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Cardio Diabetes Medicine 2017 609

diabetes. In addition to this major observation, sev- incidence of T2D and improving the behavior, psy-
eral ancillary studies have resulted in a wealth of in- cho-social, clinical and biochemical measures at 24
formation on the possible biomarkers for detection months compared with the control arm. The K-DPP is
of people developing diabetes. a collaborative programme with Monash University,
Australia and uses a cluster randomized controlled
Mobile phone messaging was shown to be a prac- design of a culturally, tailored and group based life
tical and affordable method for education and rein- style intervention programme. The data was collected
forcement of lifestyle principles to the participants in by home visits and the data collectors were given
the prevention programme. It is a cost-effective and training prior to commencement of the programme in
practical method which can be used in developed accordance with the WHO STEPS training guide and
and developing countries for large scale prevention protocol. Participants in the control arm were provid-
programmes.
ed with health education booklets which detailed the
The Diabetes Community Lifestyle Improve- primary prevention strategies. The intervention arm
ment Program (D-CLIP)(4) had multiple level, multifaceted, culturally adapted
training. The mode of delivery was peer led small
The Diabetes Community Lifestyle Improvement Pro- group sessions with support of peer leaders. Small
gram (D-CLIP) was a 3 year, randomized, controlled, group sessions were also conducted periodically. The
translation trial in 578 overweight/obese Asian Indian peer leaders met the participants in person at regular
adults with isolated IGT (iIGT), isolated IFG (iIFG) or IF- intervals. The 24 months programme has been com-
G+IGT conducted in Chennai, India. Participants were pleted and the publication results are awaited.
randomized to 2 arms, control arm which received
standard care advice and the intervention group mHealth in prevention of diabetes(4)
which received aggressive LSM training through A large prospective, parallel group cohort study in
once weekly classes regarding diet and exercise India by Pfammater and coworkers had addressed
modeled on the basis of the US Diabetes Prevention the utility of mHealth intervention to improve diabe-
Programme (DPP). This study used a stepwise inter- tes risk behaviors using text messages. This study
vention approach in which metformin was added to was started in 2011 by Arogya World in association
LSM when needed. During the first 4 months training, with Nokia Life and also supported by other orga-
changes in blood glucose were tested and metformin nizations from multiple sectors in India and US, by
500 mg twice daily was added for the participants, if implementing diabetes prevention through mHealth
they were considered to be at high risk of converting programmes. The objective was to see whether dia-
to diabetes ie, if they had IFG+IGT or IFG+HbA1c > betes risk behaviors improved, indicated by improved
5.7% (39 mmol/mol). OGTTs were performed annually, use of fruit, vegetables and fat intake and exercise
measurement of BP and anthropometry were done as the indicators. The duration of the follow up was
every 6 months. The primary outcome was diabetes 6 months. The researchers used 56 mobile text mes-
incidence diagnosed based on a single annual OGTT sages to motivate improvement in health behavior
or the semiannual fasting plasma glucose test. The and awareness of diabetes. The control group had
relative risk reduction (RRR) of diabetes was 32% in only telephonic contact at baseline and at 6 months
the intervention vs control group. It was shown that interview while the intervention group received fre-
the RRR varied by the type of prediabetes, and was quent text messages on lifestyle parameters over the
stronger in older participants (> 50 years), male or study period. This large programme had sensitized
obese. A significant observation was that 72% re- one million consumers who received multiple mes-
quired metformin in addiction to lifestyle and the sages on healthy living habits. The results showed
effectiveness was the least among iIFG. that the m-Health intervention was feasible and was
effective in assessing diabetes related health behav-
The Kerala Diabetes Prevention Programme iors in a low/middle income country.
(K-DPP) (4)
A group based peer support programme for preva- Impact of health education in rural India (4)
lence of diabetes was conducted in Kerala, South It has been shown that education at personal level
India. This Kerala Diabetes Prevention Programme can improve the knowledge regarding the risk fac-
(K-DPP) is the first implementation trial to evaluate tors for diabetes and associated complications. A
a peer led group based life style intervention pro- short community based study in rural Southern In-
gramme among individuals at high risk of develop- dia, in 703 village inhabitants, using trained trainers,
ing diabetes in rural India. The aim is to reduce the showed that culturally appropriate educational ses-

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