 2-h blood glucose concentration decreased 0.8±0.3 mmol/l in the intervention group and increased 0.2±0.3 mmol/l in the control group (P<0.05). Body weight loss and increased physical fitness were the most important determinants of improved glucose tolerance and insulin sensitivity. CONCLUSION: A lifestyle-intervention programme according to general recommendations is effective and induces beneficial changes in lifestyle, which improve glucose tolerance in subjects with IGT. Body weight loss and increased physical fitness were the most important determinants of improved glucose tolerance and insulin sensitivity.
Study on lifestyle-intervention and impaired glucose tolerance Maastricht (SLIM): Design and screening results
Mensink, Marco ; Corpeleijn, Eva ; Feskens, Edith J.M. ; Kruijshoop, Margriet ; Saris, Wim H.M. ; Bruin, Tjerk W.A. De; Blaak, Ellen E. - \ 2003
Diabetes Research and Clinical Practice 61 (2003)1. - ISSN 0168-8227 - p. 49 - 58.
Impaired glucose tolerance - Lifestyle intervention - Population screening - Prevalence - Type 2 diabetes
The study on lifestyle-intervention and impaired glucose tolerance Maastricht (SLIM) is a 3 years randomised clinical trial designed to evaluate the effect of a combined diet and physical activity intervention program on glucose tolerance in a Dutch population at increased risk for developing type 2 diabetes. Here the design of the lifestyle-intervention study is described and results are presented from the preliminary population screening, conducted between March 1999 and June 2000. In total, 2820 subjects with an increased risk of having disturbances in glucose homeostasis (i.e. age >40 years and BMI > 25 kg/m2 or a family history of diabetes) underwent a first oral glucose tolerance test (OGTT). Abnormal glucose homeostasis was detected in 826 subjects (30.4%): 226 type 2 diabetes (type 2DM, 8.3%), 215 impaired fasting glucose (IFG, 7.9%) and 385 impaired glucose tolerance (IGT, 14.2%). Both increasing age and BMI were strongly related to the prevalence of IGT and diabetes. After a second OGTT, 114 subjects with glucose intolerance and in otherwise good health were eligible for participation in the intervention study (SLIM). The high prevalence of disturbances in glucose homeostasis observed in the preliminary screening underscore the importance of early (lifestyle) interventions in those at risk for developing diabetes. SLIM will address this topic in the Dutch population.