Brazilian Diabetes Prevention Program: Pilot Study

Beneficência Portuguesa de São Paulo220 enrolled

Overview

To structure a Brazilian Diabetes Prevention Program based on guidance for changing lifestyle promoted by the American Diabetes Prevention Program, using materials already developed by the Brazilian Ministry of Health and contextualizing it to the Brazilian Public Health System (SUS) and evaluating its effectiveness in a multicentric randomized clinical trial with 220 pre-diabetic patients and a follow up of 3 months. Outcomes are diet quality and time of physical activity. Health care professionals' perceptions regarding its incorporation into clinical practice will also be evaluated.

This is a multicentric randomized clinical study coordinated by the Hospital Beneficência Portuguesa in São Paulo-Brazil and made possible by PROADI-SUS (SUS Institutional Development Support Program). The study's objective is the Brazilian Diabetes Prevention Program development based on guidance for changing lifestyle promoted by the American Diabetes Prevention Program, using materials already developed by the Brazilian Ministry of Health and contextualizing it to the Brazilian Public Health System (SUS). The program will not include a multidisciplinary orientation, but the prescription will have a multi-professional vision. The objective is to bring the multi-team together to discuss different aspects of the same intervention, such as accessibility, motivation, contexts, and needs, so that the program, to be guided by the nutritionist, can also be recognized and supported by the other teammates. Once the program is defined, the research teams from the collaborating centers will be trained and qualified. 220 individuals with pre-diabetes will be included in the study and followed for 3 months. Outcomes are diet quality and time of physical activity. Health care professionals' perceptions regarding its incorporation into clinical practice will also be evaluated.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

PREVENTION

Masking

SINGLE

Enrollment

Conditions

PreDiabetes Prediabetic State

Interventions

Brazilian Diabetes Prevention ProgramBEHAVIORAL

A Program structured in 7 visits (in group and individual) to guide the improvement of diet quality, self-care, and practice of physical activity

DietBEHAVIORAL

Hypocaloric diet prescription

Eligibility

Sex: ALLMin age: 18 YearsMax age: 65 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Body mass index greater than or equal to 24kg/m2 * Have one of the following criteria: (CDC criteria for participating in the DPP) 1. Diagnosis of prediabetes or 2. Fasting blood glucose between 100-125mg/dl or blood glucose 2h after oral glucose tolerance test between 140 and 199mg/dl or HbA1c between 5.7 and 6.4% (maximum test date: last 3 months) or 3. Previously diagnosed with gestational diabetes or 4. High risk on the CDC prediabetes risk test * With Internet access * With personal cell phone access * No prior nutritional monitoring (6 months) * Live at least 60 minutes from the survey call center Exclusion Criteria: * Diagnosis of Diabetes Mellitus * In secondary prevention for cardiovascular disease * HIV patient with detectable viral load (amount of virus greater than 40 copies per ml of blood) * Presence of illnesses that could seriously reduce your life expectancy or your ability to participate in the study * Refuse to participate in the study (signing the Free and Informed Consent Form) * Participation in another Randomized Clinical Trial whose objective interferes with the primary outcome of this research, such as diet quality and physical activity level * Pregnant and lactating women

Locations (5)

Hospital Universitário Professor Edgard Santos - HUPES

Salvador, Estado de Bahia, Brazil

Hospital de Clínicas de Goiania

Goiânia, Goiás, Brazil

Universidade Federal de Viçosa

Viçosa, Minas Gerais, Brazil

Hospital de Clínicas de Porto Alegre

Porto Alegre, Rio Grande do Sul, Brazil

Outcomes

Primary Outcomes

Quality of diet

to compare mean score of Brazilian Cardioprotective Nutritional Program dietary index (BALANCE DI) between groups. the index has a score from 0 to 40, with a high score indicating adherence to a healthy diet (BALANCE).

Time frame: 3 months

Minutes of Moderate Physical activity

to compare mean time in minutes of practice of moderate/vigorous physical activity over a week between groups

Time frame: 3 months

Secondary Outcomes

Implementation Barriers and Facilitators

Identification of Barriers and Facilitators of Program implementation from a qualitative analysis approach. This is not a score on a scale. For the qualitative data, thematic content analysis will be performed with the transcription of the focus groups. This analysis will serve to describe and understand perceptions, interpretations and beliefs from the perspective of managers and professionals about the intervention. The thematic nuclei will be defined a posteriori according to the references of models and implementation frameworks also used for the realization of the focus groups

Time frame: 3 months

Moderate or vigorous physical activity (according to IPAQ-short)

to compare proportion of individuals who perform at the end of the follow-up moderate or vigorous physical activity

Time frame: 3 months

Cardioprotective diet adherence

to compare adherence to a healthy and cardioprotective diet based on the Cardiovascular Health Diet Index (CHDI) between groups. The CHDI had 11 components and a total score ranging from 0 to 110 points. the higher the score, the greater adherence to a healthy and cardioprotective diet

Time frame: 3 months

Global DNA Methylation

Data from ClinicalTrials.gov

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