Screening for diabetes mellitus followed by a targeted lifestyle intervention to prevent diabetes mellitus among young and middle-aged Hindustani Surinamese
Samenvatting van de aanvraag
Type 2 diabetes mellitus (DM) is one of the most common chronic diseases, with a particularly high prevalence in ethnic minorities, especially the Hindustani Surinamese. The SUNSET study, part of the first ZonMw Prevention Programme (project nr. 2100.0028), has shown that 40% of the Hindustani aged 45-60 suffer from DM. In addition, international studies suggest that this group is not only younger at presentation, but also more at risk of developing cardiovascular disease. Adequate treatment of DM reduces the risk of developing cardiovascular events. This, combined with the fact that elevated blood glucose levels are present, on average, ten years before diagnosis, led the Health Council to conclude that, although the cost-benefit ratio of population screening is unknown, screening of high-risk groups seems highly effective. Further exploration of the possibilities for screening for the Hindustani seems justified, in view of the alarming prevalence of DM and the characteristics of DM in this particular population. Therefore the first aim of this study is to develop a systematic screening programme for DM in Hindustani, targeted to the characteristics and cultural background of this population. In addition, the feasibility of this programme will be evaluated. Additionally, in order to maximise the benefit of screening, people with pre-diabetes need to be offered care to prevent or postpone the onset of DM. Previous intervention studies have convincingly shown that an intensive lifestyle intervention aimed at physical activity and diet is highly effective. These studies have, however, been carried out in white populations only. We propose to develop a lifestyle intervention for pre-diabetes targeted at the Hindustani population. In addition, both the feasibility and the effectiveness of this intervention will be assessed. In total, 3600 Hindustani aged 18-60, not previously diagnosed with DM, will be selected from general practice registrations in The Hague. All will be offered screening by means of fasting plasma glucose. In case of suspected DM (fasting plasma glucose 7 mmol/l or higher), participants will be referred to their general practitioner for further diagnostic testing, and, if DM is confirmed, usual care. Persons with pre-diabetes (impaired fasting glucose: 5.6-7.0 mmol/l) will be asked to participate in a randomised controlled trial to estimate the effect of a targeted lifestyle intervention on the incidence of DM. Moreover, a sample of those with fasting plasma glucose less than 7 mmol/l at baseline will be invited for re-screening after 3 years. On the basis of the information obtained, recommendations will be made for the wider implementation of screening for DM, followed by a lifestyle modification programme to prevent DM in the Hindustani population.