title: Intensive lifestyle intervention in general practice to prevent type 2 diabetes among 18 to 60-year-old South Asians: 1-year effects on the weight status and metabolic profile of participants in a randomized controlled trial.
abstract: OBJECTIVE
  To study 1-year effectiveness of an intensive, culturally targeted lifestyle intervention in general practice for weight status and metabolic profile of South-Asians at risk of type 2 diabetes.
  
  
  METHODS
  536 South-Asians at risk of type 2 diabetes were randomized to an intervention (n = 283) or control (n = 253) group. The intervention, which was targeted culturally to the South-Asian population, consisted of individual lifestyle counselling, a family session, cooking classes, and supervised physical activity programme. All components of the intervention were carried out by professionals as part of their daily clinical practice. The control group received generic lifestyle advice. Change in weight status and metabolic profile were assessed after 1 year.
  
  
  RESULTS
  After 1 year, 201 participants were lost to follow-up. Remaining participants in intervention (n = 177) and control (n = 158) group had similar baseline characteristics. Weight loss in the intervention group was 0.2±3.3 kg, weight gain in the control group was 0.4±3.1 kg (p = 0.08). Changes in other weight-related measurements did not differ significantly between groups. Furthermore, there were no differences between groups in changes of metabolic profile. All results remained similar after repeating analyses in a multiple imputed dataset.
  
  
  CONCLUSIONS
  An intensive, culturally targeted, lifestyle intervention of 1 year did not improve weight status and metabolic profile of South-Asians at risk of type 2 diabetes. The laborious recruitment, high drop-out, and lack of effectiveness emphasise the difficulty of realising health benefits in practice and suggest that this strategy might not be the optimal approach for this population.
  
  
  BACKGROUND
  Nederlands Trial Register NTR1499.
authors.affiliation: Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. w.m.admiraal@amc.nl
authors.forename: Wanda M
authors.initials: WM
authors.lastname: Admiraal
authors.forename: Everlina M
authors.initials: EM
authors.lastname: Vlaar
authors.forename: Vera
authors.initials: V
authors.lastname: Nierkens
authors.forename: Frits
authors.initials: F
authors.lastname: Holleman
authors.forename: Barend J C
authors.initials: BJ
authors.lastname: Middelkoop
authors.forename: Karien
authors.initials: K
authors.lastname: Stronks
authors.forename: Irene G M
authors.initials: IG
authors.lastname: van Valkengoed
mesh_terms: D000293:Adolescent; D000328:Adult; D044466:Asian People; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure; D001835:Body Weight; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000378:metabolism* / Q000503:physiopathology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008019:Life Style; D050356:Lipid Metabolism; D008297:Male; D008875:Middle Aged; D012306:Risk; D055815:Young Adult
chemical_list: D001786:Blood Glucose
references.citation: Diabetes Care. 2011 Sep;34(9):1919-25
references.pmid: 21775759
references.citation: Diabetologia. 2006 Feb;49(2):289-97
references.pmid: 16391903
references.citation: BMC Public Health. 2008 Oct 26;8:371
references.pmid: 18950533
references.citation: Br Med J (Clin Res Ed). 1981 Jun 6;282(6279):1847-51
references.pmid: 6786649
references.citation: BMC Public Health. 2007 Sep 19;7:249
references.pmid: 17877832
references.citation: BMC Public Health. 2008 Dec 10;8:406
references.pmid: 19077190
references.citation: Diabetes Res Clin Pract. 2003 Jul;61(1):49-58
references.pmid: 12849923
references.citation: Diabetes Res Clin Pract. 1987 Nov;4(1):1-6
references.pmid: 3691297
references.citation: Am J Prev Med. 2008 Oct;35(4):357-63
references.pmid: 18779029
references.citation: Cochrane Database Syst Rev. 2008 Jul 16;(3):CD006424
references.pmid: 18646153
references.citation: N Engl J Med. 2001 May 3;344(18):1343-50
references.pmid: 11333990
references.citation: BMJ. 2003 Nov 8;327(7423):1059-60
references.pmid: 14604901
references.citation: Diabet Med. 2008 May;25(5):597-605
references.pmid: 18445174
references.citation: Stat Methods Med Res. 1999 Mar;8(1):3-15
references.pmid: 10347857
references.citation: Diabetologia. 1985 Jul;28(7):412-9
references.pmid: 3899825
references.citation: Health Educ Behav. 2000 Oct;27(5):616-31
references.pmid: 11009130
references.citation: Diabetes Care. 2010 Oct;33(10):2146-51
references.pmid: 20664020
references.citation: Diabetes Care. 2004 May;27(5):1047-53
references.pmid: 15111519
references.citation: Ethn Dis. 2010 Autumn;20(4):474-8
references.pmid: 21305840
references.citation: BMC Public Health. 2012 May 23;12:371
references.pmid: 22621376
references.citation: Prim Care Diabetes. 2011 Apr;5(1):45-56
references.pmid: 20869934
references.citation: Diabetes Care. 2001 Aug;24(8):1377-83
references.pmid: 11473073
references.citation: Int J Epidemiol. 2004 Oct;33(5):1112-9
references.pmid: 15166193
references.citation: Postgrad Med J. 2005 Aug;81(958):486-90
references.pmid: 16085737
references.citation: Diabetes Care. 2003 Dec;26(12):3230-6
references.pmid: 14633807
references.citation: Diabetes Care. 1997 Apr;20(4):537-44
references.pmid: 9096977
references.citation: N Engl J Med. 2002 Feb 7;346(6):393-403
references.pmid: 11832527
references.citation: Health Promot Int. 2014 Dec;29(4):680-91
references.pmid: 23564419