title: Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: follow-up of the Finnish Diabetes Prevention Study.
abstract: BACKGROUND
  Lifestyle interventions can prevent the deterioration of impaired glucose tolerance to manifest type 2 diabetes, at least as long as the intervention continues. In the extended follow-up of the Finnish Diabetes Prevention Study, we assessed the extent to which the originally-achieved lifestyle changes and risk reduction remain after discontinuation of active counselling.
  
  
  METHODS
  Overweight, middle-aged men (n=172) and women (n=350) with impaired glucose tolerance were randomly assigned to intensive lifestyle intervention or control group. After a median of 4 years of active intervention period, participants who were still free of diabetes were further followed up for a median of 3 years, with median total follow-up of 7 years. Diabetes incidence, bodyweight, physical activity, and dietary intakes of fat, saturated fat, and fibre were measured.
  
  
  RESULTS
  During the total follow-up, the incidence of type 2 diabetes was 4.3 and 7.4 per 100 person-years in the intervention and control group, respectively (log-rank test p=0.0001), indicating 43% reduction in relative risk. The risk reduction was related to the success in achieving the intervention goals of weight loss, reduced intake of total and saturated fat and increased intake of dietary fibre, and increased physical activity. Beneficial lifestyle changes achieved by participants in the intervention group were maintained after the discontinuation of the intervention, and the corresponding incidence rates during the post-intervention follow-up were 4.6 and 7.2 (p=0.0401), indicating 36% reduction in relative risk.
  
  
  CONCLUSIONS
  Lifestyle intervention in people at high risk for type 2 diabetes resulted in sustained lifestyle changes and a reduction in diabetes incidence, which remained after the individual lifestyle counselling was stopped.
authors.affiliation: Diabetes Unit, Department of Health Promotion and Chronic Disease Prevention, National Public Health Institute, Mannerheimintie 166, 00300 Helsinki, Finland. jaana.lindstrom@ktl.fi
authors.forename: Jaana
authors.initials: J
authors.lastname: Lindström
authors.forename: Pirjo
authors.initials: P
authors.lastname: Ilanne-Parikka
authors.forename: Markku
authors.initials: M
authors.lastname: Peltonen
authors.forename: Sirkka
authors.initials: S
authors.lastname: Aunola
authors.forename: Johan G
authors.initials: JG
authors.lastname: Eriksson
authors.forename: Katri
authors.initials: K
authors.lastname: Hemiö
authors.forename: Helena
authors.initials: H
authors.lastname: Hämäläinen
authors.forename: Pirjo
authors.initials: P
authors.lastname: Härkönen
authors.forename: Sirkka
authors.initials: S
authors.lastname: Keinänen-Kiukaanniemi
authors.forename: Mauri
authors.initials: M
authors.lastname: Laakso
authors.forename: Anne
authors.initials: A
authors.lastname: Louheranta
authors.forename: Marjo
authors.initials: M
authors.lastname: Mannelin
authors.forename: Merja
authors.initials: M
authors.lastname: Paturi
authors.forename: Jouko
authors.initials: J
authors.lastname: Sundvall
authors.forename: Timo T
authors.initials: TT
authors.lastname: Valle
authors.forename: Matti
authors.initials: M
authors.lastname: Uusitupa
authors.forename: Jaakko
authors.initials: J
authors.lastname: Tuomilehto
mesh_terms: D001786:Blood Glucose; D003376:Counseling; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000517:prevention & control*; D004032:Diet; D015444:Exercise; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008019:Life Style; D008297:Male; D013997:Time Factors
chemical_list: D001786:Blood Glucose