Abstract:
BACKGROUND : Globally, several diabetes prevention interventions have been shown to be cost-effective, yet they
have had limited adaptation, implementation, and evaluation in the Caribbean and among Caribbean-descent
individuals, where the burden of type 2 diabetes is high. We report on the protocol for the Lifestyle Intervention
with Metformin Escalation (LIME) study – an evidence-based diabetes prevention intervention to reduce the
incidence of diabetes among Caribbean-descent individuals with prediabetes.
METHODS : LIME is a hybrid type-I effectiveness-implementation quasi-experimental study taking place in 4 clinical
sites in Barbados, Trinidad, the U.S. Virgin Islands, and Puerto Rico. LIME targets individuals who self-identify as
Caribbean or Caribbean-descent and have high-risk prediabetes with a hemoglobin A1c (HbA1c) between 6 and
6.4%. Eligible participants in the intervention arm are enrolled in a six-week lifestyle modification workshop. Six
months later, individuals who have not lost at least 5% of their bodyweight or continue to have an HbA1c of 6%
or higher are prescribed metformin medication. In total, participants are followed for one year. The primary
effectiveness outcome is proportion of individuals who lower their HbA1c below 6%.
DISCUSSION : LIME is a unique diabetes prevention intervention for Caribbean and Caribbean-descent individuals.
LIME utilizes a tailored lifestyle change curriculum, incorporates appropriate metformin prescribing when
lifestyle change alone is insufficient, targets the highest-risk individuals with prediabetes, and is based in a
clinical setting to ensure sustainability.
