Diet and exercise interventions over 6 years can prevent or delay diabetes for 14 years
May 22, 2008 - 3:59:37 AM
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The authors conclude: This study has shown that, in Chinese people with impaired glucose tolerance, group-based interventions targeting lifestyle changes such as diet and exercise produce a durable and long-lasting reduction in incidence of type 2 diabetes…Since around 3 million excess deaths a year are attributable to diabetes worldwide, lifestyle interventions seem to be a justifiable public-health action both in developed and developing nations.
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By Lancet,
[RxPG]
Group-based diet and exercise lifestyle interventions over six years can prevent or delay diabetes for up to 14 years after the intervention period. But whether lifestyle interventions also lead to reduced cardiovascular disease (CVD) and mortality remains unclear. These are the conclusions of authors of an Article in this week's Diabetes Special Issue of The Lancet.
While several major clinical trials around the world have shown the effectiveness of lifestyle interventions to reduce diabetes incidence in people with impaired glucose tolerance*, questions remain over how long post-intervention these strategies remain effective. Professor Guangwei Li, China-Japan Friendship Hospital, Beijing, China, and Dr Ping Zhang, Centers for Disease Control and Prevention, Atlanta, Georgia, USA, and colleagues did the China Da Qing Diabetes Prevention Outcome Study (CDQDPOS), which followed-up patients 20 years after enrolment.
In 1986, 577 adults with impaired glucose tolerance from 33 clinics in China were randomly assigned to the control group or one of three lifestyle intervention groups (diet, exercise, or diet plus exercise). Active intervention took place over six years until 1992, and in 2006 study participants were followed-up to assess the long-term effect of the interventions. Primary outcomes were diabetes incidence, CVD incidence and mortality, and all-cause mortality.
The researchers found that compared with control participants, the combined lifestyle interventions reduced the incidence of diabetes by about a half (51%) during the active intervention period, and by 43% over the whole 20-year period. The average annual incidence of newly diagnosed diabetes was 7% for intervention participants and 11% in control participants. At the end of the 20 years, 80% of the intervention group had diabetes, compared with 93% of the control group. Those in the intervention group spent an average of 3.6 fewer years with diabetes than those in the control group. While there was no significant difference between intervention and control groups in the rate of first CVD events, CVD mortality and all-cause mortality, the study had limited statistical power to detect differences for these outcomes.
The authors conclude: This study has shown that, in Chinese people with impaired glucose tolerance, group-based interventions targeting lifestyle changes such as diet and exercise produce a durable and long-lasting reduction in incidence of type 2 diabetes…Since around 3 million excess deaths a year are attributable to diabetes worldwide, lifestyle interventions seem to be a justifiable public-health action both in developed and developing nations.
In an accompanying Comment, Dr Jaana Lindström, National Public Health Institute, Helsinki and University of Helsinki, Finland, and Professor Matti Uusitupa, University of Kuopio, Finland, say: We propose that lifestyle intervention should start much earlier, when people are normoglycaemic, to achieve true primary prevention of type 2 diabetes and its main consequence, cardiovascular disease. In this regard, both population-based strategies and those targeted at high-risk groups should be applied.
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