Incidence of type 2 diabetes in the randomized multiple risk factor intervention trial.
BACKGROUND
Weight loss and increased physical exercise reduce the risk for diabetes in people with impaired glucose tolerance. Randomized trial evidence on the effect of these interventions on people without impaired glucose tolerance is lacking.


OBJECTIVE
To examine the influence of a comprehensive intervention program on the risk for developing diabetes in men without impaired glucose tolerance and in a post hoc subgroup analysis by baseline cigarette smoking status.


METHODS
Randomized, controlled trial.


METHODS
22 clinical centers for the Multiple Risk Factor Intervention Trial (MRFIT).


METHODS
12,866 men age 35 to 57 years at risk for cardiovascular disease were randomly assigned to either a special intervention or usual care group and followed for 6 to 7 years; this report focuses on 11,827 men without diabetes or impaired glucose tolerance at entry for whom follow-up glucose measurements were available.


METHODS
Cardiovascular disease risk factors, fasting blood glucose levels, and diabetes medication history were assessed before randomization and annually.


METHODS
Men in the special intervention group were counseled to change diet (reduce saturated fat, cholesterol, and calorie intake), to stop smoking, and to increase physical activity. Blood pressure was treated more intensively in the special intervention group than in the usual care group.


RESULTS
11.5% of the special intervention group and 10.8% of the usual care group developed diabetes over 6 years of follow-up (hazard ratio, 1.08 [95% CI, 0.96 to 1.20]). The special intervention-usual care hazard ratio for diabetes was 1.26 (CI, 1.10 to 1.45) among smokers (63%) and 0.82 (CI, 0.68 to 0.98) among nonsmokers (37%). These estimates differed significantly (P = 0.0003). Weight gain after smoking cessation and the use of antihypertensive drugs may have counterbalanced the beneficial effect of the lifestyle intervention for the special intervention group smokers, while the lifestyle intervention was beneficial among nonsmokers.


CONCLUSIONS
Principal findings are based on a post hoc subgroup analysis.


CONCLUSIONS
In nonsmokers, an intervention program that included nutrition counseling to produce reductions in weight, serum cholesterol, and (along with antihypertensive medication) blood pressure reduced the risk for diabetes.
Davey Smith
George
G
Department of Social Medicine, University of Bristol, Bristol, United Kingdom. zetkin@bristol.ac.uk
Bracha
Yiscah
Y
Svendsen
Kenneth H
KH
Neaton
James D
JD
Haffner
Steven M
SM
Kuller
Lewis H
LH
D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology* / Q000517:prevention & control; D004038:Diet, Reducing; D015444:Exercise; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012016:Reference Values; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D016540:Smoking Cessation; D014481:United States / Q000453:epidemiology; D015431:Weight Loss
D000959:Antihypertensive Agents; D001786:Blood Glucose