Tawazon- An Intensive Lifestyle Diabetes Prevention Program: The Saudi Arabian Pilot

Abstract

Background Lifestyle modification interventions help prevent or postpone Type 2 Diabetes and its complications with diet modification and increasing physical activity. This is translational research of Tawazon-DPP in which we evaluate the efficacy of the intensive lifestyle modification program. Methods Tawazon was piloted in 2 phases over 6 and 9 months at a Tertiary Hospital. Phase I was conducted in 2017 in one district facility with 47 participants while Phase II was conducted in 2018 in 4 district facilities with 247 participants. Data are collected retrospectively in a before-and-after study design. The program included adults with 25 kg/m 2 BMI and HbA1c ranging between 5.7 and 6.4 mmol/L, while excluding participants with comorbidities, such as cardiovascular conditions, musculoskeletal injuries, and pregnancy. Results We used descriptive analysis as well as Wilcoxon rank sign test and McNemar-Bowker for before and after data comparisons. Phase I exhibited a mean age of 43±7 years and statistically significant improvement in HbA1c (0.3 mmol/L), weight (3.3 kg), BMI (1 kg/m 2 ), triglyceride (30.4 mg/dL) and LDL (14.67 mg/dL). Phase II exhibited a mean age of 45±9 years with 70% above 40 years old. Significant improvement was also found in HbA1c (0.2 mmol/L), weight (5.1 kg), and BMI (1.8 kg/m 2 ); the lipid profile in the second phase showed better results with significant improvement in total cholesterol (7.4 mg/dL), triglyceride (20.9 mg/dL), LDL (8.8 mg/dL), and (0.9 mg/dL) increase in HDL. Conclusion This pilot has taken lifestyle interventions to real-life and it led to the favored and desired outcome. It showed that long-term guided support can help patients make the needed changes in their diet, habits, and physical activity, thus, prevent or delay the onset of Type 2 diabetes.

Transcultural Lifestyle Medicine in Type 2 Diabetes Care: Narrative Review of the Literature

“…In Africa, 44 DPP content was simplified and contextualized using local examples and visual elements taken by a local photographer in the community. 44 In Saudi Arabia, 35 visual material of the content reflected the Arab culture and environment, using Islamic metaphors, and incorporating local recommendations about routines (For example, increase walking to mosque for prayer, and adjust recipes based on religious and traditional habits of Ramadan). 35 The importance of religion with health was also described in a study from Iran, 21 where the intervention included participation in religious ceremonies and sessions in mosques, particularly during Ramadan.…”

“…Most of the primary prevention activities were delivered face-to-face in groups 21,31,33,35-38,40-42,44,46-50 or individually. 41,51,52 In general, interventions were delivered by healthcare professionals in the Western Pacific region, 49,50 Europe, 31-33,41,52 and South America.…”

“…Primary prevention in DBCD is applied to patients with predisease in whom insulin resistance has led to -cell defects and mild hyperglycemia, in order to avoid or delay the progression to sustained, more advanced hyperglycemia and bona fide T2D. 18 The primary prevention educational strategies were usually delivered using contents and tools provided to the patients printed [31][32][33][34][35][36][37] or virtual, 30,38 and implemented using wearable technologies and other devices 33,39,40 (Table 4). Active participation was also encouraged as part of diabetes prevention programs, including healthy food preparation 21,30,40,41 or physical activity sessions in a group 37,40,42 or individually.…”

“…Active participation was also encouraged as part of diabetes prevention programs, including healthy food preparation 21,30,40,41 or physical activity sessions in a group 37,40,42 or individually. 33 Notably, the U.S. Diabetes Prevention Program (DPP) was a commonly used framework 35,39,[42][43][44] and included a web-based information platform, 40 videos, 40 motivational SMS messages or telephone calls, 36 and asynchronous strategies with prerecorded video lectures. 38,40 Various populations routinely included specific cultural characteristics in primary prevention programs.…”

“…38,40 Various populations routinely included specific cultural characteristics in primary prevention programs. 35,45 For example, in Latino women in U.S., 39 the DPP was delivered by community health workers in the target population, referred to as promotoras and promotores. In Africa, 44 DPP content was simplified and contextualized using local examples and visual elements taken by a local photographer in the community.…”