Introduction
Material and Method
Population | General population including both healthy people and diabetes risk-groups (including people with obesity) |
Intervention | All interventions in the workplace aimed at diabetes prevention, such as education or life-style changes |
Comparator | Not limited |
Outcomes | Blood glucose level, glycated hemoglobin level, body weight, BMI and other parameters directly or indirectly indicating risks of diabetes |
Research type | Systematic reviews with or without meta-analysis |
Results
Programs Based on Multicomponent Interventions
Programs Based on Single-Component Interventions
Author/Year Funding | N studies | Population [N] Worksite | Intervention (I) | Comparator (C) | Outcomes | Study findings |
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Fitzpatrick-Lewis 2022 [11] (MA) Diabetes Canada | 5 RCT | Adult employees in the T2DM risk group T2DM [N = 1494] Private corporations; university; railroad company; government agency | DPP-based program or a program utilizing 3 components (health education, diet changes, and increased physical activity) in a workplace | No intervention or delayed/scaled down intervention | After 4–6 months: • 5% or 7% reduction in body-weight • BMI • Physical activity level | The intervention influence the body-weight reduction by ≥ 5% (RR = 3.85 [95% CI: (1.58; 9.38); 4 RCT; n/N = 84/473 (I); 15/309 (C)]) and by ≥ 7% (RR = 9.36 [95% CI: (2.31; 37.97); 2 RCT; n/N = 27/90 (I); 2/62 (C)]) in comparison to baseline participants body-weight. The DPP-based program implementation influences lowering of the participants’ BMI–MD = −0.86 (kg/m2) [95%CI: (−1.37; −0.34); 5 RCT; N = 521 (I); 348 (C)]. Increase in physical activity levels had been noted among the program participants—SMD = 0.38 [95% CI: (0.21; 0.55); 4 RCT; N = 361 (I); 219 (C)]. |
Peñalvo 2021 [12] (MA) No funding | 82 RCT, 39 quasi-experimental | Adult employees in the risk group [median = 413] Factories, offices, hospitals, schools (employees), mixed settings | Multicomponent programs in the workplace comprising of at least of the following: Screening (A); Individual education (B); Group education (C); Food environment (D); Labeling (E); Financial incentives (F); Physical Activity (G); Self-awareness (H); Others (I) | Usual care or lesser intensity intervention (i.e., exclusively education on healthy diet) | Median intervention time: 9 months (4.5–18.0) • Changes in adiposity (body weight, BMI, waist circumference, skinfold, body fat percentage) • Biomarker changes glucose and insulin | The efficacy analysis of the wellness programs comprised of every component (A-I) showed positive influence on lowering BMI, body-weight and waist circumference among the participants (ES): • BMI (kg/m2) = −0.22 [95% CI: (−0.28; -0.17); 57 studies/67 groups; N = 92,698]; • Body-weight (kg) = −0.92 [95% CI: (−1.11; −0.72); 47 studies/59 groups; N = 162,019]; • Waist girth (cm) = −1.47 [95% CI: (−1.96; −0.98) (31 studies/37 groups; N = 21,334]. Wellness programs influence lowering of the fasting plasma glucose (mg/dl) (ES) = −1.81 [95% CI: (−3.33; −0.28); 21 studies/26 groups; N = 30,293]. Showed no influence on decreasing both the percentage fat content (the amount of fat contained in food products) (analyzed components: A, B, C, D, F, G, H, I), nor waist-hip ratio (analyzed components A, B, C, D, F, G) (ES): • Fat content (%) = −0.80% [95% CI: (−1.80; 0.21); (11 studies/13 groups; N = 1318); • Waist-hip ratio = 0.00 [95% CI: (−0.01; 0.00) (6 RCT/8 groups; N = 2839). Wellness programs comprising programs B, C, G, I components do not influence lowering the non-fat body-weight (kg) = 1.01 [95% CI: (−0.82; 2.83); 4 RCT; N = 437]. |
Inolopú 2019 [13] (SR) Instituto de Evaluación de Tecnologías en Salud e Investigación Fogarty International Center of the US National Institutes of Health | 6 RCT, 4 quasi-experimental | Adult employees in the T2DM risk group or prediabetic [N = 2536] Pharmaceutical company; IT firm, college; municipal offices, airline company; finance firm; nursing technicians; not specified (3 studies) | Interventions aimed at preventing risk factors and T2DM occurrence in the workplace: • Conventional lifestyle changing interventions (7); • Lifestyle changes coaching online (2); • Dietary coaching (1). 9 out of 10 included studies based their programs on: • Diabetes Prevention Program DPP (n = 3); • Finnish Diabetes Prevention Study (FDPS) (n = 2); • Life Style Modification Program for Physical Activity and Nutrition Program (LiSM10!) (n = 1); • Guidelines from The National Institute for Health and Care Excellence – NICE (n = 1); • Japanese Diabetes Society and the American Diabetes Association (JDS/ADA) (n = 1); • Diabetes management: healthy living with diabetes program (n = 1); not specified (n = 1) | Not specified | 4 to 36 months (mean 14,4 months) • Body-weight reduction • Calorie intake • Blood glucose levels 2h postprandial | Structured programs based on DPP, FDPS, LiSM10! and NICE recommendations influence the body-weight reduction (6 studies). In DPP-based 2 studies noted higher percentage in body-weight reduction in the intervention group had been noted: • Among pharmaceutical company employees 5% body-weight reduction in comparison to the pre-intervention baseline had been noted (45% (I) vs. 7% (C); N = 89; observation period = 12 months); • Among college employees 7% body-weight reduction in comparison to pre-intervention baseline had been noted (32.4% (I) vs 2.9% (C), p < 0.01; N = 69; observation period = 7 months). The economic incentives exchanged for body-weight reduction in the DPP-based program influenced body-eight and BMI reduction among nursing technicians (N = 99). Nutritional coaching based on JDS/ADA guidelines influences calorie intake reduction and lowering blood glucose level 2-h postprandial (1 study). No influence of the programs focused on management and treatment of diabetes (2 studies). |
Brown 2018 [14] (SR) No information | 6 RCT, 5 quasi-experimental, 11 one-group pre-post study | Adult employees in the T2DM risk group/prediabetic or T2DM diagnosed [N = 30,974] Corporate companies; healthcare providers (hospitals, clinics, health departments); insurance companies; manufacturers; universities | Conducting prophylactics programs aimed at worksite diabetes occurrence prevention (the interventions utilized in the programs lasted on average 12–24 weeks mostly conducted as 1 h weekly session with control consultation once or twice a month): • DPP-based programs (lifestyle part): group sessions in groups under 20 employees, most commonly at the cafeteria during lunchtime and during working hours (8 studies); • Remaining programs were aimed at improving nutritional habits, increasing physical activity and/or diabetes management/ cardiovascular risk factors (stress reduction, advice adherence, maintaining body-mass, restricting or quitting stimulants) (14 studies). Medical personnel responsible for conducting the interventions: dietitians, MDs, nurses, as well as psychologists, physiotherapists, and pharmacists (18 studies). Intervention form: online, phone calls, DVD, e-mails, websites, interactive notice boards, mobile apps; pedometers and computer software for physical exercise. | No intervention or delayed/reduced intervention range | After 6–12 months: • Body-mass reduction • BMI • HbA1c levels • Blood pressure | Interventions aimed at diabetes prophylactics influenced reduction in BMI/body-mass (15 out of 20 studies). Prophylactics programs aimed at lowering HbA1c levels (6 out of 10 studies) as well as blood pressure improvement (6 out of 14 studies). |
Shrestha 2018 [15] (MA) NIH Director’s Pioneer Award | 10 RCT, 7 pre-post design studies | Adult employees in CDV risk group (10 studies); diabetic employees (4 studies); employees without confirmed diagnosis or risk factors (3 studies) [N = 14,272] | Dietary interventions conducted as part of: group sessions (health educators) (8 studies); individual coaching (face-to-face o rover a phone – 9 studies); setting short-term and long-term health goals. Interventions were conducted from 3 to 36 months (median 12 months) and median of numbers of dietary interventions was 7. | Not specified | • HbA1c levels • Fasting blood glucose levels | Dietary interventions conducted in a workplace influenced HbA1c level by (mean change): −0.18% [95% CI: (−0.29; −0.06) p < 0.001; 10 studies). No influence of the dietary intervention on fasting blood glucose levels (mean change): −2.60 mg/dl [95% CI: (−5.27; 0.08) p = 0.06; 12 studies). |
Hafez 2017 [8] (narrative SR) No information | 2 RCT, 1 non- RCT, 1 cluster RCT, 3 single group time series, 2 single group pre-post, 1 multi-group pre-post, 3 cohort studies | Adult employees from T2DM risk group [N enrolled = 3746; N analyzed = 1317] Departments of public hospital, newspaper publisher and city/county health department/county police; manufacturer of medical technologies; county employees; maintenance facility; nursing home facility employees; manufacturing plant; pharmaceutical company; organizations; university; 5 companies: health insurance, wharf, camper, food industry, medical equipment supplier | Conducting prophylactics programs in workplace aimed at diabetes prevention: DPP-based programs (10 studies): • In 6 out of 10 at least 16 basic DPP sessions had been conducted and retaining phase had been utilized; • In 2 studies the time-frame for the sessions had been shortened from 16 to 12 or 4 weeks; • The sessions were most commonly held during lunch or after working hours (4 studies); • in 2 studies the participants were allowed to choose suitable form and time for their interventions; • in 6 studies financial incentives had been offered for registering and participating in the program. Non-DPP-based programs: lower intensity than in DPP-based programs aimed at support in lifestyle changes through educational sessions, websites and individual consultations (3 studies). | No intervention or delayed/reduced intervention range | After 3–12 months: • Body-mass reduction • HbA1c levels • Fasting blood glucose levels | DPP-based programs influenced: • Body-weight reduction by −0.4 to −5.1 kg in 3–6 months (8 studies) and by −1.43 to −4.9 kg in 7–12 months (6 studies); • Percentage body-weight reduction by −0.5 to −5.5% in 12 weeks to 12 months (7 studies); • Body-weight reduction by at least 5% of the baseline body-weight after 16 weeks since the intervention (14–56% of participants; 4 studies); • Decreased HbA1c levels (2 studies) and fasting blood glucose levels (1 study). Non DPP-based programs slightly influenced body-weight reduction after 6–12 months and HbA1c value decrease (2 studies). In 1 study the increase of blood glucose level had been noted after 2.5 years after the intervention (0.27 mmol/l among men and 0.35 mmol/l among women). |
Conn 2009 [9] (MA) No funding | 206 comparisons/ 138 varied design studies (pre, post, pre-post studies) | Adult employees from revenue-oriented companies (55 studies) or non-profit organizations (50 studies)—mainly educational institutions, healthcare providers, governmental offices, and manufacturers [N = 38,231] | Physical activity programs in a workplace in a form of supervised exercises (27% of studies) and/or motivational/educational sessions (80% of studies) | Two-groups pre-post intervention | • Diabetes risk • Fasting blood glucose • Anthropometric measures (encoded as BMI, weight, abdominal girth, body fat) | The intervention influenced positively decreased risk of diabetes, with a size effect between groups between 0.90 and 0.98—two-group post-test = 0.98 [95% CI: (0.06; 1.90); two-group pre-post = 0.90 [95% CI: (0.27; 0.53); 6 groups. The size effect was influenced by small number of studies/sample. Mean size effect for diabetes risk had been −12.6 mg/dl for fasting blood glucose—treatment group/control subjects (81.0 (I) vs 93.6 (C)). The intervention has influenced positively lowering of the anthropometric parameters with a size effect for two-group post-test = 0.08 [95% CI: (0.02; 0.15)]; 44 groups. |