Effects of lifestyle intervention in persons at risk for type 2 diabetes mellitus - results from a randomised, controlled trial

Vegard Nilsen, Per S Bakke, Frode Gallefoss, Vegard Nilsen, Per S Bakke, Frode Gallefoss

Abstract

Background: Lifestyle change is probably the most important single action to prevent type 2 diabetes mellitus. The purpose of this study was to assess the effects of a low-intensity individual lifestyle intervention by a physician and compare this to the same physician intervention combined with an interdisciplinary, group-based approach in a real-life setting.

Methods: The "Finnish Diabetes Risk score" (FINDRISC) was used by GPs to identify individuals at high risk. A randomised, controlled design and an 18 month follow-up was used to assess the effect of individual lifestyle counselling by a physician (individual physician group, (IG)) every six months, with emphasis on diet and exercise, and compare this to the same individual lifestyle counselling combined with a group-based interdisciplinary program (individual and interdisciplinary group, (IIG)) provided over 16 weeks. Primary outcomes were changes in lifestyle indicated by weight reduction ≥ 5%, improvement in exercise capacity as assessed by VO2 max and diet improvements according to the Smart Diet Score (SDS).

Results: 213 participants (104 in the IG and 109 in the IIG group, 50% women), with a mean age of 46 and mean body mass index 37, were included (inclusion rate > 91%) of whom 182 returned at follow-up (drop-out rate 15%). There were no significant differences in changes in lifestyle behaviours between the two groups. At baseline 57% (IG) and 53% (IIG) of participants had poor aerobic capacity and after intervention 35% and 33%, respectively, improved their aerobic capacity at least one metabolic equivalent. Unhealthy diets according to SDS were common in both groups at baseline, 61% (IG) and 60% (IIG), but uncommon at follow-up, 17% and 10%, respectively. At least 5% weight loss was achieved by 35% (IG) and 28% (IIG). In the combined IG and IIG group, at least one primary outcome was achieved by 93% while all primary outcomes were achieved by 6%. Most successful was the 78% reduction in the proportion of participants with unhealthy diet (almost 50% absolute reduction).

Conclusion: It is possible to achieve important lifestyle changes in persons at risk for type 2 diabetes with modest clinical efforts. Group intervention yields no additional effects. The design of the study, with high inclusion and low dropout rates, should make the results applicable to ordinary clinical settings.

Trial registration: ClinicalTrials.gov: NCT00202748.

Figures

Figure 1
Figure 1
Flow of participants through trial.
Figure 2
Figure 2
Overview of the study design.
Figure 3
Figure 3
Reduction in proportion of patients with unhealthy diet from baseline to follow-up.

References

    1. Alonso-Magdalena P, Quesada I, Nadal A. Endocrine disruptors in the etiology of type 2 diabetes mellitus. Nat Rev Endocrinol. 2011;7(6):346–53. doi: 10.1038/nrendo.2011.56.
    1. van Dam RM. The epidemiology of lifestyle and risk for type 2 diabetes. Eur J Epidemiol. 2003;18(12):1115–25.
    1. Tuomilehto J, Lindstrom J, Eriksson JG, Valle TT, Hamalainen H, Ilanne-Parikka P. et al.Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med. 2001;344(18):1343–50. doi: 10.1056/NEJM200105033441801.
    1. Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA. et al.Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393–403.
    1. Lindstrom J, Ilanne-Parikka P, Peltonen M, Aunola S, Eriksson JG, Hemio K. et al.Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: follow-up of the Finnish Diabetes Prevention Study. Lancet. 2006;368(9548):1673–9. doi: 10.1016/S0140-6736(06)69701-8.
    1. Knowler WC, Fowler SE, Hamman RF, Christophi CA, Hoffman HJ, Brenneman AT. et al.10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study. Lancet. 2009;374(9702):1677–86. doi: 10.1016/S0140-6736(09)61457-4.
    1. Orozco LJ, Buchleitner AM, Gimenez-Perez G, Roqué i Figuls M, Richter B, Mauricio D. Exercise or exercise and diet for preventing type 2 diabetes mellitus. Cochrane Database of Systematic Reviews. 2008. Art. No.: CD003054.
    1. Nield L, Summerbell CD, Hooper L, Whittaker V, Moore H. Dietary advice for the prevention of type 2 diabetes mellitus in adults. Cochrane Database of Systematic Reviews. 2008. Art. No.: CD005102.
    1. Hamman RF, Wing RR, Edelstein SL, Lachin JM, Bray GA, Delahanty L. et al.Effect of weight loss with lifestyle intervention on risk of diabetes. Diabetes Care. 2006;29(9):2102–7. doi: 10.2337/dc06-0560.
    1. Dansinger ML, Tatsioni A, Wong JB, Chung M, Balk EM. Meta-analysis: the effect of dietary counseling for weight loss. Ann Intern Med. 2007;147(1):41–50.
    1. Curioni CC, Lourenco PM. Long-term weight loss after diet and exercise: a systematic review. Int J Obes (Lond) 2005;29(10):1168–74. doi: 10.1038/sj.ijo.0803015.
    1. Ash S, Reeves M, Bauer J, Dover T, Vivanti A, Leong C. et al.A randomised control trial comparing lifestyle groups, individual counselling and written information in the management of weight and health outcomes over 12 months. Int J Obes (Lond) 2006;30(10):1557–64. doi: 10.1038/sj.ijo.0803263.
    1. Berg TJ. Can type 2 diabetes be prevented? Tidsskr Nor Laegeforen. 2000;120(20):2430–3.
    1. Lindstrom J, Tuomilehto J. The diabetes risk score: a practical tool to predict type 2 diabetes risk. Diabetes Care. 2003;26(3):725–31. doi: 10.2337/diacare.26.3.725.
    1. Schwarz PE, Li J, Lindstrom J, Tuomilehto J. Tools for predicting the risk of type 2 diabetes in daily practice. Horm Metab Res. 2009;41(2):86–97. doi: 10.1055/s-0028-1087203.
    1. Silventoinen K, Pankow J, Lindstrom J, Jousilahti P, Hu G, Tuomilehto J. The validity of the Finnish Diabetes Risk Score for the prediction of the incidence of coronary heart disease and stroke, and total mortality. Eur J Cardiovasc Prev Rehabil. 2005;12(5):451–8. doi: 10.1097/01.hjr.0000174793.31812.21.
    1. Rubak S, Sandbaek A, Lauritzen T, Christensen B. Motivational interviewing: a systematic review and meta-analysis. Br J Gen Pract. 2005;55(513):305–12.
    1. Pickering TG, Hall JE, Appel LJ, Falkner BE, Graves J, Hill MN. et al.Recommendations for blood pressure measurement in humans and experimental animals: Part 1: blood pressure measurement in humans: a statement for professionals from the Subcommittee of Professional and Public Education of the American Heart Association Council on High Blood Pressure Research. Hypertension. 2005;45(1):142–61.
    1. Svilaas A, Strom EC, Svilaas T, Borgejordet A, Thoresen M, Ose L. Reproducibility and validity of a short food questionnaire for the assessment of dietary habits. Nutr Metab Cardiovasc Dis. 2002;12(2):60–70.
    1. Foster C, Jackson AS, Pollock ML, Taylor MM, Hare J, Sennett SM. et al.Generalized equations for predicting functional capacity from treadmill performance. Am Heart J. 1984;107(6):1229–34. doi: 10.1016/0002-8703(84)90282-5.
    1. Vivian H, editor. The Physical Fitness Specialist Certification Manual, The Cooper Institute for Aerobics Research, revised 1997 printed in Advance Fitness Assessment & Exercise Prescription. 3. Heyward; 1998. p. 48.
    1. Myers J, Prakash M, Froelicher V, Do D, Partington S, Atwood JE. Exercise capacity and mortality among men referred for exercise testing. N Engl J Med. 2002;346(11):793–801. doi: 10.1056/NEJMoa011858.
    1. Ross R, Bradshaw AJ. The future of obesity reduction: beyond weight loss. Nat Rev Endocrinol. 2009;5(6):319–25. doi: 10.1038/nrendo.2009.78.
    1. Han TS, Richmond P, Avenell A, Lean ME. Waist circumference reduction and cardiovascular benefits during weight loss in women. Int J Obes Relat Metab Disord. 1997;21(2):127–34. doi: 10.1038/sj.ijo.0800377.
    1. Wang C, Harris WS, Chung M, Lichtenstein AH, Balk EM, Kupelnick B. et al.n-3 Fatty acids from fish or fish-oil supplements, but not alpha-linolenic acid, benefit cardiovascular disease outcomes in primary- and secondary-prevention studies: a systematic review. Am J Clin Nutr. 2006;84(1):5–17.
    1. Mancia G, De BG, Dominiczak A, Cifkova R, Fagard R, Germano G. et al.2007 Guidelines for the management of arterial hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) Eur Heart J. 2007;28(12):1462–536.
    1. Johansson G, Wikman A, Ahren AM, Hallmans G, Johansson I. Underreporting of energy intake in repeated 24-hour recalls related to gender, age, weight status, day of interview, educational level, reported food intake, smoking habits and area of living. Public Health Nutr. 2001;4(4):919–27.
    1. Lissner L. Measuring food intake in studies of obesity. Public Health Nutr. 2002;5(6A):889–92.
    1. Elobeid MA, Padilla MA, McVie T, Thomas O, Brock DW, Musser B. et al.Missing data in randomized clinical trials for weight loss: scope of the problem, state of the field, and performance of statistical methods. PLoS One. 2009;4(8):e6624. doi: 10.1371/journal.pone.0006624.
    1. Inelmen EM, Toffanello ED, Enzi G, Gasparini G, Miotto F, Sergi G. et al.Predictors of drop-out in overweight and obese outpatients. Int J Obes (Lond) 2005;29(1):122–8. doi: 10.1038/sj.ijo.0802846.
    1. Melin I, Reynisdottir S, Berglund L, Zamfir M, Karlstrom B. Conservative treatment of obesity in an academic obesity unit. Long-term outcome and drop-out. Eat Weight Disord. 2006;11(1):22–30.
    1. Drewnowski A. Obesity, diets, and social inequalities. Nutr Rev. 2009;67(Suppl 1):S36–S39.
    1. Darmon N, Drewnowski A. Does social class predict diet quality? Am J Clin Nutr. 2008;87(5):1107–17.
    1. Svetkey LP, Stevens VJ, Brantley PJ, Appel LJ, Hollis JF, Loria CM. et al.Comparison of strategies for sustaining weight loss: the weight loss maintenance randomized controlled trial. JAMA. 2008;299(10):1139–48. doi: 10.1001/jama.299.10.1139.
    1. Chaston TB, Dixon JB. Factors associated with percent change in visceral versus subcutaneous abdominal fat during weight loss: findings from a systematic review. Int J Obes (Lond) 2008;32(4):619–28. doi: 10.1038/sj.ijo.0803761.
    1. Norris SL, Zhang X, Avenell A, Gregg E, Schmid CH, Lau J. Long-term non-pharmacological weight loss interventions for adults with prediabetes. Cochrane Database of Systematic Reviews. 2005. Art. No.: CD005270.
    1. Droyvold WB, Nilsen TI, Kruger O, Holmen TL, Krokstad S, Midthjell K. et al.Change in height, weight and body mass index: Longitudinal data from the HUNT Study in Norway. Int J Obes (Lond) 2006;30(6):935–9. doi: 10.1038/sj.ijo.0803178.
    1. Flegal KM, Carroll MD, Ogden CL, Curtin LR. Prevalence and Trends in Obesity Among US Adults, 1999-2008. JAMA. 2010;4(7):382–93.
    1. Crandall JP, Knowler WC, Kahn SE, Marrero D, Florez JC, Bray GA. et al.The prevention of type 2 diabetes. Nat Clin Pract Endocrinol Metab. 2008;4(7):382–93. doi: 10.1038/ncpendmet0843.
    1. Berghofer A, Pischon T, Reinhold T, Apovian CM, Sharma AM, Willich SN. Obesity prevalence from a European perspective: a systematic review. BMC Public Health. 2008;8:200. doi: 10.1186/1471-2458-8-200.
    1. Wareham NJ, van Sluijs EM, Ekelund U. Physical activity and obesity prevention: a review of the current evidence. Proc Nutr Soc. 2005;64(2):229–47. doi: 10.1079/PNS2005423.
    1. Lemmens VE, Oenema A, Klepp KI, Henriksen HB, Brug J. A systematic review of the evidence regarding efficacy of obesity prevention interventions among adults. Obes Rev. 2008;9(5):446–55. doi: 10.1111/j.1467-789X.2008.00468.x.
    1. Blackburn GL, Walker WA. Science-based solutions to obesity: what are the roles of academia, government, industry, and health care? Am J Clin Nutr. 2005;82(1 Suppl):207S–10S.

Source: PubMed

스폰서 및 공동 작업자

건강 상태

약물 개입

3
구독하다