BRIDGES

With the increasing of diabetes incidence and resource constraints worldwide, it is increasingly important to develop and evaluate low-cost interventions in high risk communities. The proposed study will determine if integrating community workers (CW) in rural, underserved communities to provide self-management support will improve patient outcomes. This intervention will be compared with standard diabetes self-management education, which is not supported by CW. Training, a web-site and supervision from diabetes educators will be available to the CW as an ongoing resource. We will evaluate patient outcomes, CW satisfaction and retention rates, and the long term impact and sustainability of the project.
*Pending signature of agreement 

Knowledge and expertise regarding proper treatment of diabetes mellitus type 2 (T2DM) don’t translate well into diabetes care. Even disease management programs (DMP) appear to have rather small effects. Emphasizing patient self management and peer support are promising new approaches in diabetes care beyond DMP. We therefore propose a study evaluating a peer support program centered on patient self management. The intervention under investigation will be that peer groups of diabetic patients will exercise together, meet to talk about personal, social and emotional issues regarding diabetes and have access to support by MDs, dieticians, clinical psychologists and physical education trainers.

We established a provincial antenatal care network to screen for gestational diabetes mellitus (GDM) in Tianjin 10 years ago but the perinatal management of women with GDM remains suboptimal. Two large randomized trials have confirmed the benefits of tight control of hyperglycaemia on maternal health and foetal outcomes. In this proposal, we aim to translate a proven GDM-care protocol to daily practice using a shared care model within the three-tier antenatal care system in Tianjin, with a randomized design. The primary outcome is reduced incidence of deliveries of babies with birth weight ≥ 4500 grams. The secondary outcomes are reduced pregnancy-induced hypertension and macrosomia.

The main aim of this study is to investigate to what extent it is possible to reach normal glucose metabolism and optimal cardiovascular disease (CVD) risk factor levels with early lifestyle interventions in people at high risk of type 2 diabetes compared with those who receive standard therapy (usual care) only. The project will show the effect of these interventions for the first time in people of low socio-economic levels living in a Caribbean environment.