Prevention of Diabetes Progression in Primary Care through Shared Medical Appointments

INTERVENTION: Participants (120 or 12 groups x 10 per group) and controls (120) from 6 Primary Care Centres in Western Sydney will attend 6 x Shared Medical Appointments with a trained Facilitator and General Practitioner over 3 months in an experiential learning model aiming to prevent the progression of, or reverse early‐stage Type 2 diabetes. Participants (8‐12 per group) will be provided materials on physical activity, nutrition, stress management and sleep. A pre‐prepared audio‐visual presentation (12‐15 minutes) will precede an interactive question and answer learning session with a trained Facilitator (Practice Nurse appropriate or Allied Health Professional (AHP)) followed by individual consultations by the GP with all present contributing. Materials supplied (Participant Handbook; Eating Plan; Patient Handouts) to participants and Facilitators have been prepared in conjunction with the Australian Society of Lifestyle Medicine (ASLM). Sessions last for approximately 100 minutes with the medical consultations taking 1 hour. Sessions will be conducted fortnightly over three months. Session topics (6) include 1 introduction (explaining Pre‐diabetes), 2 on physical activity; weeks 2 and 4 ‐ aerobic exercise and strength exercise; 2 on nutrition (physical and psychological components of nutrition and 1 on Stress and Sleep. Materials have been designed especially for this study but based on our previous study of weight control and the PREVIEW study on diabetes reversal. Adherence to strategies will be checked by questionnaire at the (immediate) end of the study. CONDITION: Diabetes ;Pre‐diabetes; ; Diabetes ; Pre‐diabetes Metabolic and Endocrine ‐ Diabetes Public Health ‐ Health service research PRIMARY OUTCOME: Body weight using standard digital scales pre and post intervention testing and again at 12 months post intervention commencement[Immediately before and at the end of the intervention (3 months) and again 12 months post intervention commencement (primary timepoint)] Changes in HbA1c levels as measured by serum assay; compared with controls[ Immediately before and at the end of the intervention (3 months) and again 12 months post intervention commencement (primary timepoint)] SECONDARY OUTCOME: Patient satisfaction with process as measured by likert scales[3 months post the start of the intervention where the start is defined as date of first session.] Provider satisfaction with process as measured by likert scales[3 months post the start of the intervention where the start is defined as date of first session.] INCLUSION CRITERIA: Age 18‐65 HbA1c <6.5>5.6 and no diagnosed diabetes or HbA1C <7.0 with T2D diagnosed within 3 years, but not on diabetic medication. Body weight/BMI (<45>24 for Caucasian and >22 for Asian and Aboriginal)