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Implementation of a new model of care for prediabetic patients

Hunter New England Local Health District

Grant:
  • Translational Research Grants Scheme
Date Funded:
  • 14 May, 2018
Chief Investigator/s:
  • Professor John Attia

Consistent referral of pre-diabetics to the Get Healthy Service plus a simple zinc supplement has the potential to improve glycaemic control, and prevent progression to diabetes. If effective, the partnership and model of care plan can be readily scaled and translated through the Get Healthy Service, general practitioners, and local health district diabetes services. This study aims to ‘help people manage their own health’, which is identified as a State health priority.

Two million Australians have prediabetes and are at high risk of developing type 2 diabetes and cardiovascular disease. Prevention of diabetes and its cardiovascular consequences is a Translational Research Grants Scheme priority. Tertiary diabetes services do not currently reach those with prediabetes, representing a lost opportunity for early intervention and future cost savings for the health system.

This project seeks to implement a new, evidence-based model of care for diabetes prevention. Lifestyle intervention is well established for prevention, but applied inconsistently. An additional strategy that may be effective in reducing insulin resistance is zinc supplementation, supported by evidence from two different meta-analyses of 25 small-scale randomised controlled trials and other studies. Working through an innovative model of partnership between two local health districts and general practitioners (via the Hunter New England Central Coast Primary Health Network), we will recruit 410 people aged 40-70 years with prediabetes (defined as HbA1c 5.7-6.4%), to test whether we can reduce their risk of diabetes and cardiovascular disease. A randomised controlled trial will be conducted; the control group (n=205) will receive the existing and effective NSW Health Get Healthy Information and Coaching Service for diabetes prevention, and a placebo capsule, while the intervention group (n=205) will receive the same lifestyle intervention, plus a 30mg daily elemental zinc capsule. Outcomes over 12 months will include measures of adherence, insulin resistance and glycaemic markers, lipids, other cardiovascular disease risk factors, and cost-effectiveness.

Collaborators: Clinical Excellence Commission, The Australian Prevention Partnership Centre, Hunter New England Central Coast Primary Health Network, Blackmores Institute, University of Otago (New Zealand)