PMID- 27404094 OWN - NLM STAT- MEDLINE DCOM- 20170526 LR - 20220129 IS - 1549-1676 (Electronic) IS - 1549-1277 (Print) IS - 1549-1277 (Linking) VI - 13 IP - 7 DP - 2016 Jul TI - Engagement, Retention, and Progression to Type 2 Diabetes: A Retrospective Analysis of the Cluster-Randomised "Let's Prevent Diabetes" Trial. PG - e1002078 LID - 10.1371/journal.pmed.1002078 [doi] LID - e1002078 AB - BACKGROUND: Prevention of type 2 diabetes mellitus (T2DM) is a global priority. Let's Prevent Diabetes is a group-based diabetes prevention programme; it was evaluated in a cluster-randomised trial, in which the primary analysis showed a reduction in T2DM (hazard ratio [HR] 0.74, 95% CI 0.48-1.14, p = 0.18). We examined the association of engagement and retention with the Let's Prevent Diabetes prevention programme and T2DM incidence. METHODS AND FINDINGS: We used data from a completed cluster-randomised controlled trial including 43 general practices randomised to receive either standard care or a 6-h group structured education programme with an annual refresher course for 2 y. The primary outcome was progression to T2DM at 3 y. The characteristics of those who attended the initial education session (engagers) versus nonengagers and those who attended all sessions (retainers) versus nonretainers were compared. Risk reduction of progression to T2DM by level of attendance was compared to standard care. Eight hundred and eighty participants were recruited, with 447 to the intervention arm, of which 346 (77.4%) were engagers and 130 (29.1%) were retainers. Retainers and engagers were more likely to be older, leaner, and nonsmokers than nonretainers/nonengagers. Engagers were also more likely to be male and be from less socioeconomically deprived areas than nonengagers. Participants who attended the initial session and at least one refresher session were less likely to develop T2DM compared to those in the control arm (30 people of 248 versus 67 people of 433, HR 0.38 [95% CI 0.24-0.62]). Participants who were retained in the programme were also less likely to develop T2DM compared to those in the control arm (7 people of 130 versus 67 people of 433, HR 0.12 [95% CI 0.05-0.28]). Being retained in the programme was also associated with improvements in glucose, glycated haemoglobin (HbA1c), weight, waist circumference, anxiety, quality of life, and daily step count. Given that the data used are from a clinical trial, those taking part might reflect a more motivated sample than the population, which should be taken into account when interpreting the results. CONCLUSIONS: This study suggests that being retained/engaged in a relatively low-resource, pragmatic diabetes prevention programme for those at high risk is associated with reductions in the progression to T2DM in comparison to those who receive standard care. Nonengagers and nonretainers share similar high-risk traits. Service providers of programmes should focus on reaching these hard-to-reach groups. TRIAL REGISTRATION: ClinicalTrials.gov ISRCTN80605705. FAU - Gray, Laura J AU - Gray LJ AUID- ORCID: 0000-0002-9284-9321 AD - University of Leicester, Department of Health Sciences, Leicester, United Kingdom. FAU - Yates, Thomas AU - Yates T AD - University of Leicester, Diabetes Research Centre, Leicester, United Kingdom. FAU - Troughton, Jacqui AU - Troughton J AD - Leicester Diabetes Centre, University Hospitals of Leicester, Leicester, United Kingdom. FAU - Khunti, Kamlesh AU - Khunti K AD - University of Leicester, Diabetes Research Centre, Leicester, United Kingdom. FAU - Davies, Melanie J AU - Davies MJ AD - University of Leicester, Diabetes Research Centre, Leicester, United Kingdom. CN - Let's Prevent Diabetes Team LA - eng GR - RP-PG-0606-1272/DH_/Department of Health/United Kingdom PT - Journal Article PT - Randomized Controlled Trial DEP - 20160712 PL - United States TA - PLoS Med JT - PLoS medicine JID - 101231360 SB - IM MH - Adult MH - Aged MH - Diabetes Mellitus, Type 2/epidemiology/*prevention & control MH - Disease Progression MH - Female MH - Health Education MH - Humans MH - Incidence MH - Male MH - Middle Aged MH - Patient Compliance MH - Retrospective Studies MH - Risk Reduction Behavior PMC - PMC4942137 COIS- LJG declares no support from any organisation for the submitted work, no financial relationships with any organisations that might have an interest in the submitted work in the previous three years, and no other relationships or activities that could appear to have influenced the submitted work. JT received a travel grant to speak at the European Federation for Dietitian Association conference in Amsterdam 2015. The travel grant was from the International Sweeteners Association. MJD, KK, and TY declare no support from any organisation for the submitted work and no financial relationships with any organisations that might have an interest in the submitted work in the previous three years. An adapted version of the Let's Prevent Diabetes intervention is on the framework for the NHS Diabetes Prevention Programme. This work is led by Ingeus (main contractor), and Leicester Diabetes Centre, University Hospitals of Leicester (sub-contractor) will provide training and quality assurance for which funding will be received. MJD, KK, TY, and LG were involved in the development of this adapted programme. MJD, KK, and TY were members (KK chair) of the NICE PH 38 (Preventing type 2 diabetes: risk identification and interventions for individuals at high risk) Programme Development Group. KK is a member of the Expert Reference Group of the NHS Diabetes Prevention Programme. EDAT- 2016/07/13 06:00 MHDA- 2017/05/27 06:00 PMCR- 2016/07/12 CRDT- 2016/07/13 06:00 PHST- 2016/02/18 00:00 [received] PHST- 2016/06/03 00:00 [accepted] PHST- 2016/07/13 06:00 [entrez] PHST- 2016/07/13 06:00 [pubmed] PHST- 2017/05/27 06:00 [medline] PHST- 2016/07/12 00:00 [pmc-release] AID - PMEDICINE-D-16-00548 [pii] AID - 10.1371/journal.pmed.1002078 [doi] PST - epublish SO - PLoS Med. 2016 Jul 12;13(7):e1002078. doi: 10.1371/journal.pmed.1002078. eCollection 2016 Jul.