Prevention of diabetes mellitus in subjects with impaired glucose tolerance in the Finnish Diabetes Prevention Study: results from a randomized clinical trial.
Type 2 diabetes mellitus is increasing worldwide largely as a result from increasing obesity and sedentary lifestyle. The Finnish Diabetes Prevention Study (DPS) is the first individually randomized controlled clinical trial to test the feasibility and efficacy of lifestyle modification in high-risk subjects. We randomly assigned 522 (172 men, 350 women) middle-aged (mean age 55 yr), overweight (mean body mass index 31 kg/m(2)) subjects with impaired glucose tolerance either to the lifestyle intervention or control group. Each subject in the intervention group received individualized counseling aimed at reducing weight and intake of total and saturated fat, and increasing intake of fiber and physical activity. An oral glucose tolerance test was performed annually to detect incident cases of diabetes and to measure changes in metabolic parameters. The mean (+/- SD) weight reduction from baseline to year 1 and to year 2, respectively, was 4.2 +/- 5.1 kg and 3.5 +/- 5.5 in the intervention group and 0.8 +/- 3.7 kg and 0.8 +/- 4.4 in the control group (P < 0.001 between the groups). At the time of first analysis of the outcome data the mean duration of follow-up was 3.2 yr. The risk of diabetes was reduced by 58% (P < 0.001) in the intervention group compared with the control group. The reduction in the incidence of diabetes was directly associated with number and magnitude of lifestyle changes made. In conclusion, the DPS is the first controlled trial demonstrating that type 2 diabetes can be prevented by changes in lifestyle in high-risk subjects.
Lindström
Jaana
J
National Public Health Institute, Department of Epidemiology, Diabetes and Genetic Epidemiology Unit, Helsinki, Finland.
Eriksson
Johan G
JG
Valle
Timo T
TT
Aunola
Sirkka
S
Cepaitis
Zygimantas
Z
Hakumäki
Martti
M
Hämäläinen
Helena
H
Ilanne-Parikka
Pirjo
P
Keinänen-Kiukaanniemi
Sirkka
S
Laakso
Mauri
M
Louheranta
Anne
A
Mannelin
Marjo
M
Martikkala
Vesa
V
Moltchanov
Vladislav
V
Rastas
Merja
M
Salminen
Virpi
V
Sundvall
Jouko
J
Uusitupa
Matti
M
Tuomilehto
Jaakko
J
D000328:Adult; D016001:Confidence Intervals; D003924:Diabetes Mellitus, Type 2 / Q000517:prevention & control* / Q000628:therapy; D004032:Diet; D005260:Female; D005387:Finland; D005500:Follow-Up Studies; D005951:Glucose Tolerance Test; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D011322:Primary Prevention / Q000379:methods*; D012016:Reference Values; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome; D015431:Weight Loss