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A toolkit for the prevention of type 2 diabetes in Europe

The IMAGE Toolkit for diabetes prevention provides practical information for anyone involved in healthcare and prevention activities for adults at risk of developing type 2 diabetes (which will be referred to throughout as ‘diabetes’). This includes those working in primary andspecialised healthcare services, physicians, physical activity experts, dieticians, nurses, and also others planning or already involved in diabetes prevention interventions (e.g. teachers, business partners). The IMAGE Toolkit for diabetes prevention also provides useful information for local and national politicians and health policy makers interested in creating an environment which facilitateshealthy ageing and the implementation of the WHO recommendation that “we must make the healthy choice the easy choice.”

The IMAGE Toolkit for diabetes prevention is one of the products developed by the European study group of the IMAGE project. It is based on the IMAGE evidence-based guideline and training curriculum for diabetes prevention managers and should preferably be used alongsidethese products. For more information please visit www.image-project.eu

ExEcutivE summary thE nEEd for changE
Why is it time to act? How can I make a difference?

3 5 9

How to budget and finance a prevention programme 13 Checklist “How to start” 14 Spreadsheet / budget calculation for 19 programme costs

BudgEting & financE in a prEvEntion programmE

idEntifyingpEoplE at risk
How to identify people at risk Risk screening tools Finnish diabetes risk score FINDRISC Challenges of working with special consideration groups

21 26 28 29

changing lifEstylE BEhaviours
How to change behaviour Physical activity to prevent diabetes Nutrition and dietary guidance to prevent diabetes Other behaviours to consider Example behaviour change session plans Suggestedprogramme timeline SMART goals Action plan worksheet Physical activity diary Food diary

31 36 38 41 42 52 53 55 56 57

The Appendix is highlighted throughout the document by the green stripe down the edge of the page.

advErsE EffEcts of lifEstylE intErvEntions & programmE Evaluation Risks and adverse effects 59 Evaluation and quality assurance 60 IMAGE evaluation and quality assurance 61


Join forcEs to makE a diffErEncE! Background litEraturE

63 65


When we ask people what they value most, health is usually top of the list. While effective care is available for many chronic diseases, the fact remains that for the patient, the tax payer and the whole of society: PREVENTION IS BETTER THAN CURE. Diabetes andits complications are a serious threat to the survival and well-being of an increasing number of people. It is predicted that one in ten Europeans aged 20-79 will have developed diabetes by 2030. Once a disease of old age, diabetes is now common among adults of all ages and is beginning to affect adolescents and even children. Diabetes accounts for up to 18% of total healthcare expenditure inEurope. THE GOOD NEWS IS THAT DIABETES IS PREVENTABLE. Compelling evidence shows that the onset of diabetes can be prevented or delayed greatly in individuals at high risk (people with impaired glucose regulation). Clinical research has shown a reduction in risk of developing diabetes of over 50% following relatively modest changes in lifestyle that include adopting a healthy diet, increasing physicalactivity, and maintaining a healthy body weight. These results have since been reproduced in real-world prevention programmes. Even a delay of a few years in the progression to diabetes is expected to reduce diabetes-related complications, such as heart, kidney and eye disease and, consequently, to reduce the cost to society. A comprehensive approach to diabetes prevention should combine...