Importance of weight loss maintenance and risk prediction in the prevention of type 2 diabetes: analysis of European Diabetes Prevention Study RCT - PubMed (original) (raw)
Randomized Controlled Trial
doi: 10.1371/journal.pone.0057143. Epub 2013 Feb 25.
Martin White, Jaana Lindström, Annemieke Th den Boer, Ellen Blaak, Johan G Eriksson, Edith Feskens, Pirjo Ilanne-Parikka, Sirkka M Keinänen-Kiukaanniemi, Mark Walker, John C Mathers, Matti Uusitupa, Jaakko Tuomilehto
Affiliations
- PMID: 23451166
- PMCID: PMC3581561
- DOI: 10.1371/journal.pone.0057143
Randomized Controlled Trial
Importance of weight loss maintenance and risk prediction in the prevention of type 2 diabetes: analysis of European Diabetes Prevention Study RCT
Linda Penn et al. PLoS One. 2013.
Abstract
Background: Prevalence of type 2 diabetes (T2D) is increasing worldwide. T2D prevention by lifestyle intervention is effective. Pragmatic scalable interventions are needed, with evidence to efficiently target and monitor such interventions. We report pooled analyses of data from three European trial cohorts: to analyse T2D incidence, sustained weight loss and utility of risk predictors.
Methods: We analysed data on 749 adults with impaired glucose tolerance (278 men and 471 women, mean age 56 years, mean BMI 31 kgm(-2)) recruited between 1993 and 2003, and randomised to intensive lifestyle intervention (I) or lifestyle advice control (C). The intervention aimed to increase physical activity, modify diet, and promote weight loss≥5%. Using Cox-regression survival analysis, we assessed T2D incidence and the impact on T2D incidence of sustained weight loss, and of baseline cut-point values of FINDRISC score, fasting plasma glucose (FPG), and HbA1c.
Results: Mean follow-up duration was 3.1 years. T2D was diagnosed in 139 participants (I = 45/379, C = 94/370). Cumulative T2D incidence was 57% lower in the intervention compared with the control group (HR 0.42 (95% CI 0.29 to 0.60) P<0.001). Participants with ≥5% weight loss at one year had 65% lower T2D incidence (HR 0.35 (95% CI 0.22 to 0.56) P<0.001); maintaining ≥5% weight loss for two and three years further reduced T2D incidence. Recommended cut-points to identify those at high risk for T2D would have identified different proportions of European Diabetes Prevention Study (EDIPS) participants with similar hazard-ratios for intervention effect.
Conclusions: Pooled analysis of EDIPS trial data reinforces evidence for T2D prevention by lifestyle intervention. Analysis showed the preventive effect of ≥5% weight loss, especially if maintained long term, which has utility for intervention monitoring. Analysis of proposed cut-points demonstrates difficulties in balancing risk and benefit, to efficiently target interventions and suggests evidence is needed to define clinical policy.
Trial registrations: THE FINNISH DIABETES PREVENTION STUDY, HELSINKI, FINLAND: ClinicalTrials.gov; NCT00518167 The SLIM diabetes prevention study, Maastricht, The Netherlands: Clinical Trials.gov; NCT00381186 The EDIPS-Newcastle diabetes prevention study, Newcastle upon Tyne, UK: International Standard Randomised Controlled Trial Number; ISRCTN15670600.
Conflict of interest statement
Competing Interests: The authors have the following interests. M. Walker has been paid for consultancy work by Sanofi. JL has been paid for lectures by MSD and Ely Lilly Finland and paid for travel and meeting expenses by Novo Nordisk. Following completion of: 1 the EDIPS-Newcastle study, LP, M. White, JCM, and M. Walker (with full agreement of the Wellcome Trust); 2 the DPS JL; and 3 the SLIM study EB A-dB; have supplied expertise, data and study samples to Tethys Bioscience, 5858 Horton St, Suite 280 Emeryville, CA 94608. Newcastle University, THL Finland, and Maastricht University received remuneration from Tethys bioscience as well as additional sample analysis data. These resources did not contribute to completion of the submitted work. There are no other relationships or activities that could appear to have influenced the submitted work.
Figures
Similar articles
- Prevention of type 2 diabetes in adults with impaired glucose tolerance: the European Diabetes Prevention RCT in Newcastle upon Tyne, UK.
Penn L, White M, Oldroyd J, Walker M, Alberti KG, Mathers JC. Penn L, et al. BMC Public Health. 2009 Sep 16;9:342. doi: 10.1186/1471-2458-9-342. BMC Public Health. 2009. PMID: 19758428 Free PMC article. Clinical Trial. - Sustained diabetes risk reduction after real life and primary health care setting implementation of the diabetes in Europe prevention using lifestyle, physical activity and nutritional intervention (DE-PLAN) project.
Gilis-Januszewska A, Lindström J, Tuomilehto J, Piwońska-Solska B, Topór-Mądry R, Szybiński Z, Peltonen M, Schwarz PE, Windak A, Hubalewska-Dydejczyk A. Gilis-Januszewska A, et al. BMC Public Health. 2017 Feb 15;17(1):198. doi: 10.1186/s12889-017-4104-3. BMC Public Health. 2017. PMID: 28202029 Free PMC article. - The iHealth-T2D study, prevention of type 2 diabetes amongst South Asians with central obesity and prediabetes: study protocol for a randomised controlled trial.
Kasturiratne A, Khawaja KI, Ahmad S, Siddiqui S, Shahzad K, Athauda LK, Jayawardena R, Mahmood S, Muilwijk M, Batool T, Burney S, Glover M, Palaniswamy S, Bamunuarachchi V, Panda M, Madawanarachchi S, Rai B, Sattar I, Silva W, Waghdhare S, Jarvelin MR, Rannan-Eliya RP, Gage HM, van Valkengoed IGM, Valabhji J, Frost GS, Loh M, Wickremasinghe AR, Kooner JS, Katulanda P, Jha S, Chambers JC. Kasturiratne A, et al. Trials. 2021 Dec 18;22(1):928. doi: 10.1186/s13063-021-05803-7. Trials. 2021. PMID: 34922608 Free PMC article. - Effects of dietary and physical activity interventions on the risk of type 2 diabetes in South Asians: meta-analysis of individual participant data from randomised controlled trials.
Jenum AK, Brekke I, Mdala I, Muilwijk M, Ramachandran A, Kjøllesdal M, Andersen E, Richardsen KR, Douglas A, Cezard G, Sheikh A, Celis-Morales CA, Gill JMR, Sattar N, Bhopal RS, Beune E, Stronks K, Vandvik PO, van Valkengoed IGM. Jenum AK, et al. Diabetologia. 2019 Aug;62(8):1337-1348. doi: 10.1007/s00125-019-4905-2. Epub 2019 Jun 15. Diabetologia. 2019. PMID: 31201437 Review. - Behavioral and Pharmacotherapy Weight Loss Interventions to Prevent Obesity-Related Morbidity and Mortality in Adults: An Updated Systematic Review for the U.S. Preventive Services Task Force [Internet].
LeBlanc EL, Patnode CD, Webber EM, Redmond N, Rushkin M, O’Connor EA. LeBlanc EL, et al. Rockville (MD): Agency for Healthcare Research and Quality (US); 2018 Sep. Report No.: 18-05239-EF-1. Rockville (MD): Agency for Healthcare Research and Quality (US); 2018 Sep. Report No.: 18-05239-EF-1. PMID: 30354042 Free Books & Documents. Review.
Cited by
- 2023 Clinical Practice Guidelines for Diabetes Management in Korea: Full Version Recommendation of the Korean Diabetes Association.
Moon JS, Kang S, Choi JH, Lee KA, Moon JH, Chon S, Kim DJ, Kim HJ, Seo JA, Kim MK, Lim JH, Song YJ, Yang YS, Kim JH, Lee YB, Noh J, Hur KY, Park JS, Rhee SY, Kim HJ, Kim HM, Ko JH, Kim NH, Kim CH, Ahn J, Oh TJ, Kim SK, Kim J, Han E, Jin SM, Bae J, Jeon E, Kim JM, Kang SM, Park JH, Yun JS, Cha BS, Moon MK, Lee BW. Moon JS, et al. Diabetes Metab J. 2024 Jul;48(4):546-708. doi: 10.4093/dmj.2024.0249. Epub 2024 Jul 26. Diabetes Metab J. 2024. PMID: 39091005 Free PMC article. No abstract available. - Transition between cardiometabolic conditions and body weight among women: which paths increase the risk of diabetes and cardiovascular diseases?
Baneshi MR, Dobson A, Mishra GD. Baneshi MR, et al. J Hum Hypertens. 2024 Aug;38(8):611-619. doi: 10.1038/s41371-024-00923-4. Epub 2024 Jun 12. J Hum Hypertens. 2024. PMID: 38866978 Free PMC article. - Body weight changes and diabetes mellitus incident: A cohort study from the Middle East.
Salesi R, Kermani-Alghoraishi M, Sadeghi A, Roohafza H, Talaei M, Sarrafzadegan N, Sadeghi M. Salesi R, et al. J Prev Med Hyg. 2023 Nov 1;64(3):E345-E351. doi: 10.15167/2421-4248/jpmh2023.64.3.2650. eCollection 2023 Sep. J Prev Med Hyg. 2023. PMID: 38125999 Free PMC article. - Impact of individual and environmental factors on dietary or lifestyle interventions to prevent type 2 diabetes development: a systematic review.
Bodhini D, Morton RW, Santhakumar V, Nakabuye M, Pomares-Millan H, Clemmensen C, Fitzpatrick SL, Guasch-Ferre M, Pankow JS, Ried-Larsen M, Franks PW; ADA/EASD PMDI; Tobias DK, Merino J, Mohan V, Loos RJF. Bodhini D, et al. Commun Med (Lond). 2023 Oct 5;3(1):133. doi: 10.1038/s43856-023-00363-0. Commun Med (Lond). 2023. PMID: 37794109 Free PMC article. - Prediabetes: what are we talking about?
Escalada San Martín J. Escalada San Martín J. Adv Lab Med. 2021 Jul 26;2(3):305-312. doi: 10.1515/almed-2021-0034. eCollection 2021 Aug. Adv Lab Med. 2021. PMID: 37362411 Free PMC article. No abstract available.
References
- International Diabetes Federation (2011) Diabetes Atlas 5th edition. Brussels.
- NICE (2012) PH 38 Preventing type 2 diabetes - risk identification and interventions for individuals at high risk. Available: http://guidanceniceorguk/PH38. London.
- NICE (2011) PH35 Preventing type 2 diabetes - population and community interventions: supporting evidence. Available: http://guidanceniceorguk/PH35. London.
- Chatterton H, Younger T, Fischer A, Khunti K (2012) Risk identification and interventions to prevent type 2 diabetes in adults at high risk: summary of NICE guidance. BMJ 345. - PubMed
- Tuomilehto J, Lindstrom J, Eriksson JG, Valle TT, Hamalainen H, et al. (2001) Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. New England Journal of Medicine 344: 1343–1350. - PubMed
Publication types
MeSH terms
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical
Research Materials