O-58 Diabetes Prevention in the Caribbean using Lifestyle Intervention and Metformin Escalation: Results from the LIME Study
Author(s):
S Hassan, NP Sobers, J Paul-Charles, J Herbert, K Dharamraj, E Cruz, E Garcia, L Fredericks, D Galusha, OP Adams, R Maharaj, CM Nazario, M Nunez, and M Nunez-Smith
Type Of Study:
- Experimental or Intervention Study
Country(ies) Of Focus:
- Barbados
- Trinidad and Tobago
- Other
Year of Presentation:
2023
Objective: To describe the reach and effectiveness of the
Lifestyle Intervention and Metformin Escalation (LIME)
Clinical Trial in reducing the risk of diabetes among individuals with pre-diabetes in the Caribbean.
Methods: LIME is a quasi-experimental study using a pre-post study design that took place between 2018 and 2021. LIME recruited individuals with high-risk pre-diabetes (hemoglobin A1c – HbA1c – between 6.0 and 6.4%) across clinical sites in Barbados, Trinidad & Tobago, Puerto Rico, and the US Virgin Islands. Eligible participants were enrolled in a 6-week lifestyle modification workshop. Six months later, individuals who did not lose at least 5% of their bodyweight or had an HbA1c of 6% or higher were prescribed metformin medication. The primary outcome was change in HbA1c at 6- and 12-months.
Results: Of 914 individuals screened, 211 (23%) had highrisk pre-diabetes. Of those, 114 enrolled in the study (54% reach). At 6-months follow-up, there was a reduction in average HbA1c from 6.19% to 5.95% (p=0.0007), average weight from 86.7kg to 85Kg (p=0.0005), with a reduction in added sugar intake from 7.3 tsp/day to 3.8 tsp/day (p<0.0001) but no significant change in physical activity level or fruit and vegetable intake. Reduction in HbA1c (6.19% to 5.67%, p<0.0001) and weight (85.1 to 83.7, p=0.0149) was maintained at 12 months.
Conclusion: LIME is an effective diabetes prevention intervention for individuals with pre-diabetes in the Caribbean. LIME demonstrates the high burden of pre-diabetes in the community. Future work should investigate cost-effectiveness, and scale-up of the intervention.