Scaling Up Diabetes Prevention in Victoria, Australia: Policy Development, Implementation, and Evaluation

Abstract

OBJECTIVEThe Australian lifestyle intervention program Life! is only the second reported, large-scale diabetes prevention program. This article describes the genesis and the successful establishment of Life! and its key outcomes for participants and implementation. RESEARCH DESIGN AND METHODSLife!, a behavior-change intervention, comprises six group sessions over 8 months. The Victorian Department of Health funded Diabetes Australia-Victoria to implement the program. Experience of the Greater Green Triangle diabetes prevention implementation trial was used for intervention design, workforce development, training, and infrastructure. Clinical and anthropometric data from participants, used for program evaluation, were recorded on a central database. RESULTSLife! has a statewide workforce of 302 trained facilitators within 137 organizations. Over 29,000 Victorians showed interest in Life!, and 15,000 individuals have been referred to the program. In total, 8,412 participants commenced a Life! program between October 2007 and June 2011, and 37% of the original participants completed the 8-month program. Participants completing sessions 1 to 5 lost an average of 1.4 kg weight (P < 0.001) and waist circumference of 2.5 cm (P < 0.001). Those completing six sessions lost an average of 2.4 kg weight (P < 0.001) and waist circumference of 3.8 cm (P < 0.001). The weight loss of 2.4 kg represents 2.7% of participants' starting body weight. CONCLUSIONSThe impact of Life! is attributable to applying available evidence for the system's design of the intervention and collaboration between policy makers, implementers, and evaluators using the principles of continuous quality improvement to support successful, large-scale recruitment and implementation.

Slowing Down the Progression of Type 2 Diabetes: We Need Fair, Innovative, and Disruptive Action on Environmental and Policy Levels!

“…Recent large-scale translational investigations on "real-world" diabetes prevention programs demonstrate modest weight loss and decreased risk for diabetes. While these results do not seem overwhelming at the individual level, from a populationlevel perspective, these could have a large impact (7,33). As community-level programs are in their infancy and still being evaluated, the first results imply that they are feasible and effective, although there still is a place for improvement.…”

“…Furthermore, healthy lifestyle campaigns using cognitive arguments are at a disadvantage in the battle against the marketing campaigns of food and beverage industry targeting consumers on an emotional level. If we want to reach a scalable development of diabetes prevention programs, we need to change the strategy, content, policy, and laws to reach a population impact (6,33). Together with a business-oriented management, we may be able to build an attractive product called "prevention," which would be bought by the consumer because it addresses his or her intuitive individual needs.…”

Diabetes Prevention in Australia: 10 Years Results and Experience

“…From 2007 to 2011, ‘Life!’ was a Victorian statewide, group based lifestyle intervention targeting 25,000 Victorians over the age of 50 at high risk of T2DM [25]. ‘Life’ consists of predefined protocol of components including a strictly defined intervention based on the GGT DPP, including the HAPA model for behavioural change, standardised facilitator training and manual, and a participant manual to record the lipid, blood pressure, and blood glucose levels plus their individualised goals and outcomes.…”

Quality improvement in diabetes—successful in achieving better care with hopes for prevention

“…Two large‐scale examples of implementing diabetes prevention programs in real‐world settings are in Finland (FIN‐D2D) and, more recently, Australia's LIFE! program . Both programs adopted the LSM strategies and goals for weight loss proposed by the Finnish Diabetes Preventions Study (DPS), targeting individuals at risk for diabetes through individual or group interventions .…”