LIME: Preventing Diabetes Using Lifestyle Intervention and Metformin Escalation

LIME is an evidence-based intervention that seeks to decrease the number of people who develop diabetes. We engage our stakeholders, site teams, and participants throughout the process of designing, implementing and evaluating the intervention. We apply implementation science frameworks and tools to determine the best way to integrate the intervention into our clinical sites so that it is more effective and sustainable. We work closely with our stakeholder community to adapt the intervention so that it is culturally appropriate, relevant, and sensitive to our Caribbean and Caribbean-descent populations.

A Healthy, Happy, Sweet Life

Real-World Approach

The LIME study involves two components: lifestyle intervention and metformin escalation.

Participants are clinic patients who have pre-diabetes. Their blood sugar is higher than normal but not high enough to be diabetes. These are individuals who have a high risk of developing diabetes.
Participants attend workshops focused on diabetes prevention, healthy eating, and increasing physical activity. Our trainers provide practical information, like how to make traditional foods healthy and how to estimate portion size.
Six months after attending the workshops participants who still have elevated blood sugars and have not lost any weight will be prescribed a medication called metformin.
We follow participants every six months to monitor their progress, including changes in weight, blood sugar, and blood pressure. The follow-up period is two-and-a-half years (30 months).

Our LIME Teams

Frequently Asked Questions

Where are the LIME study sites?: The four intervention sites are located in Barbados, Puerto Rico, Trinidad & Tobago, and the U.S. Virgin Islands. We chose these sites because of their high rates of diabetes and our strong research affiliations through the ECHORN network.

Our research is led by the following teams:

University of Puerto Rico Hospital in Carolina Internal Medicine Clinic: Dr. Elsie Cruz, Dr. Enid Garcia

Southwest Regional Health Authority, Trinidad & Tobago: Dr. Kavita Dharamraj

USVI Department of Health, Community Health Services: Ms. Lyna Fredericks

University of the West Indies, Cave Hill and Barbados Ministry of Health Polyclinics: Dr. Joseph Herbert, Dr. Natasha Sobers, Dr. Joanne Paul-Charles
Who is eligible to participate?: LIME participants must meet the following criteria:

Resident in study location

Adult between 40-60 years old

Not pregnant

No history of Type I, Type II, or gestational diabetes

Not currently on medications that alter blood sugar

Linked to a healthcare provider and have health insurance to cover the cost of medication and labs

Able to attend weekly workshops

BMI of greater than 23 kg/m2

Normal kidney function
What are the lifestyle workshops?: The lifestyle workshops are based on the Chronic Disease Self-Management Curriculum. This workshop curriculum has been shown to be effective and cost-effective. It was adapted by the East Harlem Partnership for Diabetes Prevention in collaboration with researchers at Mt. Sinai (NIH/NIMHD #R24MD00169 PI: Horowitz, Carol) to a diabetes prevention curriculum called HEED: Help Educate to Eliminate Diabetes. HEED was piloted with a diverse community in East Harlem, NYC and shown to have sustained weight loss at 12 months.

We worked closely with our stakeholder network and the original HEED developers to adapt the HEED workshop curriculum to make it culturally appropriate, relevant, and sensitive to our Caribbean and Caribbean-descent populations. The workshops consist of six weekly sessions that are each two-and-a-half hours long. Staff and clinic affiliates at each site are trained to be workshop leaders and conduct these workshops.

To help sustain the lifestyle changes they were exposed to during the workshop series, patients can use the iHEED app or join a What’s App group. iHEED is designed to encourage group support and activities, offer updated information on diabetes prevention, and identify local resources that are tailored to each user’s select needs. It is available for download on Android and iOs.
For more information: To learn more about LIME please contact yaletcc@yale.edu