{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T17:51:11Z","timestamp":1791309071584,"version":"4.3.1"},"posted":{"date-parts":[[2026,10,2]]},"group-title":"Public and Global Health","reference-count":68,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T00:00:00Z","timestamp":1790899200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"name":"European Commission","award":["643692"],"award-info":[{"award-number":["643692"]}],"id":[{"id":"https:\/\/ror.org\/00k4n6c32","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,10,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Type 2 diabetes (T2D) disproportionately affects socioeconomically disadvantaged communities. Evidence on the feasibility and effectiveness of prevention and self-management strategies in complex contexts remains limited.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To report effectiveness outcomes from a feasibility trial comparing the SMART2D intervention with routine primary care for T2D prevention and control in two neighbourhoods in Stockholm.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A cluster-randomized feasibility trial with hybrid type 1 design was conducted in two neighbourhoods among individuals at high risk of T2D (n=84) or with diagnosed T2D (n=58), allocated to an integrated care arm (n=70; personal coaching and community outreach) or facility-only arm (n=72; routine care). Primary outcomes were glycaemic control (participants with T2D) and HbA1c reduction (participants at high risk of T2D); secondary outcomes were retention to care and diabetes incidence (participants at high risk of T2D). Analysis used intention-to-treat principles: difference-in-differences with mixed-effects models for HbA1c reduction, and modified Poisson regression (IRR, 95% CI) for other outcomes.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Among participants with T2D, glycaemic control (adjusted IRR=0.92, 95% CI=0.89-0.95) and retention to care (adjusted IRR=0.91, 95% CI=0.91-0.92) were significantly lower in the integrated care arm. Among participants at high risk of T2D, integrated care showed a marginally significant, greater HbA1c reduction (adjusted 2.02, 0.20-3.84) and significantly higher retention to care (adjusted IRR=1.22, 1.15-1.29), plus fewer incident diabetes cases (0 vs. 2 in facility-only).<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Integrated care (personal coaching, community outreach) benefited HbA1c reduction and retention among participants at high risk of T2D, whereas facility-only care improved glycaemic control and retention among participants with T2D.<\/jats:p>\n                <\/jats:sec>","DOI":"10.64898\/2026.09.30.26364359","type":"posted-content","created":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T00:40:21Z","timestamp":1790988021000},"source":"Crossref","is-referenced-by-count":0,"title":["Proof-of-implementation of the SMART2D intervention: findings from a cluster randomised feasibility trial for prevention and control of type 2 diabetes in socio-economically disadvantaged neighbourhoods in Stockholm, Sweden"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9532-6059","authenticated-orcid":false,"given":"Meena","family":"Daivadanam","sequence":"first","affiliation":[{"name":"Global Health and Migration Unit, Dept. of Women\u2019s and Children\u2019s Health, Uppsala University, Uppsala, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristi Sidney","family":"Annerstedt","sequence":"additional","affiliation":[{"name":"Dept. of Global Public Health, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6109-7203","authenticated-orcid":false,"given":"Helle M\u00f6lsted","family":"Alvesson","sequence":"additional","affiliation":[{"name":"Dept. of Global Public Health, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5681-2644","authenticated-orcid":false,"given":"Linda","family":"Timm","sequence":"additional","affiliation":[{"name":"Dept. of Neurobiology, Care sciences and Society, Division of Occupational Therapy, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carl Johan","family":"Sundberg","sequence":"additional","affiliation":[{"name":"Dept. of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Delobelle","sequence":"additional","affiliation":[{"name":"Chronic Diseases Initiative for Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josefien Van","family":"Olmen","sequence":"additional","affiliation":[{"name":"Department of Public Health, Vrije Universiteit Brussel, Brussels, Belgium"},{"name":"Department of Family Medicine & Population Health University of Antwerp; Centre for Research in Health System Performance (CRiHSP), Yong Loo Lin School of Medicine, National University of Singapore; Department of Family Medicine (DFM) National University Health System"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1047-909X","authenticated-orcid":false,"given":"Pilvikki","family":"Absetz","sequence":"additional","affiliation":[{"name":"Health Sciences Unit, Faculty of Social Sciences, Tampere University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Guwatudde","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"54368","reference":[{"key":"2026100610001138000_2026.09.30.26364359v1.1","unstructured":"International Diabetes Federation. 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