Finnish Diabetes Prevention Study Group: Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: follow-up of the Finnish Diabetes Prevention Study

Department of Dental Public Health, University of Helsinki, Helsinki, Uusimaa, Finland
The Lancet (Impact Factor: 45.22). 12/2006; 368(9548):1673-9. DOI: 10.1016/S0140-6736(06)69701-8
Source: PubMed

ABSTRACT Lifestyle interventions can prevent the deterioration of impaired glucose tolerance to manifest type 2 diabetes, at least as long as the intervention continues. In the extended follow-up of the Finnish Diabetes Prevention Study, we assessed the extent to which the originally-achieved lifestyle changes and risk reduction remain after discontinuation of active counselling.
Overweight, middle-aged men (n=172) and women (n=350) with impaired glucose tolerance were randomly assigned to intensive lifestyle intervention or control group. After a median of 4 years of active intervention period, participants who were still free of diabetes were further followed up for a median of 3 years, with median total follow-up of 7 years. Diabetes incidence, bodyweight, physical activity, and dietary intakes of fat, saturated fat, and fibre were measured.
During the total follow-up, the incidence of type 2 diabetes was 4.3 and 7.4 per 100 person-years in the intervention and control group, respectively (log-rank test p=0.0001), indicating 43% reduction in relative risk. The risk reduction was related to the success in achieving the intervention goals of weight loss, reduced intake of total and saturated fat and increased intake of dietary fibre, and increased physical activity. Beneficial lifestyle changes achieved by participants in the intervention group were maintained after the discontinuation of the intervention, and the corresponding incidence rates during the post-intervention follow-up were 4.6 and 7.2 (p=0.0401), indicating 36% reduction in relative risk.
Lifestyle intervention in people at high risk for type 2 diabetes resulted in sustained lifestyle changes and a reduction in diabetes incidence, which remained after the individual lifestyle counselling was stopped.

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    • "It has been shown that T2D can be efficiently prevented by lifestyle intervention in high-risk individuals in research setting . Furthermore, these lifestyle interventions seem to have a long-lasting effect on T2D risk factors [9] [10]. Finland was one of the first countries in the world to establish a national program for prevention of T2D, accompanied by a prevention implementation project within the primary health care [11]. "
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    • "Moderate-intensity exercise for 150 min/week or vigorous-intensity exercise for 90 min/week is recommended to achieve therapeutic benefits for type 2 diabetes (Physical Activity Guidelines Advisory Committee 2008, American Diabetes Association 2013). Results of a Finnish diabetes prevention study demonstrated reduced incidence of type 2 diabetes even 3 years after termination of lifestyle intervention (Lindstrom et al. 2006). The mechanism for improvement may be one of several benefits of exercise. "
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    • "The DPP intensive lifestyle counseling arm included 16 one-on-one in person coaching sessions and additional group meetings and resulted in a 4-year sustained weight loss and a 58% reduction in diabetes incidence, outperforming both the medication condition and the control condition [9]. Similar long-term weight loss and disease prevention benefits from intensive lifestyle treatment have been shown in the Look AHEAD trial, the Finnish Diabetes Prevention Study, and the Chinese Da Qing diabetes prevention study [10] [11] [12]. Thorpe and Yang [13] advocate for the dissemination of weight loss programs based on the lifestyle intervention developed for DPP and project billions of dollars saved if such programs were to be implemented at a national level. "
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