Early Lifestyle Interventions in People with Impaired Glucose Tolerance in Northern Colombia: The DEMOJUAN Project.

BACKGROUND: The objective of the demonstration project for type 2 diabetes prevention in the Barranquilla and Juan Mina (DEMOJUAN) study was to investigate the extent to which it is possible to reach normal glucose metabolism with early lifestyle interventions in people at high risk of type 2 diabetes (prediabetes), compared with those who receive standard usual care. METHODS: DEMOJUAN was a randomized controlled trial conducted in Juan Mina and Barranquilla, Northern Colombia. Eligible participants were randomized into one of three groups (control group, initial nutritional intervention, and initial physical activity intervention). The duration of the intervention was 24 months. The main study outcome in the present analysis was reversion to normoglycemia. Relative risks and their corresponding 95% confidence intervals were calculated for reversal to normoglycemia and T2D incidence. RESULTS: There was no statistically significant association between the intervention groups and reversion to normoglycemia. The relative risk of reversion to normoglycemia was 0.88 (95% CI 0.70-1.12) for the initial nutritional intervention group participants and 0.95 (95% CI 0.75-1.20) for the initial physical activity intervention group participants. CONCLUSIONS: Our study did not find any statistically significant differences in reversion to normoglycemia or the development of type 2 diabetes between the intervention groups and the control group in this population.

A demonstration area for type 2 diabetes prevention in Barranquilla and Juan Mina (Colombia): Baseline characteristics of the study participants.

Type 2 diabetes (T2D) imposes a heavy public health burden in both developed and developing countries. It is necessary to understand the effect of T2D in different settings and population groups. This report aimed to present baseline characteristics of study participants in the demonstration area for the "Type 2 Diabetes Prevention in Barranquilla and Juan Mina" (DEMOJUAN) project after randomization and to compare their fasting and 2-hour glucose levels according to lifestyle and T2D risk factor levels.The DEMOJUAN project is a randomized controlled field trial. Study participants were recruited from study sites using population-wide screening using the Finnish Diabetes Risk Score (FINDRISC) questionnaire. All volunteers with FINDRISC of ≥13 points were invited to undergo an oral glucose tolerance test (OGTT). Participant inclusion criteria for the upcoming field trial were either FINDRISC of ≥13 points and 2-hour post-challenge glucose level of 7.0 to 11.0 mmol/L or FINDRISC of ≥13 points and fasting plasma glucose level of 6.1 to 6.9 mmol/L. Lifestyle habits and risk factors for T2D were assessed by trained interviewers using a validated questionnaire.Among the 14,193 participants who completed the FINDRISC questionnaire, 35% (n = 4915) had a FINDRISC score of ≥13 points and 47% (n = 2306) agreed to undergo the OGTT. Approximately, 33% (n = 772) of participants underwent the OGTT and met the entry criteria; these participants were randomized into 3 groups. There were no statistically significant differences found in anthropometric or lifestyle risk factors, distribution of the glucose metabolism categories, or other diabetes risk factors between the 3 groups (P > .05). Women with a past history of hyperglycaemia had significantly higher fasting glucose levels than those without previous hyperglycaemia (103 vs 99 mg/dL; P < .05).Lifestyle habits and risk factors were evenly distributed among the 3 study groups. No differences were found in fasting or 2-hour glucose levels among different lifestyle or risk factor categories with the exception of body mass index, past history of hyperglycaemia, and age of ≥64 years in women. TRIAL REGISTRATION: NCT01296100 (2/12/2011; Clinical trials.gov).

Screening for people with glucose metabolism disorders within the framework of the DEMOJUAN project (DEMOnstration area for primary prevention of type 2 diabetes, JUAN Mina and Barranquilla, Colombia).

BACKGROUND: Until now, no systematic screening for T2D or prevention activities targeting T2D has been implemented in Colombia. The aims of this study were i) describe the feasibility of implementing the Finnish Diabetes Risk Score (FINDRISC) as a screening tool for glucose metabolism disorders (GMD) in the primary health care system in Barranquilla in Colombia during 2011 and 2012, and ii) to describe the risk factors for T2D in the population screened. METHODS: This screening was opportunistic among people aged 34-60 years living in five primary health care catchment areas in Barranquilla, Colombia. People with 13 or more FINDRISC points were invited to an oral glucose tolerance test (OGTT). RESULTS: Out of 14193 participants with the FINDRISC completed, 35% (n=4915) had a score of 13 points or higher (men 23%, women 40%). Among those with FINDRISC completed, the percentage of people with BMI<25 kg/m2 was 46% in men and 35% in women. The prevalence of screen-detected T2D was 18% in men and 12% in women, respectively, among those with FINDRISC >12 attending an OGTT. In both sexes the prevalence of isolated IGT, isolated IFG, and IFG and IGT combined were 8%, 11%, and 8%, respectively. CONCLUSIONS: In total, 2% of all 14 193 screened participants had undetected T2D and 7% GMD. This figure would potentially be 4.6% (T2D), respectively 15% (GMD) if all with a FINDRISC>12 attend the OGTT. Thus, we found the FINDRISC to be a useful tool to identify people with GMD. This article is protected by copyright. All rights reserved.