A pragmatic lifestyle modification programme reduces the incidence of predictors of cardio-metabolic disease and dysglycaemia in a young healthy urban South Asian population: a randomised controlled trial

Abstract

BackgroundThere is an increasing incidence of type 2 diabetes mellitus (T2DM) in young urban South-Asians. We tested the effect of a pragmatic trimonthly lifestyle modification (LSM) programme (P-LSM) versus a less-intensive 12-monthly control LSM (C-LSM) intervention on a primary composite endpoint of predictors of cardio-metabolic disease (new onset T2DM, hypertension, impaired glucose tolerance (IGT), impaired fasting glycaemia (IFG) and markers of cardio-renal disease) in participants aged 5–40 years with risk factors for T2DM.MethodsThis was a randomised controlled trial performed at the National Diabetes Centre, Sri-Lanka. We individually randomised 4672 participants at risk of T2DM, of whom 3539 (mean age 22.5 (range 6–40 years, 48% males) received either trimonthly (P-LSM n = 1726) or 12-monthly (C-LSM n = 1813) peer educator advice aimed at reducing weight, improving diet, reducing psychological stress and increasing physical activity.ResultsDuring a median follow-up of 3 years, the cumulative incidence of the primary endpoint was n = 479 in P-LSM (74 per 1000 person years) vs. 561 in C-LSM (96 per 1000 person years), with an incident rate ratio (IRR) of 0.89 (95% CI 0.83–0.96, P = 0.02). In post hoc analyses, new onset dysglycaemia (T2DM, IFG and IGT), was the major contributor to the composite and was significantly reduced by P-LSM (IRR 0.9, 95% CI 0.83–0.97, P = 0.01). A significant impact of P-LSM on the incidence of the composite endpoint was noted in 1725 participants (P-LSM n = 850, C-LSM n = 875) aged below 18; P-LSM n = 140 (48 per 1000 person years) versus C-LSM n = 174 (55.4 per 1000 person years), with an IRR of 0.83 (95% CI 0.73–0.94, P = 0.004).ConclusionsIn a young at-risk South-Asian population, a pragmatic LSM programme significantly reduces the incidence of predictors of cardio-metabolic disease. Our results highlight the importance of early intervention in young at-risk subjects.Trial registrationWorld Health Organization international clinical trial registry platform (SLCTR/2008/003). Registration Date: March 28, 2008. Retrospectively registered.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-017-0905-6) contains supplementary material, which is available to authorized users.

Effects of dietary and physical activity interventions on the risk of type 2 diabetes in South Asians: meta-analysis of individual participant data from randomised controlled trials

“…Following fulltext review of 17 articles, six RCTs fulfilled the inclusion criteria for the individual participant data meta-analysis [12,[15][16][17][18]26]. The characteristics of excluded studies [33][34][35][36][37][38][39][40][41][42][43] are given in ESM Table 1. We obtained individual participant data for all six eligible studies for the meta-analysis (Table 1).…”

Ethnicity and Metabolic Syndrome: Implications for Assessment, Management and Prevention

“…Others have looked at translating successful interventions in European-derived populations to different racial/ethnic groups and delivering them in local communities. These studies have demonstrated significant reduction in MetS risk factors in African-Americans, [116] Hispanics [117,118] and South Asians living in India, Pakistan and the United Kingdom [119][120][121]. Community initiatives have also worked in increasing physical activity through walking programs in Hispanic neighbourhoods [122] and improving nutrition through local dietary counselling in African-American neighbourhoods [123].…”

DIABRISK-SL trial: further consideration of age and impact of imputations

“…The intervention implemented by Wijesuriya et al [1] is generally well described; however, given the wide age range of participants included in the study (6–40 years), further details are required regarding the nature of the intervention delivered to children. It is unclear whether the study provided a nuanced intervention for those aged under 18 years considering different approaches for the various age brackets and their respective developmental stages [3].…”

“…There is an increasing incidence of type 2 diabetes mellitus (T2DM) in young urban South-Asians. In a large scale randomised controlled trial delivered in Sri Lanka, Wijesuriya et al compared a trimonthly lifestyle modification programme with a less-intensive 12-monthly control programme to determine impact predictors of cardiometabolic disease in participants aged 5–40 years with risk factors for T2DM [1].…”