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608 Primary Prevention of Type 2 Diabetes Make In India

high degree of familial aggregation. The two Indian Diabetes Prevention Programmes
mentioned above have shown that T2D can be pre-
The Indian Diabetes Prevention Programme-1 vented in persons having high risk of developing the
(IDPP-1) (5) disease, by consistent LSM focused on improved

The Indian Diabetes Prevention Programme-1 (IDPP- physical activity and healthy diet. It has also been
1) was the first pioneering community based, ran- shown that the beneficial changes were associated
domized, controlled trial from India conducted by with improved dietary habits, independent of chang-
Ramachandran et al which showed the feasibility of es in body weight.
primary prevention of diabetes using lifestyle modifi- Such programmes required trained personnel and
cation (LSM) or use of small doses of metformin. The constant contact with the study participants and
study was done in 531 participants with persistent therefore were labor intensive, costly and had not
IGT, who were younger and had lower BMI than the been widely implemented even in high-income coun-
participants in the western studies. The study groups tries. At present, there is an urgent need to translate
were 1) control with standard advice 2) LSM of mod- the findings from the clinical trials into community
erate intensity 3) treatment with metformin (250 mg level programs using cheaper and widely accessible
twice daily) 4) a combination of LSM and metformin methods of communication for motivating people to
therapy. In a median follow up of 30 months, the adhere to the preventive strategies.
rate of conversion to diabetes was high in the control
group (18.3% per year). All 3 modes of intervention In an attempt to use more economical and scalable
resulted in equal relative risk reduction of approx- methodology to reach larger number of people even
imately 29%. LSM is the preferred strategy as it is in remote parts of the country, novel methodologies
safe and acceptable to the participants. No additional such as use of information technology (IT), telemed-
benefit of combining LSM with metformin was noted. icine and short messaging services (SMS) through
The mechanism by which the incidence of diabetes mobile phones have been tested for their effective-
was reduced in persons with IGT was by improving ness for education and motivation of participants in
the beta cell function and by reducing insulin resis- prevention of non-communicable diseases. Mobile
tance. More importantly, the beneficial changes in technology is becoming widely available, popular and
basic pathophysiology occurred without significant comparatively cheaper.
weight reduction. The Indian SMS Study (7)
The Indian Diabetes Prevention Pro- The Indian SMS study in 537 participants with IGT
gramme-2 (IDPP-2) (6) was undertaken in 2009, with the objective of eval-
uating whether tailored, mobile phone messaging
The Indian Diabetes Prevention Programme-2 (IDPP- encouraging lifestyle changes could reduce incident
2) was the second, community based, placebo-con- T2D compared with standard lifestyle advice given
trolled, 3-year prospective study in another cohort of only at baseline. This was a collaborative study be-
407 participants with persistent IGT, to test whether tween India Diabetes Research Foundation (IDRF)
a combination with pioglitazone would enhance the and the Department of Medicine, Imperial College,
efficacy of LSM. Persons with IGT were randomized London, UK and was funded by the UK India Ed-
either to a LSM and 30 mg of pioglitazone or LSM ucation and Research Initiative. This two year inter-
and a placebo groups. At the end of 3 years, the vention study was conducted in men with persistent
results showed that there was no additional benefit IGT, who were randomized to the control group with
in adding pioglitazone to LSM. The cumulative inci- standard lifestyle advice only at baseline and the in-
dence of diabetes in the placebo (31.6%) and piogli- tervention group who received motivational text mes-
tazone (29.8%) were similar. Therefore it was evident sages on various aspects of healthy lifestyle at least
that in Asian Indians, addition of pioglitazone did not 3 times per week. The participants were followed up
enhance the effectiveness of LSM. It appears that at 6 monthly intervals with anthropometric and bio-
the maximum possible effect on the pathophysiology chemical investigations. At the end of the study, the
was produced by LSM and no additional improve- cumulative incidence of T2D was significantly lower
ment could occur by adding an insulin sensitizer. The in the intervention group than in the control group.
effectiveness of LSM was evident from the fact that There was a 36% relative risk reduction among the
the conversion rate of IGT to diabetes was only 32%, participants who were motivated using the SMS.
as against 55% in the control group observed in the
IDPP-1. The study was the first to prove the effect of mobile
technology or mobile health in primary prevention of

GCDC 2017