Background and theory
Previous clinical trials have shown the efficacy of lifestyle interventions in the prevention of type 2 diabetes in different populations [1, 2, 3, 4] and the sustainability of the beneficial effects for several years after the discontinuation of the intervention [5, 6].
The efficacy of such interventions depends strongly on the lifestyle changes adopted, which emphasizes successful health behavior change in the prevention of type 2 diabetes . Importantly, sustainable and scalable models are needed to reach and identify individuals at increased risk of type 2 diabetes and to deliver personalized and effective lifestyle interventions.
The implementation of evidence-based approaches for reaching and identifying individuals at increased risk and preventing type 2 diabetes as permanent practices in the health care system and the society is still a challenge. Individuals at increased risk can be identified based on a history of non-diabetic dysglycaemia or gestational diabetes [7, 8] but also using validated risk screening tools, such as the Finnish Diabetes Risk Score (FINDRISC) . However, such risk screening tools are not yet utilized systematically in the identification of individuals at increased risk of type 2 diabetes in the health care system and the society.
Many seminal lifestyle intervention studies, such as the Diabetes Prevention Study in Finland  and the Diabetes Prevention Program in the United States  as well as most of the implementation studies following these efficacy trials [10, 11] have been based on face-to-face counselling either individually or in groups.
However, individual counseling is resource-intensive and may not be feasible for most health care systems . Group counseling demands less resources but requires special skills  which may limit its use in the health care system. Although digital interventions are more scalable than face-to-face interventions, adherence to digital interventions remains a challenge [13, 14].
Stop Diabetes – Knowledge-Based Solutions (StopDia): A Strategic Reseach Funding project
The Stop Diabetes (StopDia) study was set to create and implement evidence-based and digitally supported strategies for the prevention of type 2 diabetes at population level in three provinces in Finland.
The project received funding from the Strategic Recearch Council on June 2016. The Strategic Research Council (SRC) funds high-quality research that has great societal impact. The research should seek to find concrete solutions to grand challenges that require multidisciplinary approaches. An important element of such research is active collaboration between those who produce new knowledge and those who use it.
Importantly, the risk identification and the StopDia lifestyle interventions are fully integrated in the Finnish health care system to facilitate their long-term implementation.
- Tuomilehto J, Lindström J, Eriksson JG, Valle TT, Hämäläinen H, Ilanne-Parikka P, et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med. 2001;344(18):1343–50. PubMed Google Scholar
- Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393–403. PubMed Google Scholar
- Ramachandran A, Snehalatha C, Mary S, Mukesh B, Bhaskar AD, Vijay V. The Indian diabetes prevention Programme shows that lifestyle modification and metformin prevent type 2 diabetes in Asian Indian subjects with impaired glucose tolerance (IDPP-1). Diabetologia. 2006;49(2):289–97. PubMed Google Scholar
- Telle-Hjellset V, Kjøllesdal MKR, Bjørge B, Holmboe-Ottesen G, Wandel M, Birkeland KI, et al. The InnvaDiab-DE-PLAN study: a randomised controlled trial with a culturally adapted education programme improved the risk profile for type 2 diabetes in Pakistani immigrant women. Br J Nutr. 2013;109(3):529–38. PubMed Google Scholar
- Lindström J, Peltonen M, Eriksson JG, Ilanne-Parikka P, Aunola S, Keinänen-Kiukaanniemi S, et al. Improved lifestyle and decreased diabetes risk over 13 years: long-term follow-up of the randomised Finnish diabetes prevention study (DPS). Diabetologia. 2013;56(2):284–93. PubMed Google Scholar
- Diabetes Prevention Program Research Group. Long-term effects of lifestyle intervention or metformin on diabetes development and microvascular complications over 15-year follow-up: the diabetes prevention program outcomes study. Lancet Diabetes Endocrinol. 2015;3(11):866–75. PubMed Central Google Scholar
- Bellamy L, Casas J-P, Hingorani AD, Williams D. Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis. Lancet. 2009;373(9677):1773–9. PubMed Google Scholar
- Morris DH, Khunti K, Achana F, Srinivasan B, Gray LJ, Davies MJ, et al. Progression rates from HbA1c 6.0–6.4% and other prediabetes definitions to type 2 diabetes: a meta-analysis. Diabetologia. 2013;56(7):1489–93. PubMed Google Scholar
- Lindström J, Tuomilehto J. The diabetes risk score: a practical tool to predict type 2 diabetes risk. Diabetes Care. 2003;26(3):725–31. PubMed Google Scholar
- Aziz Z, Absetz P, Oldroyd J, Pronk NP, Oldenburg B. A systematic review of real-world diabetes prevention programs: learnings from the last 15 years. Implement Sci. 2015;10(1):172. PubMed PubMed Central Google Scholar