The Research Question

"What interventions are likely to be effective in reducing the incidence of Type 2 Diabetes and its medical complications in the adult population of Newfoundland and Labrador?"

 

• FULL REPORT

• 4-PAGE SUMMARY

• 1-PAGE BRIEFING NOTE

• ONLINE COMPANION DOCUMENT

 

Dissemination

CHRSP will host a dissemination event (live meeting and webinar) to launch this report at 2:30pm on June 8, 2016 at the NLCAHR Boardroom, 95 Bonaventure Avenue, Suite 300.  Dr. Laura Rosella, our Subject Expert for this study and the Project Lead Sarah Mackey will present a detailed overview of the project findings at that time.  All are welcome to attend. Contact rochelle.baker@med.mun.ca for details.

Background

Our health system partners have asked CHRSP to synthesize the best available research evidence on the prevention of Type 2 Diabetes mellitus, a disease with widespread prevalence and long-term population health implications for our province. In 2011, the Department of Health and Community Services released a report entitled "Improving Health Together: A Policy Framework for Chronic Disease Prevention and Management in Newfoundland and Labrador." It contained six key policy statements, one of which involves the need for policies that will both prevent chronic diseases and raise awareness of them through health promotion and disease prevention strategies. Earlier detection and reduced progression of chronic disease were key health outcomes included in the framework. To address this complex issue, CHRSP has assembled a project team under the leadership of subject expert Dr. Laura Rosella from Public Health Ontario, Assistant Professor at the Dalla Lana School of Public Health at the University of Toronto and Adjunct Scientist at the Institute for Clinical Evaluative Sciences (ICES). Our Health Economist was Dr. Michel Grignon of McMaster University and our Health System Leader was Rosemarie Goodyear, CEO of Central Health. Sarah Mackey, Research Officer at CHRSP was the project leader.

The CHRSP Project Team

• Laura Rosella, Scientist, Public Health Ontario, Assistant Professor, Dalla Lana School of Public Health, Adjunct Scientist, Institute for Clinical Evaluative Sciences (ICES) (Subject Expert)
• Rosemarie Goodyear, CEO, Senior Vice President, Quality, Planning and Priorities, CH (Health System Leader)
• Janet Fisher, Primary Health Care Manager, Eastern Health
• Michelle House, VP, Population Health, Western Health
• Dr. Brendan Barrett, Professor, Medicine (Nephrology), Faculty of Medicine, Memorial University, Clinical Nephrologist, Eastern Health
• Dr. Marshall Godwin, Family Practice Unit, Faculty of Medicine, Memorial University
• Jocelyn Martin, Clinical Lead Dietitian, Diabetes Education Program, Eastern Health
• Antionette Cabot, Clinical Nurse Manager Community Clinics South, Grenfell Health
• Wendy Gillingham, Community Coordinator, Programs & Partnerships, Canadian Diabetes Association, NL Chapter
• Douglas Howse, Program and Policy Development Specialist, Healthy Living Division, Department of Health and Community Services
• Michel Grignon, Director, Centre for Health Economics and Policy Analysis, McMaster University (Health Economist)

Results in Brief

1. At present, there is an insufficient amount of high-quality evidence on the long-term clinical benefits and potential harms of screening for T2D. The limited evidence that is available showed no evidence of improved mortality through screening for T2D, either in the general population or in high-risk populations after 10 years of follow-up.
2. Overall, more robust evidence is needed to confidently evaluate the cost-effectiveness of screening interventions for T2D. In the limited studies available, there was some evidence to suggest that targeted opportunistic screening to detect and manage diabetes among high-risk patients (i.e., patients with obesity and/or with high blood pressure) may be either cost-saving or cost less than $6,000 USD per quality-adjusted life year (QALY) gained. However, it should be noted that there was disagreement between studies on the range of cost.
3. Universal population screening of all adults aged at or over 45 years compared with no screening was not shown to be cost-effective at all, with a predicted incremental cost-effectiveness ratio (ICER) of close to CAD$200,000.
4. Evidence shows that some oral anti-diabetic drug classes and some other drug classes can effectively prevent the onset of T2D in specific at-risk populations. The authors describe these populations differently: as hypertensive, as high risk, as pre-diabetic, as having at least one cardiovascular disease or as having one cardiovascular disease risk). Other drug classes had no significant preventive effect. Additionally, some drug classes are more effective for promoting regression to normoglycemia than for reducing T2D incidence, depending on the individual’s risk profile.
5. Good quality evidence shows that many effective lifestyle interventions (that promote modest weight loss through improved diet and/or increase physical activity) can decrease the incidence of T2D in both the short and long-term. Improvements in blood pressure, triglycerides, weight, BMI and waist circumference were also commonly reported. A key factor in the success of combination lifestyle interventions is adherence to lifestyle changes.
6. Most preventive interventions are considered cost-effective, with ICER of less than $20,000 USD per QALY.
7. There are a number of heterogeneous strategies that prevent T2D. The effectiveness of these interventions appears to be dependent on age, weight loss, and an individual’s risk profile, among other factors. There is insufficient evidence to comment on the effectiveness of mixed interventions on cardiovascular outcomes or on all-cause morbidity and mortality.