Type 2 diabetes is a serious, expensive and growing public health challenge. NICE guidance recommends diabetes prevention in people at high risk via intensive lifestyle interventions promoting weight loss. There are few robustly evaluated ‘real-world' diabetes prevention programmes in the UK. Immediate evidence on the effectiveness, cost-effectiveness and deliverability of such programmes is needed to inform the proposed UK National Diabetes Prevention Programme.
Type 2 diabetes is a growing public health challenge. NICE guidance recommends diabetes prevention in people at high risk via intensive lifestyle interventions promoting weight loss through diet and physical activity. However, there are few robustly evaluated ‘real-world' diabetes prevention programmes in the UK.
Background System mapping has mainly been used to develop theories and understanding of complex systems; to hypothesise how an intervention might work in a complex system or to inform intervention development. There are a few examples of the use of system mapping as part of process evaluation. In this paper, we describe an innovative approach to using system mapping as part of the process evaluation of a randomised controlled trial of the Active, Connected, Engaged (ACE) community-based active ageing programme. Method Ten participatory workshops were held across three of the ACE sites (Cardiff, Stoke-on-Trent and Manchester, UK). These involved over 100 participants, volunteers and stakeholders (from National Health Service, statutory and voluntary sectors). Their aim was to gather area-specific information on participants’ barriers and facilitators to physical activity and the needs of peer volunteers and service providers; and create ‘baseline’ system maps before the launch of the programme in the three areas of ACE delivery. Results System maps were produced showing the main outcome (physical activity) and the interactions between the key motivators and barriers described by older people, as well as ideas from stakeholders and volunteers about how these barriers can be addressed. Findings led to refinements to ACE intervention processes and the study’s logic model. Conclusions System mapping helped to refine the ACE processes and fine-tune the logic model. The value of this approach will increase in the next phase when it will be used to explore any changes to the physical activity system including changes to stakeholders’ ways of working and collaborating to tackle barriers to activity following the completion of the ACE trial. Trial registration number ISRCTN17660493 .
The prevalence of type 2 diabetes among Native Americans is two to five times higher than for non-Hispanic Whites. Complications and mortality rates are also significantly higher for Native Americans with diabetes. Despite these alarming numbers, there are few culturally tailored programs to prevent diabetes among Native Americans. PURPOSE To describe the baseline fitness levels and metabolic profiles of Native American women participating in a culturally tailored lifestyle intervention. METHODS 200 Native American women between the ages of 18–40, living in an urban area, who are not pregnant and do not have diabetes were recruited into a diabetes prevention intervention. Measures were conducted at baseline and at 6, 12, and 18 months post-intervention. Only baseline data are reported here. Measurements included fasting glucose and insulin resistance (HOMA model), resting blood pressures (SBP and DBP), fasting lipids, height, weight, BMI, %fat (bioelectrical impedance, BIA), predicted VO2 peak using YMCA protocol, and self-reported activity using a modifiable physical activity questionnaire. RESULTS The mean+SD for age, height, weight, and BMI of the entire sample were 29.27±6.6 yr, 162.06±5.6 cm, 77.15±17.28 kg, 29.35±6.3 kg/m2 respectively. Despite high levels of obesity, the mean lipid profiles and resting blood pressures were normal (Total Cholesterol 168.3±28.4 mg/dL, Triglycerides 129.3±56.3 mg/dL, HDL 49.7±12.0 mg/dL, LDL 92.8±22.8 mg/dL, SBP116.2±12.3mmHg, DBP68.1±10.1 mmHg). Following baseline, women were randomized into either an intervention or delayed intervention group. The profiles of these two groups were:TableCONCLUSION These data illustrate that these young urban Native American women show high risk for type 2 diabetes based on low fitness level, high %body fat, and high insulin resistance. However, lipid profiles and blood pressures are normal and self-reported physical activity levels exceed the U.S. Surgeon General's recommendations.
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