Can type 2 diabetes be prevented in UK general practice? A lifestyle-change feasibility study (ISAIAH).
BACKGROUND
The increasing incidence of type 2 diabetes mellitus is attributed to increasing weight, reduced physical activity, and poor diet quality. Lifestyle change in patients with pre-diabetes can reduce progression to diabetes but this is difficult to achieve in practice.


OBJECTIVE
To study the effectiveness of a lifestyle-change intervention for pre-diabetes in general practice.


METHODS
A feasibility study.


METHODS
A medium-sized general practice in Sheffield.


METHODS
Participants were 33 patients with pre-diabetes. The intervention was a 6-month delayed entry comparison of usual treatment with a lifestyle-change programme: increased exercise and diet change, either reduction in glycaemic load, or reduced-fat diet. The main outcome measures were weight, body mass index (BMI), waist circumference, fasting glucose, lipid profile, and nutrition.


RESULTS
A statistically significant difference was observed between control and intervention groups in three markers for risk of progression to diabetes (weight (P<0.03), BMI (P<0.03), and waist circumference (P<0.001)). No significant differences in fasting glucose or lipid profiles were seen. Aggregated data showed a statistically non-significant improvement in all the measures of metabolic risk of progression to diabetes in the low-glycaemic-load group when compared with a low-fat-diet group (P>0.05). Significant total energy, fat, and carbohydrate intake reduction was achieved and maintained in both groups.


CONCLUSIONS
A lifestyle-change intervention feasibility programme for pre-diabetic patients was implemented in general clinical practice. The potential of a low-glycaemic-load diet to be more effective than a low-fat diet in promoting change in the features associated with progression to diabetes is worthy of further investigation.
Barclay
Chris
C
Academic Unit of Primary Medical Care, University of Sheffield, Northern General Hospital, Herries Road, Sheffield, S5 7AU. csbarclay@btinternet.com
Procter
Kimberley L
KL
Glendenning
Robert
R
Marsh
Peter
P
Freeman
Jenny
J
Mathers
Nigel
N
D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000178:diet therapy / Q000517:prevention & control*; D018752:Diet, Fat-Restricted; D015444:Exercise; D005194:Family Practice; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009042:Motivation; D012307:Risk Factors; D016896:Treatment Outcome; D015431:Weight Loss
D001786:Blood Glucose