title: Importance of weight loss maintenance and risk prediction in the prevention of type 2 diabetes: analysis of European Diabetes Prevention Study RCT.
abstract: BACKGROUND
  Prevalence of type 2 diabetes (T2D) is increasing worldwide. T2D prevention by lifestyle intervention is effective. Pragmatic scalable interventions are needed, with evidence to efficiently target and monitor such interventions. We report pooled analyses of data from three European trial cohorts: to analyse T2D incidence, sustained weight loss and utility of risk predictors.
  
  
  METHODS
  We analysed data on 749 adults with impaired glucose tolerance (278 men and 471 women, mean age 56 years, mean BMI 31 kgm(-2)) recruited between 1993 and 2003, and randomised to intensive lifestyle intervention (I) or lifestyle advice control (C). The intervention aimed to increase physical activity, modify diet, and promote weight loss≥5%. Using Cox-regression survival analysis, we assessed T2D incidence and the impact on T2D incidence of sustained weight loss, and of baseline cut-point values of FINDRISC score, fasting plasma glucose (FPG), and HbA1c.
  
  
  RESULTS
  Mean follow-up duration was 3.1 years. T2D was diagnosed in 139 participants (I = 45/379, C = 94/370). Cumulative T2D incidence was 57% lower in the intervention compared with the control group (HR 0.42 (95% CI 0.29 to 0.60) P<0.001). Participants with ≥5% weight loss at one year had 65% lower T2D incidence (HR 0.35 (95% CI 0.22 to 0.56) P<0.001); maintaining ≥5% weight loss for two and three years further reduced T2D incidence. Recommended cut-points to identify those at high risk for T2D would have identified different proportions of European Diabetes Prevention Study (EDIPS) participants with similar hazard-ratios for intervention effect.
  
  
  CONCLUSIONS
  Pooled analysis of EDIPS trial data reinforces evidence for T2D prevention by lifestyle intervention. Analysis showed the preventive effect of ≥5% weight loss, especially if maintained long term, which has utility for intervention monitoring. Analysis of proposed cut-points demonstrates difficulties in balancing risk and benefit, to efficiently target interventions and suggests evidence is needed to define clinical policy.
  
  
  BACKGROUND
  THE FINNISH DIABETES PREVENTION STUDY, HELSINKI, FINLAND: ClinicalTrials.gov; NCT00518167 The SLIM diabetes prevention study, Maastricht, The Netherlands: Clinical Trials.gov; NCT00381186 The EDIPS-Newcastle diabetes prevention study, Newcastle upon Tyne, UK: International Standard Randomised Controlled Trial Number; ISRCTN15670600.
authors: Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom. linda.penn@ncl.ac.uk
authors: Linda
authors: L
authors: Penn
authors: Martin
authors: M
authors: White
authors: Jaana
authors: J
authors: Lindström
authors: Annemieke Th
authors: AT
authors: den Boer
authors: Ellen
authors: E
authors: Blaak
authors: Johan G
authors: JG
authors: Eriksson
authors: Edith
authors: E
authors: Feskens
authors: Pirjo
authors: P
authors: Ilanne-Parikka
authors: Sirkka M
authors: SM
authors: Keinänen-Kiukaanniemi
authors: Mark
authors: M
authors: Walker
authors: John C
authors: JC
authors: Mathers
authors: Matti
authors: M
authors: Uusitupa
authors: Jaakko
authors: J
authors: Tuomilehto
mesh_terms: D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000517:prevention & control*; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D006943:Hyperglycemia; D015994:Incidence; D008019:Life Style; D008297:Male; D008875:Middle Aged; D015431:Weight Loss