ArticlesSustained reduction in the incidence of type 2 diabetes by lifestyle intervention: follow-up of the Finnish Diabetes Prevention Study
Introduction
The pandemic of type 2 diabetes is an enormous public health problem.1, 2 Studies using lifestyle intervention in people with impaired glucose tolerance have shown that the progress to manifest type 2 diabetes can be prevented or postponed.3, 4, 5, 6, 7, 8 Lifestyle intervention in these studies lasting for 3–6 years emphasised bodyweight control, physical activity, and dietary modification. Reduction in relative risk achieved in the intervention group compared with the control group ranged from 30% to 67%, as shown in a recent meta-analysis.9 The Finnish Diabetes Prevention Study5 and the US Diabetes Prevention Program6 both revealed a 58% relative risk reduction in the progression from impaired glucose tolerance to type 2 diabetes, during a mean intervention period of about 3 years.
However, whether the risk reduction achieved during active counselling for lifestyle changes will last after discontinuation of the intervention is not known. The extended follow-up of the Diabetes Prevention Study was designed to assess the long-term results of the lifestyle intervention originally aimed at reducing the risk for developing type 2 diabetes in high-risk individuals.
Section snippets
Methods
The Diabetes Prevention Study was a randomised controlled trial aimed at prevention of type 2 diabetes by lifestyle intervention. The study design has been described in detail previously.10 The study protocol was approved by the ethics committee of the National Public Health Institute in Helsinki, Finland, and all study participants gave written informed consent. Randomisation started in 1993 and was completed in 1998 (figure 1). The first interim analysis was done in March, 2000.5 According to
Results
The total number of cases of diabetes diagnosed during the overall follow-up of 7 years was 75 in the intervention group and 110 in the control group (figure 1). The incidence rates were 4·3 (95% CI 3·4–5·4) and 7·4 (6·1–8·9) per 100 person-years in the intervention and control group, respectively (p=0·0001 log-rank test). The corresponding hazard ratio was 0·57 (0·43–0·76; figure 2). The cumulative incidence of diabetes at year 6 was 23% in the intervention group and 38% in the control group,
Discussion
Individually randomised controlled lifestyle intervention studies have shown the benefit of healthy lifestyle on delaying the deterioration of glucose tolerance to manifest type 2 diabetes, at least as long as the inter–vention continues.5, 6, 7, 8 Our study with a median of 7 years total follow-up shows that a marked difference in the cumulative incidence of diabetes can be sustained after the discontinuation of active counselling. The absolute difference in diabetes risk between the
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