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

AimTo 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.Methods536 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.ResultsAfter 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.DiscussionAn 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.Trial RegistrationNederlands Trial Register NTR1499

Comparable Dietary Patterns Describe Dietary Behavior across Ethnic Groups in the Netherlands, but Different Elements in the Diet Are Associated with Glycated Hemoglobin and Fasting Glucose Concentrations

“…In Western societies, ethnic minority populations suffer a disproportionate burden of disease (1): for example, the risk of type 2 diabetes (T2D) 11 among South Asian migrants is 5 times that for those of Dutch origin (2,3). Diet is considered an important modifiable risk factor for T2D (4).…”

“…Participants with known diabetes (self-reported or taking glucose-lowering medication) were excluded. HbA1c, glycated hemoglobin; HELIUS, HEalthy LIfe in an Urban Setting 2. Defined as consumption of, e.g., specific type 2 diabetes diet, cholesterol-lowering diet, blood pressure-lowering diet, diet to reduce salt intake 3.…”

Lifestyle interventions in preventing new type 2 diabetes in Asian populations

“…A recent trial performed in the Netherlands studied the effectiveness of an intensive, culturally targeted lifestyle intervention in general practice for weight status and metabolic profile of South Asians at risk of T2DM [66]. Although T2DM incidence is not included among outcomes, the trial is of great interest because limitations connected with the high-risk approach in minority groups are clearly shown.…”

“…Although T2DM incidence is not included among outcomes, the trial is of great interest because limitations connected with the high-risk approach in minority groups are clearly shown. Low initial response rate and laborious recruitment, high dropout rate, and the lack of effect of the lifestyle intervention on weight change and other metabolic parameters indeed led the authors to raise the question whether the high-risk strategy is the optimal approach to prevent T2DM in minority groups [66]. Admiraal et al conclude that health gain might be better achieved by focusing on prevention strategies that tackle the high risk of T2DM among South Asians at an earlier stage [67].…”

Evaluación de un programa ministerial para manejo del síndrome metabólico en adultos con sobrepeso y obesidad

“…Jebb y col. también encontraron resultados positivos al analizar la efectividad de un programa basado en educación sobre estilos de vida saludables, aplicado a 395 sujetos pertenecientes a centros de APS de Australia, Alemania y el Reino Unido durante un año, encontrando una disminución de peso promedio de 2,3 kg 4 . Sin embargo, otros estudios similares no han encontrado resultados tan favorables, como los observados por Admiraal y col. en una intervención durante 1 año en sujetos sudasiáticos con riesgo de desarrollar diabetes mellitus 2 (DM2), donde el grupo intervenido con cambios de estilo de vida saludables (n = 177) no presentó mejorías significativas en el peso ni en el perfil metabólico respecto al grupo control (n = 158) 5 ; o los resultados del Programa Nacional de Prevención de Diabetes en 400 centros de APS de Finlandia durante los años 2003-2008, donde la disminución de peso y de circunferencia de cintura (CC) fueron sólo de 1 kg y de 1,3 cm, respectivamente 6 . En Chile, el Ministerio de Salud (MINSAL), desarrolló una intervención en cambios de estilo de vida saludables llamado "Programa de Alimentación Saludable y Actividad Física-Adultos" (PASAF), dirigido a adultos con índice de masa corporal (IMC) entre 25 y 45 kg/m², y uno o más de los siguientes factores de riesgo: dos glicemias de ayuno alteradas (100-125 mg/dL), prehipertensión (presión sistólica entre 130-139 mmHg o diastólica entre 85-89 mmHg), o antecedentes de DM2 en un familiar de primer grado.…”