847-P: Effect of Simple Multipronged Strategies in a Real-World Situation in Prevention of Diabetes in a Developing Country: Interim Report from South India

Aim: Implementation of newer intervention strategies in Prediabetes (PDM) may delay the onset of DM. Aim was to see the effect of simple multi pronged approach in a real world situation to prevent progression to DM.

Methods: PDM subjects (n=220) were assigned into 2 groups(Gp) from Aug 2017 in a diabetes centre in Chennai, India. OGTT was done and diagnosis was by WHO criteria. PDM subjects; IFG, IGT, Elevated 1h PG, were assigned to control and intervention groups; (n=110 in each). Gp1 received standard care, Gp2 intensive counseling on physical activity (PA) and diet (reducing calories, carbohydrates, fat, increasing fibre). PA included walking for 150min/week and customized advice based on profession. Working subjects to avoid prolonged sitting at work place, using stairs in work areas, walking instead of hiring vehicles for short distances; Business professionals advised to walk in corridors during stay in hotels for business purpose; Housewives to do simple walks in balconies and terrace, to avoid electronic appliances. Subjects were followed up(FU) once in 6 months and repeated OGTT. Calls, mails and SMS used for FU. Those came for FU(n=91;47vs41) till Sep 2019 were included for interim analysis.

Results: Mean age of subjects was 44 years and duration of FU was 12.1 (range 4-28) months. There was a significant difference in conversion rate to DM. (Gp1 vs. 2;34 vs. 9.1%,p=0.004). The subjects who reverted back to normal was significantly higher in Gp 2 compared to Gp1 (31.8 vs. 10.6%;p =0.012). The survival curve showed mean survival time for Gp1 was 19.6 (95% CI 16.6-22.8) and Gp2 was 22.2 months (CI 19.9-24.4;p=0.014). In Gp2, there was a significant reduction in Wt, body fat (p=0.022), WHR(P=0.003), elevated 1 hr glucose (p=0.004) whereas in Gp1 reduction was observed only in glucose levels (p<0.001).

Conclusion: It was possible to prevent diabetes in subjects with prediabetes using multi-pronged intervention strategies in real world scenario.