title: Prevention of type 2 diabetes in a primary healthcare setting: three-year results of lifestyle intervention in Japanese subjects with impaired glucose tolerance.
abstract: BACKGROUND
  A randomized control trial was performed to test whether a lifestyle intervention program, carried out in a primary healthcare setting using existing resources, can reduce the incidence of type 2 diabetes in Japanese with impaired glucose tolerance (IGT). The results of 3 years' intervention are summarized.
  
  
  METHODS
  Through health checkups in communities and workplaces, 304 middle-aged IGT subjects with a mean body mass index (BMI) of 24.5 kg/m2 were recruited and randomized to the intervention group or control group. The lifestyle intervention was carried out for 3 years by public health nurses using the curriculum and educational materials provided by the study group.
  
  
  RESULTS
  After 1 year, the intervention had significantly improved body weight (-1.5 ± 0.7 vs. -0.7 ± 2.5 kg in the control; p = 0.023) and daily non-exercise leisure time energy expenditure (25 ± 113 vs. -3 ± 98 kcal; p = 0.045). Insulin sensitivity assessed by the Matsuda index was improved by the intervention during the 3 years. The 3-year cumulative incidence tended to be lower in the intervention group (14.8% vs.8.2%, log-rank test: p = 0.097). In a sub-analysis for the subjects with a BMI > 22.5 kg/m2, a significant reduction in the cumulative incidence was found (p = 0.027).
  
  
  CONCLUSIONS
  The present lifestyle intervention program using existing healthcare resources is beneficial in preventing diabetes in Japanese with IGT. This has important implications for primary healthcare-based diabetes prevention.
  
  
  BACKGROUND
  UMIN000003136.
authors.affiliation: Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan. nsakane@kyotolan.hosp.go.jp
authors.forename: Naoki
authors.initials: N
authors.lastname: Sakane
authors.forename: Juichi
authors.initials: J
authors.lastname: Sato
authors.forename: Kazuyo
authors.initials: K
authors.lastname: Tsushita
authors.forename: Satoru
authors.initials: S
authors.lastname: Tsujii
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Kotani
authors.forename: Kokoro
authors.initials: K
authors.lastname: Tsuzaki
authors.forename: Makoto
authors.initials: M
authors.lastname: Tominaga
authors.forename: Shoji
authors.initials: S
authors.lastname: Kawazu
authors.forename: Yuzo
authors.initials: Y
authors.lastname: Sato
authors.forename: Takeshi
authors.initials: T
authors.lastname: Usui
authors.forename: Isao
authors.initials: I
authors.lastname: Kamae
authors.forename: Toshihide
authors.initials: T
authors.lastname: Yoshida
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Kiyohara
authors.forename: Shigeaki
authors.initials: S
authors.lastname: Sato
authors.forename: Hideshi
authors.initials: H
authors.lastname: Kuzuya
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000032:analysis; D015992:Body Mass Index; D001835:Body Weight / Q000502:physiology; D003153:Community Health Services / Q000706:statistics & numerical data; D057186:Comparative Effectiveness Research; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000517:prevention & control* / Q000628:therapy; D004734:Energy Metabolism; D005260:Female; D005500:Follow-Up Studies; D018149:Glucose Intolerance / Q000503:physiopathology*; D005951:Glucose Tolerance Test; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D007328:Insulin / Q000378:metabolism; D007564:Japan; D007899:Leisure Activities / Q000523:psychology; D008019:Life Style; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000379:methods*; D011637:Public Health Nursing / Q000193:education / Q000379:methods
chemical_list: D001786:Blood Glucose; D007328:Insulin