Predictors of lifestyle intervention outcome and dropout: the SLIM study

Abstract

Background/Objectives: To evaluate the effect of a 4.1-year (range 3-6 years) lifestyle intervention according to general public health recommendations on glucose tolerance and dropout in a Dutch population with impaired glucose tolerance (IGT). Subjects/Methods: In the Study on Lifestyle intervention and Impaired glucose tolerance Maastricht, 147 Caucasian IGT subjects were randomized to an intervention group (INT: n ¼ 74; 38 male, 36 female) and control group (CON: n ¼ 73; 37 male, 36 female). Annually, subjects underwent measurements of body weight, anthropometry, glucose tolerance (oral glucose tolerance test), insulin resistance (homeostasis model assessment-insulin resistance), maximal aerobic capacity (VO 2 max), blood lipids and blood pressure. INT received individual advice regarding a healthy diet and physical activity. Results: INT decreased their saturated fat intake, increased their carbohydrate intake (Po0.05) and VO 2 max (P ¼ 0.04) compared with CON. Body weight did not change significantly (P ¼ 0.20) between the groups. After an initial decrease, 2-h glucose levels overall increased in INT ( þ 0.11 mmol/l), but significantly less than CON ( þ 1.18 mmol/l; P ¼ 0.04). Diabetes incidence was lower in INT versus CON (30 versus 56%, P ¼ 0.04). Change in body weight was associated with change in 2-h glucose levels (b ¼ 0.399 mmol/l per kg, P ¼ 0.02). Dropouts had a lower aerobic fitness and socioeconomic status, and a higher body mass index (BMI) and 2-h glucose compared with non-dropouts. Conclusions: Prolonged feasible changes in diet and physical activity prevent deterioration of glucose tolerance and reduce diabetes risk. Low socioeconomic status, low aerobic fitness and high BMI and 2-h glucose are indicative of dropout to the program.

Identifying prediabetes – Is it beneficial in the long run?

“…These effects were similar in all racial and ethnic groups and in both sexes. Similar results were observed in independent studies of Asian Indian [30], Dutch [31] and Swedish [32] populations where lifestyle modification was shown to reduce the incidence of DM.…”

Sex-specific differences in diabetes prevention: a systematic review and meta-analysis

“…Body weight Pooled results of three RCTs [35][36][37][38][39] showed that 1 year of lifestyle interventions was more effective in reducing body weight than treatment as usual. Overall, people with prediabetes receiving lifestyle interventions achieved an additional mean weight reduction of −2.44 kg (95% CI −3.…”

“…Seven RCTs with more than 1,200 men and 970 women compared lifestyle interventions with treatment as usual [2,14,15,[26][27][28][29][30][31][32][33][34][35][36][37][38][39][48][49][50][51]. Follow-up periods lasted up to 6 years.…”

“…People in control groups received counselling about diabetes, verbal and written information about diet and exercise or consultation of a dietitian at the beginning of the study phase. Six studies provided sexstratified data on 1,644 men and women with prediabetes for meta-analyses of the effect of lifestyle interventions on diabetes incidence, body weight, fasting plasma glucose and 2 h post-challenge-glucose after 1 and 3 years of follow-up [2,15,[28][29][30][31][32][33][34][35][36][37][38][39][48][49][50][51].…”

“…Diabetes incidence We conducted meta-analyses of four RCTs [34][35][36][37][38][39] with data on 884 people with prediabetes to assess sex-specific differences of the effect of lifestyle interventions on the prevention of progression to type 2 diabetes. After 1 year, prediabetic people receiving lifestyle interventions had a numerically lower (albeit not statistically significant) risk of progressing to type 2 diabetes than people in the treatment as usual groups (RR 0.…”