Improved lifestyle and decreased diabetes risk over 13 years: long-term follow-up of the randomised Finnish Diabetes Prevention Study (DPS)

• Published in: Diabetologia Vol. 56; no. 2; pp. 284 - 293
• Main Authors: Lindström, J., Peltonen, M., Eriksson, J. G., Ilanne-Parikka, P., Aunola, S., Keinänen-Kiukaanniemi, S., Uusitupa, M., Tuomilehto, J.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01.02.2013; Springer; Springer Nature B.V
• Subjects: Adult; Biological and medical sciences; Blood Glucose - metabolism; Body Weight - physiology; Chronic illnesses; Diabetes; Diabetes Mellitus, Type 2 - epidemiology; Diabetes Mellitus, Type 2 - prevention & control; Diabetes. Impaired glucose tolerance; Diet; Disease prevention; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Exercise; Exercise - physiology; Fasting; Female; Glucose; Human Physiology; Humans; Internal Medicine; Intervention; Life Style; Lifestyles; Male; Medical sciences; Medicine; Medicine & Public Health; Metabolic Diseases; Middle Aged; Nutrition research; Overweight; Plasma; Public health; Finland; Prevention; Type 2 diabetes; Diet; Physical activity; Lifestyle; Long-term; Randomised controlled study; Weight; Endocrinopathy; Physical exercise; Metabolic diseases; Long term; Feeding; Risk factor; Finnish
• ISSN: 0012-186X; 1432-0428
• DOI: 10.1007/s00125-012-2752-5

Aims/hypothesis This study aimed to determine whether lifestyle intervention lasting for 4 years affected diabetes incidence, body weight, glycaemia or lifestyle over 13 years among individuals at high risk of type 2 diabetes. Methods Overweight, middle-aged men ( n  = 172) and women ( n  = 350) with impaired glucose tolerance were randomised in 1993–1998 to an intensive lifestyle intervention group ( n  = 265), aiming at weight reduction, dietary modification and increased physical activity, or to a control group ( n  = 257) that received general lifestyle information. The primary outcome was a diagnosis of diabetes based on annual OGTTs. Secondary outcomes included changes in body weight, glycaemia, physical activity and diet. After active intervention (median 4 years, range 1–6 years), participants still free of diabetes and willing to continue their participation (200 in the intervention group and 166 in the control group) were further followed until diabetes diagnosis, dropout or the end of 2009, with a median total follow-up of 9 years and a time span of 13 years from baseline. Results During the total follow-up the adjusted HR for diabetes (intervention group vs control group) was 0.614 (95% CI 0.478, 0.789; p  < 0.001). The corresponding HR during the post-intervention follow-up was 0.672 (95% CI 0.477, 0.947; p  = 0.023). The former intervention group participants sustained lower absolute levels of body weight, fasting and 2 h plasma glucose and a healthier diet. Adherence to lifestyle changes during the intervention period predicted greater risk reduction during the total follow-up. Conclusions/interpretation Lifestyle intervention in people at high risk of type 2 diabetes induces sustaining lifestyle change and results in long-term prevention of progression to type 2 diabetes. Trial registration ClinicalTrials.gov NCT00518167 Funding The DPS study has been financially supported by the Academy of Finland (128315, 129330), Ministry of Education, Novo Nordisk Foundation, Yrjö Jahnsson Foundation, Juho Vainio Foundation, Finnish Diabetes Research Foundation, Finnish Foundation for Cardiovascular Research, Unilever, and Competitive Research Funding from Tampere, Kuopio and Oulu University Hospitals. The study sponsors had no role in the design and conduct of the study; the collection, analysis and interpretation of the data; or the preparation, review or approval of the manuscript.