Reduced inequality in health by prevention of diabetes in Pakistani immigrants through blood glucose regulation in a randomised intervention

InnvaDiab III; prevention of type 2 diabetes (T2D) in Pakistani women. The prevalence of overweight, obesity and T2D increases in Norway as in the rest of the world. It is the group of South Asian immigrants, mostly from Pakistan, India and Bangladesh who have the greatest incidence. Pakistanis are the largest non-Western immigrant group in Oslo and it is also in this group the incidence of T2D is highest (37%). In addition, this is a group that is poorly addressed in the Norwegian health care. It is therefore natural to have the greatest focus on this group. The overall goal with InnvaDiab III is to prevent T2D by Pakistani immigrant women. The goal for InnvaDiab III is to use established knowledge about the regulation of blood sugar. InnvaDiab I, and similar studies have shown and blood sugar change value when changing the type and amount of carbohydrates in a meal, as well as performs quiet physical activity immediately after meals, for instance in the form of a walking trip. It is also known that the information on its own response (direct bio-feedback) may promote behavior change to achieve a more favorable lifestyle. We will use these research results in a prevention project among female immigrants from Pakistan. The goal is to utilize a prevention model that is easy to carry out for groups of immigrants, and that is cost effective. We want to focus on 1) the importance of blood glucose regulation and 2) mastery of glucose by means of dietary and physical activity in each participant. Through InnvaDiab III, we will seek to ensure that all participants can optimize their own lifestyle with respect. Life situation, family relationships, individual ability and self-efficacy. This will eventually reduce social inequalities in health and improve the integration of this group. This group has low socioeconomic status, and it is important to arrive at the simple lifestyle interventions that can help to improve risk for T2D in order to contribute to reduce social inequalities in health. InnvaDiab III will eventually be able to provide information on health promotion and disease prevention measures that can also be used including out in the various healthy living centers now being established in connection with the coordination reform. It will be essential to provide simple and cost-effective T2D prevention measures for immigrants. We use a non-admonishing disclosure form and moreover we emphasize social support. This disclosure form is previously tried out on a similar group, with good results. Participants will be divided into one of two intervention groups, and the duration will be 4 months. 10-12 participants in the intervention groups, the project runs over four days from 09 to 12 in 4 months. All participants will receive a full review of their own health in terms of risk of T2D. On inclusion day all the women are asked to fill out a standardized form of an interview with an interpreter. In addition, we take anthropometric measurements, taken a number of blood samples eg fasting and 2-h glucose, blood fats, hormones and vitamins and HbA1C. All communication takes place in the participants' own languages? (Urdu, Punjabi). After inclusion, participants will be randomized to the control group or two intervention groups. Group 1 will receive an introduction to what happens in your body when you eat different types and amounts of KH. In addition, the principle of the strong effect on learning and mastering the possibility that direct biofeedback gear used; there is shown a strong learning effect immediately see their own values. Participants receive different type and amount of KH in terms of cornflakes (resp. 25 g and 50 g KH) and chickpeas (50g available KH), and PPG will be measured every 15 min. for 2 hours. Participants will then see his baskets. Participants will see his baskets simultaneously last time so that the total can see how different types and quantities KH affects them. It will be emphasized individual and group-based counseling after. Group 2 will receive an introduction to what happens in your body when you eat different types and amounts of KH, and that PPG is mitigated by a leisurely walking tour after the meal (15 min and 30 min). PPG will also here be measured every 15 min. for 2 hours, to give the participants directly bio-feedback on both intake of KH and light physical activity. Since several studies have shown a strong blood sugar reducing effect of light physical activity after meals, we want to inform them so as to achieve a better long-term effect on the risk profile for T2D of the measure. We have so far recruited 200 women aged 18-65 years with a Pakistani-born parents to attend InnvaDiab III, and will not recruit more. It devotes itself to be difficult to obtain devices that are not in some way have been involved in InnvaDiab I, II or III. The intervention is done, and we are now working on post-test.

This project aims at improving health in a low socio-economic population of immigrants from Pakistan with a high risk for type 2 diabetes (T2D). As a result of the InnvaDiab study there has been established a team of physicians, and a dietician at the fam ily-centre at Søndre-Nordstrand. That project was called InnvaDiab II and has funding from ?Oslo-Sør founds? to 31.12.2011. This application is for InnvaDiab III, which intends to obtain knowledge for future health promotion and disease prevention, and de crease the inequalities in health. The overall goal is to preven the Metabolic Syndrome (MetS) and T2D by a RCT. The intervention will use non-directive health education about the importance of blood glucose regulation by physical activity and diet. The p rimary outcome variable is fasting blood glucose In Part 1), follow-up data already collected from the ?InnvaDiab I? study will be analysed to investigate whether there are long term effects on physiological and psychological risk factor for MetS and T2D . In Part 2), a randomised controlled trial will be conducted to test the effect of a less comprehensive intervention program than used in the InnvaDiab I study. The participants will be randomised to either a control group or to one of two intervention g roups lasting for 4 months. The participants in both intervention groups will be given education about blood glucose regulation and physical activity for prevention of T2D. Since several studies have demonstrated a strong blood glucose blunting effect of light post meal physical activity, we intend to use daily post meal walking as a tool to reduce the long term glycemic load. In addition, the principles of direct bio-feedback will be applied for intervention group 2, i.e. the strong learning effect of se eing their own immediate blood sugar responses to intake of CHO, as influenced by slow post meal walking.