Importance of Weight Loss Maintenance and Risk Prediction in the Prevention of Type 2 Diabetes: Analysis of European Diabetes Prevention Study RCT

Abstract

BackgroundPrevalence 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.MethodsWe 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.ResultsMean 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.ConclusionsPooled 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.Trial registrationsThe 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.

The ABCD of Obesity: An EASO Position Statement on a Diagnostic Term with Clinical and Scientific Implications

“…It is now time to move away from the Sisyphean task of pursuing weight loss aims alone and onto achieving other valued health goals [31]. Lifestyle intervention may reduce type 2 diabetes and cardiometabolic risk by 58%, despite moderate weight loss [32]. Many NCDs have common etiologies, whereby a shift from a vertical to a horizontal approach will ultimately pave the path to more effective prevention and management strategies.…”

‘Knowing what Matters in diabetes: Healthier below 7’: results of the campaign’s first 10 years (part 2), participants without known diabetes history

“…Improvements in body weight, diet and exercise capacity can easily be achieved with modest efforts 14. However, more intensive lifestyle interventions and, in particular, a weight loss of at least 5% maintained over a longer period of time had a more pronounced effect in European clinical trials 15,16. Consequently, such improvements were associated with a markedly reduced incidence of diabetes over an observational period of one to several years 15–18, with lifestyle interventions being clearly superior to metformin and also improving associated cardiovascular risk factors such as hypertension and dyslipidaemia 17.…”

Long-term weight loss following a randomised controlled trial of a weight management programme for men delivered through professional football clubs: the Football Fans in Training follow-up study

“…Data on the timing of the delivery of the protocol were available for 6 out of 10 clubs, either coach-reported or from researcher observation field notes, and five out of six clubs delivered the information on data transfer and linkage during session 6, as per protocol. The total number of men who completed data linkage permission forms across the 10 clubs was 87 (range [5][6][7][8][9][10][11][12][13][14][15][16][17] The number of completed data linkage permission forms returned in phase 2b (range 4-17) was smaller than in phase 1 (range 9-35) and phase 2a (range [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19], which may reflect the fact that the data linkage permission process was conducted over two sessions. This conclusion is supported by variation in the dates on the completed data linkage permission forms in some clubs, suggesting that coaches may have had some problems in getting men to complete their forms after session 6 (i.e.…”

“…[7][8][9][10] Participants in weight loss programmes typically regain 30-35% of lost weight in the first year post intervention, and most return to their baseline weight within 3-5 years. [11][12][13][14] As long-term weight maintenance is essential to maximise the health benefits associated with weight reduction, 15 it is important to understand how to support people to sustain their weight loss following behavioural interventions. Systematic reviews indicate that a combination of energy and fat reduction, regular PA and behavioural strategies (such as regular weighing) is required for successful long-term weight loss.…”