Open Access Study protocol

SLIMMER: a randomised controlled trial of diabetes prevention in Dutch primary health care: design and methods for process, effect, and economic evaluation

Geerke Duijzer1*, Annemien Haveman-Nies12, Sophia C Jansen2, Josien ter Beek2, Gerrit J Hiddink3 and Edith JM Feskens1

Author Affiliations

1 Division of Human Nutrition; Academic Collaborative Centre AGORA, Wageningen University, P.O. Box 8129, 6700 VE Wageningen, the Netherlands

2 GGD Noord- en Oost-Gelderland (Community Health Service), P.O. Box 51, 7311 AB Apeldoorn, the Netherlands

3 Strategic Communication, Sub-department Communication, Philosophy and Technology: Centre for Integrative Development, Social Sciences, Wageningen University, P.O. Box 8130, 6700 EW Wageningen, the Netherlands

For all author emails, please log on.

BMC Public Health 2014, 14:602  doi:10.1186/1471-2458-14-602

Published: 14 June 2014



Implementation of interventions in real-life settings requires a comprehensive evaluation approach. The aim of this article is to describe the evaluation design of the SLIMMER diabetes prevention intervention in a Dutch real-life setting.


The SLIMMER study is a randomised, controlled intervention study including subjects aged 40 through 70 years with impaired fasting glucose or high risk of diabetes. The 10-month SLIMMER intervention involves a dietary and physical activity intervention, including case management and a maintenance programme. The control group receives usual health care and written information about a healthy lifestyle. A logic model of change is composed to link intervention activities with intervention outcomes in a logical order. Primary outcome is fasting insulin. Measurements are performed at baseline and after 12 and 18 months and cover quality of life, cardio-metabolic risk factors (e.g. glucose tolerance, serum lipids, body fatness, and blood pressure), eating and physical activity behaviour, and behavioural determinants. A process evaluation gives insight in how the intervention was delivered and received by participants and health care professionals. The economic evaluation consists of a cost-effectiveness analysis and a cost-utility analysis. Costs are assessed from both a societal and health care perspective.


This study is expected to provide insight in the effectiveness, including its cost-effectiveness, and delivery of the SLIMMER diabetes prevention intervention conducted in Dutch primary health care. Results of this study provide valuable information for primary health care professionals, researchers, and policy makers.

Trial registration

The SLIMMER study is registered with (NCT02094911) since March 19, 2014.

Type 2 diabetes mellitus; Prevention; Combined lifestyle intervention; Primary health care; Real-life setting; Evaluation design