Feasibility and effectiveness of a culturally targeted diabetes prevention program among South Asians in Dutch primary care: The DH!AAN-study

South Asian migrants and their offspring living in high-income countries (henceforth "South Asians") are at particularly high risk of diabetes. Prevention of new diabetes cases among South Asians potentially leads to an important health gain. Therefore, we developed a culturally targeted lifestyle intervention for South Asians. The DH!AAN-study, a 2-year randomized controlled trial, was set up to evaluate the feasibility and effectiveness of this lifestyle intervention within Dutch primary care. We also evaluated the systematic screening prior to the trial on its feasibility. The intervention consisted of individual counselling (Motivational Interviewing), a family session, cooking classes and participation in supervised physical activity.
Although the systematic screening for diabetes and pre-diabetes among 18-60 year old Hindustani Surinamese seemed to be relevant and feasible in terms of prevalence and reach, the intensive invitation strategies used were costly and time consuming. Despite the extensive targeting, we found that the lifestyle intervention only achieved a moderately positive effect on the glucose metabolism after 2 years. This effect was particularly observed among people with a high BMI, suggesting that this strategy may be more suitable for South Asians with a high BMI than for those with a lower BMI. The limited effectiveness in combination with the substantial investments, raise the question of whether intensive lifestyle intervention alone is the optimal approach to prevent diabetes among this high risk South Asian population. Additional or alternative preventive strategies should be investigated to evaluate their effect on the increased risk of diabetes.