Long-term effectiveness of a lifestyle intervention on the prevention of type 2 diabetes in a middle-income country

Abstract

This study aims to assess the effects of a community-based lifestyle intervention program on the incidence of type 2 diabetes (T2D). For this purpose, three communities in Tehran were chosen; one community received a face-to-face educational session embedded in a long-term communitywide lifestyle intervention aimed at supporting lifestyle changes. We followed up 9,204 participants (control: 5,739, intervention: 3,465) triennially from 1999 to 2015 (Waves 1-5). After a median follow-up of 3.5 years (wave 2), the risk of T2D was 30% lower in the intervention community as compared with two control communities by (Hazard-ratio: 0.70 [95% CI 0.53; 0.91]); however, the difference was not statistically significant in the following waves. After a median follow-up of 11.9 years (wave 5), there was a non-significant 6% reduction in the incidence of T2D in the intervention group as compared to the control group (Hazard-ratio: 0.94 [0.81, 1.08]). Moreover, after 11.9 years of follow-up, the intervention significantly improved the diet quality measured by the Dietary Approaches to Stop Hypertension concordance (DASH) score. Mean difference in DASH score in the intervention group versus control group was 0.2 [95% CI 0.1; 0.3]. In conclusion, the intervention prevented T2D by 30% in the short-term (3.5 years) but not long-term; however, effects on improvement of the diet maintained in the long-term. Registration: This study is registered at IRCT, a WHO primary registry (https ://irct.ir). The registration date 39 is 2008-10-29 and the IRCT registration number is IRCT138705301058N1. The burden of type 2 diabetes (T2D) is high and increasing in Low-and Middle-Income Countries (LMICs) like Iran 1. Iranians have a high risk of developing T2D with an incidence rate of the disease being 11 per 1,000 person-years 2. Given the high burden of T2D in Iran, there is an urgent need for effective prevention programs for T2D that can be implemented nationally. Community-wide strategies are vital to have a major impact on trends in raising the T2D epidemic 3-5. Several studies have assessed the effects of community-wide lifestyle interventions on the prevention of T2D. For this aim, community-wide interventions were delivered to a community living within a certain geographic area

National trends in cardiovascular health metrics among Iranian adults using results of three cross-sectional STEPwise approaches to surveillance surveys

“…Major gains will likely achieve from public health strategies targeting incorrect diet, physical inactivity, and preventing or stopping cigarette smoking 32 . As a successful example, in a community-based study in Tehran, it was shown that family-school and community based educational sessions resulted in about 20% decrease incidence of metabolic syndrome during 6 years follow up 33 .…”

Managing Metabolic Risk Factors of Non-Communicable Diseases: A Field Trial

“…This result may also pertain to the lack of medication interventions by NPHWs and no physician supervision. In contrast to this study, the effectiveness of behavioral lifestyle interventions was documented when accompanied by therapeutic interventions [49,50] and supervised by physicians [51,52]. Another reason for not observing an effect on cholesterol-related outcomes may be the short one-year period of the interventions.…”

Long-term effectiveness of a community-based lifestyle intervention on smoking behaviors in adults: novel findings from Middle-East

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