title: Cardiovascular mortality, all-cause mortality, and diabetes incidence after lifestyle intervention for people with impaired glucose tolerance in the Da Qing Diabetes Prevention Study: a 23-year follow-up study.
abstract: BACKGROUND
  Lifestyle interventions among people with impaired glucose tolerance reduce the incidence of diabetes, but their effect on all-cause and cardiovascular disease mortality is unclear. We assessed the long-term effect of lifestyle intervention on long-term outcomes among adults with impaired glucose tolerance who participated in the Da Qing Diabetes Prevention Study.
  
  
  METHODS
  The study was a cluster randomised trial in which 33 clinics in Da Qing, China-serving 577 adults with impaired glucose tolerance-were randomised (1:1:1:1) to a control group or lifestyle intervention groups (diet or exercise or both). Patients were enrolled in 1986 and the intervention phase lasted for 6 years. In 2009, we followed up participants to assess the primary outcomes of cardiovascular mortality, all-cause mortality, and incidence of diabetes in the intention-to-treat population.
  
  
  RESULTS
  Of the 577 patients, 439 were assigned to the intervention group and 138 were assigned to the control group (one refused baseline examination). 542 (94%) of 576 participants had complete data for mortality and 568 (99%) contributed data to the analysis. 174 participants died during the 23 years of follow-up (121 in the intervention group vs 53 in the control group). Cumulative incidence of cardiovascular disease mortality was 11.9% (95% CI 8.8-15.0) in the intervention group versus 19.6% (12.9-26.3) in the control group (hazard ratio [HR] 0.59, 95% CI 0.36-0.96; p=0.033). All-cause mortality was 28.1% (95% CI 23.9-32.4) versus 38.4% (30.3-46.5; HR 0.71, 95% CI 0.51-0.99; p=0.049). Incidence of diabetes was 72.6% (68.4-76.8) versus 89.9% (84.9-94.9; HR 0.55, 95% CI 0.40-0.76; p=0.001).
  
  
  CONCLUSIONS
  A 6-year lifestyle intervention programme for Chinese people with impaired glucose tolerance can reduce incidence of cardiovascular and all-cause mortality and diabetes. These findings emphasise the long-term clinical benefits of lifestyle intervention for patients with impaired glucose tolerance and provide further justification for adoption of lifestyle interventions as public health measures to control the consequences of diabetes.
  
  
  BACKGROUND
  Centers for Disease Control and Prevention, WHO, the China-Japan Friendship Hospital, Da Qing First Hospital.
authors.affiliation: Department of Endocrinology, China-Japan Friendship Hospital, Beijing, China; Center of Endocrinology and Cardiovascular Disease, National Center of Cardiology & Fuwai Hospital, Beijing, China. Electronic address: guangwei_li@medmail.com.cn.
authors.forename: Guangwei
authors.initials: G
authors.lastname: Li
authors.affiliation: Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, USA. Electronic address: pzhang@cdc.gov.
authors.forename: Ping
authors.initials: P
authors.lastname: Zhang
authors.affiliation: Department of Cardiology, Da Qing First Hospital, Da Qing, China.
authors.forename: Jinping
authors.initials: J
authors.lastname: Wang
authors.affiliation: Center of Endocrinology and Cardiovascular Disease, National Center of Cardiology & Fuwai Hospital, Beijing, China.
authors.forename: Yali
authors.initials: Y
authors.lastname: An
authors.affiliation: Center of Endocrinology and Cardiovascular Disease, National Center of Cardiology & Fuwai Hospital, Beijing, China.
authors.forename: Qiuhong
authors.initials: Q
authors.lastname: Gong
authors.affiliation: Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Edward W
authors.initials: EW
authors.lastname: Gregg
authors.affiliation: Department of Endocrinology, China-Japan Friendship Hospital, Beijing, China.
authors.forename: Wenying
authors.initials: W
authors.lastname: Yang
authors.affiliation: Department of Endocrinology, China-Japan Friendship Hospital, Beijing, China.
authors.forename: Bo
authors.initials: B
authors.lastname: Zhang
authors.affiliation: Department of Endocrinology, China-Japan Friendship Hospital, Beijing, China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Shuai
authors.affiliation: Department of Endocrinology, China-Japan Friendship Hospital, Beijing, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Hong
authors.affiliation: Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Michael M
authors.initials: MM
authors.lastname: Engelgau
authors.affiliation: Department of Cardiology, Da Qing First Hospital, Da Qing, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Li
authors.affiliation: Department of Management of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland.
authors.forename: Gojka
authors.initials: G
authors.lastname: Roglic
authors.affiliation: Department of Cardiology, Da Qing First Hospital, Da Qing, China.
authors.forename: Yinghua
authors.initials: Y
authors.lastname: Hu
authors.affiliation: Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ, USA.
authors.forename: Peter H
authors.initials: PH
authors.lastname: Bennett
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism*; D002318:Cardiovascular Diseases / Q000097:blood / Q000401:mortality* / Q000517:prevention & control; D002681:China / Q000453:epidemiology; D016000:Cluster Analysis; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control; D015444:Exercise; D005260:Female; D005500:Follow-Up Studies; D018149:Glucose Intolerance / Q000453:epidemiology*; D005951:Glucose Tolerance Test; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D040242:Risk Reduction Behavior; D013997:Time Factors; D015431:Weight Loss
chemical_list: D001786:Blood Glucose