title: Sustained diabetes risk reduction after real life and primary health care setting implementation of the diabetes in Europe prevention using lifestyle, physical activity and nutritional intervention (DE-PLAN) project.
abstract: Real life implementation studies performed in different settings and populations proved that lifestyle interventions in prevention of type 2 diabetes can be effective. However, little is known about long term results of these translational studies. Therefore, the purpose of this study was to examine the maintenance of diabetes type 2 risk factor reduction achieved 1 year after intervention and during 3 year follow-up in primary health care setting in Poland.
  
  
  
  Study participants (n = 262), middle aged, slightly obese, with increased type 2 diabetes risk ((age 55.5 (SD = 11.3), BMI 32 (SD = 4.8), Finnish Diabetes Risk Score FINDRISC 18.4 (SD = 2.9)) but no diabetes at baseline, were invited for 1 individual and 10 group lifestyle counselling sessions as well as received 6 motivational phone calls and 2 letters followed by organized physical activity sessions combined with counselling to increase physical activity. Measurements were performed at baseline and then repeated 1 and 3 years after the initiation of the intervention.
  
  
  
  One hundred five participants completed all 3 examinations (baseline age 56.6 (SD = 10.7)), BMI 31.1 (SD = 4.9)), FINDRISC 18.57 (SD = 3.09)). Males comprised 13% of the group, 10% of the patients presented impaired fasting glucose (IFG) and 14% impaired glucose tolerance (IGT). Mean weight of participants decreased by 2.27 kg (SD = 5.25) after 1 year (p = <0.001). After 3 years a weight gain by 1.13 kg (SD = 4.6) (p = 0.04) was observed. In comparison with baseline however, the mean total weight loss at the end of the study was maintained by 1.14 kg (SD = 5.8) (ns). Diabetes risk (FINDRISC) declined after one year by 2.8 (SD = 3.6) (p = 0.001) and the decrease by 2.26 (SD = 4.27) was maintained after 3 years (p = 0.001). Body mass reduction by >5% was achieved after 1 and 3 years by 27 and 19% of the participants, respectively. Repeated measures analysis revealed significant changes observed from baseline to year 1 and year 3 in: weight (p = 0.048), BMI (p = 0.001), total cholesterol (p = 0.013), TG (p = 0.061), fasting glucose level (p = 0.037) and FINDRISC (p = 0.001) parameters. The conversion rate to diabetes was 2% after 1 year and 7% after 3 years.
  
  
  
  Type 2 diabetes prevention in real life primary health care setting through lifestyle intervention delivered by trained nurses leads to modest weight reduction, favorable cardiovascular risk factors changes and decrease of diabetes risk. These beneficial outcomes can be maintained at a 3-year follow-up.
  
  
  
  ISRCTN, ID ISRCTN96692060 , registered 03.08.2016 retrospectively.
authors.affiliation: Chair and Department of Endocrinology, Jagiellonian University, Medical College, Kopernika 17, 31-501, Kraków, Poland. myjanusz@cyfronet.pl.
authors.forename: Aleksandra
authors.identifier: 0000-0002-9982-6499
authors.initials: A
authors.lastname: Gilis-Januszewska
authors.affiliation: Chronic Disease Prevention Unit, National Institute for Health and Welfare (THL), Helsinki, Finland.
authors.forename: Jaana
authors.initials: J
authors.lastname: Lindström
authors.affiliation: Centre for Vascular Prevention, Danube-University Krems, Krems, Austria.|Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland.|Department of Public Health, University of Helsinki, Helsinki, Finland.|Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia.|Dasman Diabetes Institute, Dasman, Kuwait.
authors.forename: Jaakko
authors.initials: J
authors.lastname: Tuomilehto
authors.affiliation: Chair and Department of Endocrinology, Jagiellonian University, Medical College, Kopernika 17, 31-501, Kraków, Poland.
authors.forename: Beata
authors.initials: B
authors.lastname: Piwońska-Solska
authors.affiliation: Department of Epidemiology and Population Studies, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Roman
authors.initials: R
authors.lastname: Topór-Mądry
authors.affiliation: Chair and Department of Endocrinology, Jagiellonian University, Medical College, Kopernika 17, 31-501, Kraków, Poland.
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Szybiński
authors.affiliation: Chronic Disease Prevention Unit, National Institute for Health and Welfare (THL), Helsinki, Finland.
authors.forename: Markku
authors.initials: M
authors.lastname: Peltonen
authors.affiliation: Department for Prevention & Care of Diabetes, Medical Clinic Unit III, University Clinic Carl Gustav Carus at Technical University DreSDen, DreSDen, Germany.
authors.forename: Peter E H
authors.initials: PE
authors.lastname: Schwarz
authors.affiliation: Department of Family Medicine, Chair of Medicine and Gerontology, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Adam
authors.initials: A
authors.lastname: Windak
authors.affiliation: Chair and Department of Endocrinology, Jagiellonian University, Medical College, Kopernika 17, 31-501, Kraków, Poland.
authors.forename: Alicja
authors.initials: A
authors.lastname: Hubalewska-Dydejczyk
mesh_terms: D000368:Aged; D015992:Body Mass Index; D003376:Counseling; D003924:Diabetes Mellitus, Type 2 / Q000517:prevention & control*; D004032:Diet; D005060:Europe; D015444:Exercise; D005260:Female; D018149:Glucose Intolerance; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D011044:Poland; D011320:Primary Health Care / Q000458:organization & administration*; D012307:Risk Factors; D040242:Risk Reduction Behavior
keywords: Diabetes type 2 prevention; Diet; Lifestyle intervention; Physical activity; Real life setting; Risk factors