Dimini (Diabetes mellitus? - Not me!): Activating the health literacy of insured persons at increased risk for type 2 diabetes mellitus by means of coaching in the contractedmedical practice

Background Changes in lifestyle can reduce the risk of developing type 2 diabetes mellitus. Dimini (Diabetes mellitus? Not me!), funded by the German Innovation Fund, investigated whether individuals at-risk of developing type 2 diabetes can be identified at an early stage and at a low threshold in the general practitioner's office. Moreover, the study explored whether the lifestyle intervention Dimini leads to an improved health literacy as well as to reduced body weight. Methods Dimini (01NVF17012) was implemented from June 1, 2017 to November 30, 2020, in primary care practices in Hesse and in Schleswig-Holstein as randomized controlled trial. To include participants, the general practitioners performed a risk-screening using the FINDRISK test. For the intervention group, the 15-month observation period included a three- month long lifestyle intervention, optional coachings appointments, as well as three control appointments for both the intervention and the control group, at which time data was collected. The endpoints that were examined included body weight, health literacy and degree of goal attainment. Results Of the 3,349 individuals screened with the FINDRISK, 1,430 (42,8 %) showed an increased risk for developing type 2 diabetes (FINDRISK >= 12) of which a total of 1,170 participants were included in the study. Mean body weight decreased significantly by 1,6 kg ( 1,1 %) during the intervention period (V = 106 721, p < 0,001). The Mann-Whitney U test (W= 49265, p = 0,036) showed significantly more weight loss in the intervention group (Mt0-t3 = 2,06 kg, SD= 6,97) than in the control group (Mt0-t3 = 1,18 kg, SD = 5,88). Health literacy did not improve significantly over the course of the intervention. Twenty-one (7,2 %) participants met their personal weight loss goal set for the study, 55 (18 %) exceeded it, and 217 (74,1 %) did not achieve it. The goal of being active 30 minutes a day was reached by 177 participants (79,4 %, self-reported). Conclusion The study shows the potential of implementing nationwide risk screening. The intervention shows a small significant effect on weight reduction. Subgroup-specific prevention approaches should be offered following the risk screening. These approaches should include existing structures as well as various (medical and therapeutical) disciplines. A stronger orientation of the health care system with regard to health promotion and prevention seems necessary.