Michelle Phan

Abstract 3
Dawes D, Ashe M, Campbell K, Cave D, Elley R, Kaczorowski J, et al. Preventing diabetes in
primary care: A feasibility cluster randomized trial. Can J Diabetes 2014;08:004.
Type 2 diabetes is a common chronic condition in Canada, with a prevalence of 3.7 million by
2018-2019. Canada uses roughly 3.5% of its public healthcare spending on diabetes care. Trials
have shown that the development of pre-diabetes to diabetes can be reduced and sustained by
lifestyle interventions. The evidence from these trials shows that the implementation could be
scaled up for widespread adaptation. The high cost of these programs would limit the
widespread dissemination and implementation. The purpose of this study is to determine the
feasibility of implementing the Facilitated Lifestyle Intervention Prescription (FLIP), a low-cost
program for those with pre-diabetes.

This community-based cluster, randomized controlled trial was conducted in British Columbia.
Physicians recruited participants with pre-diabetes. Six family practices recruited 59 eligible
people. The participants were randomly assigned to the FLIP intervention (n= 35) or usual care
(n=24). The FLIP program consisted of three sections: a lifestyle prescription based on Canadian
recommendations for healthy eating and activity; a pedometer; and telephone support by a
community based facilitator for six months. Participants assigned to usual care received care
consistent with Canadian Diabetes Association guidelines. To measure feasibility, the costs to
deliver the programs were collected, as well as recruitment rates of the family practices,
participants, and facilitators. Effectiveness of the programs was analyzed using clinical data from
the beginning of the trial and six months after the start of the trial.

The trial had a 95% participant retention rate over the six months. At six months, two of the
control group participants had A1C levels indicating a shift to the diagnosis of diabetes, while
none of the FLIP participants moved from pre-diabetic states. In comparison to the control, the
FLIP intervention also had substantial reductions in weight, BMI, waist circumference, and
increased exercise endurance at a 95% confidence interval.

The results of this study indicate that a six month facilitated lifestyle intervention designed to
decrease diabetes progression is feasible. The authors saw a cluster variation and suggested
adjustments for some results, but since this is a pilot study they did not make the adjustments.
The authors concluded that it is feasible to implement FLIP because it cost C$144 per person for
the six month trial which is less than the US lifestyle intervention that costs approximately
US$1400 per person for the first year and US$700 per person per year afterwards. The authors
also suggested a larger trial with a longer follow up for future research.

Comment: The FLIP program had eleven more participants than the control group; random
assignment of participants should have had about the same amount participants for each group.
The authors also should have compared the cost of the FLIP program to the cost of usual care in
Canada rather than comparing it to the cost of a US intervention.