Recruiting high-risk individuals to a diabetes prevention program: how hard can it be?
L ifestyle prevention programs in Fin-land (Diabetes Prevention Study [DPS]) (1,2) and the U.S. (Diabetes Prevention Program [DPP]) (3) have shown that the development of type 2 diabetes can be prevented. A cost-effectiveness study revealed that lifestyle intervention was effective in all ages (4). Whether lifestyle intervention will be cost-effective in the general population is determined by 1) the recruitment of the majority of high-risk individuals and 2) the compliance to lifestyle changes. We studied the recruitment rate in an open, randomized, and controlled trial aiming to reduce the incidence of diabetes. Intervention consisted of physical activity and dietary information that was to be organized by a nonprofit organization for the intervention group and information about lifestyle change in the control group. We consecutively recruited 40-, 50-, and 60-year-old participants with impaired glucose tolerance (IGT) and/or impaired fasting glucose (IFG) from the ongoing Västerbotten Intervention Program (5), from September to November 2004. A drop-out questionnaire with fixed and open-ended questions was distributed. Exclusion criteria included patients with diseases or medication interfering with glucose and lipid metabolism. A second oral glucose tolerance test was planned to confirm IGT and/or IFG before randomization. Participants gave their informed consent, and the study was approved by the ethics committee at Umeå University, Umeå, Sweden. Fifty (22 male subjects and 28 female subjects, mean 54 Ϯ 7.8 years) of 404 subjects (12%) were eligible and informed about the intervention study. Only eight (16%) subjects accepted to participate. In the follow-up examination, 7 patients reverted to normal glucose tolerance ; thus, one patient remained eligible for inclusion. A total of 11 of 42 (26%) subjects filled in the drop-out questionnaire. The main reasons for not participating were lack of time (n ϭ 5), nonaccessibility to the nonprofit organization (n ϭ 3), disabling diseases (n ϭ 1), and no reason for not participating (n ϭ 2). A total of 8 of 11 individuals intended to change their lifestyle on their own, and 4 were interested in medical treatment for risk reduction. The main limitation of our study is the small sample size. Nevertheless, only a minority of the identified individuals were motivated to enroll in the intervention. The reasons for not participating are potentially numerous; thus, we could not cover them all with our drop-out questionnaire. The majority of the nonpartici-pators referred to lack of time. Most of the identified subjects were healthy and had no obvious …