Evaluation under real-life conditions of a lifestyle intervention for diabetes prevention developed by the municipal health services of Madrid, Spain

Abstract

The Diet, Physical Activity and Health (Alimentación, Actividad física y Salud, ALAS) program is an intervention implemented by the municipal health services of Madrid with the objective of reducing weight and preventing diabetes in high-risk population by improving diet and physical activity. The ALAS program combines individual visits with a 10-session group workshop that takes place over a 6-month period. This study evaluated the effectiveness of the ALAS intervention implemented under real-life conditions between 2016 and 2019. The intervention was evaluated with a pre- and post-intervention study with follow-up performed 6 and 12 months from the start of the program. The analyzed outcomes were a 5–10% reduction in the initial weight, body mass index (BMI), waist circumference and a change in glycemic status in prediabetic participants. Statistical models were adjusted by sociodemographic variables. The participants were recruited from municipal community health centers or referred by municipal occupational health services. Between 2016 and 2019, 1629 people participated in the program. At 6 months, 85% of the participants had lost weight; 43% had lost 5% or more of their initial weight, and 12% had lost 10% or more. Regarding BMI, 22.3% of participants who were initially obese were no longer obese, and 15.2% of the overweight participants achieved normal weight. A total of 35.1% of the prediabetic participants reverted to normoglycemic status. The intervention was found to be more effective for men, for those who completed the intervention and those who accessed the program through the occupational health route. Among the participants who accessed the intervention via the community, the intervention was more effective in those with a high educational level. The evaluation demonstrated the effectiveness of the ALAS program for reducing weight and the risk of developing Type 2 diabetes when applied under real-life conditions. The effectiveness of the intervention differed according to gender, access route and educational level of the participants.

Impact of COVID-19 Confinement on the Health-Related Habits of People at High Risk of Type 2 Diabetes

“…In addition, for this population, the ALAS programme serves as a motivator and supports the implementation of change. In fact, the 32% efficacy in the 5% reduction in baseline weight is similar to the 34% established in previous evaluations of the programme [ 17 ] for participants who did not complete the intervention. That is, the simple fact of having access to the intervention (without completing it) may promote change.…”

“…Those who enrol in the programme through the second path are mainly municipal officials, meaning they are civil servants, a socio-economic profile that is typically subjected to more favourable social determinants than the general population captured in universal access services. This may explain why the pre–post results of the intervention are better in the group of people who accessed the programme through an occupational health referral, as happened in the evaluation of the ALAS programme itself [ 17 ].…”

“…The programme began in 2011 and continues today. An effectiveness study was conducted with 1629 people who participated between 2016 and 2019 [ 17 ], concluding that (1) at the end of the intervention, 85% had lost weight, with 43% losing more than 5% of their baseline weight; (2) 22.3% of the people with obesity no longer presented obesity; (3) 35.1% of people classified as prediabetic according to the criteria of the American Diabetes Association became normoglycaemic; and (4) the effects on weight lasted at least 6 months after the end of the intervention.…”

Epidemiological Situation of High-Prevalence Non-Communicable Diseases in Spain: A Systematic Review

“…Preventive measures applied to the disease are of great benefit to diabetic patients. These include maintaining adequate metabolic and risk factor control, physical activity, consumption of fruit and vegetables with improvements in eating habits, avoidance of smoking, reduction in HbA1c levels, weight and BMI reduction, which are all part of the basis of guidelines that help to reduce glucose levels [55,56,58,61,64]. These findings coincide with other studies such as that of G. Liu et al (2023) [84] and another conducted in China by Wu et al (2022) [85], in which they establish that leading a healthy lifestyle (healthy diet, not smoking, exercise, and the consumption of vegetables and fruit) reduces the risk of complications and becomes a protective factor against DM2.…”

“…Similarly, the results of Represas-Carrera et al (2021) [63] showed a marked improvement in adherence to the Mediterranean diet, with the intervention group delivering the best results. In the analysis applied by Martin-Ridaura et al (2022) [58], after a pre-post intervention evaluation of the ALAS programme, which aims to promote healthier lifestyles, reduce obesity and prevent the development of type 2 diabetes in the population of Madrid, remarkable results were obtained. In the first instance, 6 months after the intervention, participants showed a decrease in their initial weight, waist circumference and BMI.…”