Prevention of Type II diabetes in subjects with impaired glucose tolerance: the Diabetes Prevention Study (DPS) in Finland

Abstract

Aims/hypothesis. The aim of the Diabetes Prevention Study is to assess the efficacy of an intensive diet-exercise programme in preventing or delaying Type II (non-insulin-dependent) diabetes mellitus in subjects with impaired glucose tolerance, to evaluate the effects of the intervention programme on cardiovascular risk factors and to assess the determinants for the progression to diabetes in persons with impaired glucose tolerance. Methods. A total of 523 overweight subjects with impaired glucose tolerance ascertained by two oral glucose tolerance tests were randomised to either a control or intervention group. The control subjects received general information at the start of the trial about the lifestyle changes necessary to prevent diabetes and about annual follow-up visits. The intervention subjects had seven sessions with a nutritionist during the first year and a visit every 3 months thereafter aimed at reducing weight, the intake of saturated fat and increasing the intake of dietary fibre. Intervention subjects were also guided individually to increase their physical activity. Results. During the first year, weight loss in the first 212 study subjects was 4.7 ± 5.5 vs 0.9 ± 4.1 kg in the intervention and control group, respectively (p < 0.001). The plasma glucose concentrations (fasting: 5.9 ± 0.7 vs 6.4 ± 0.8 mmol/l, p < 0.001; and 2-h 7.8 ± 1.8 vs 8.5 ± 2.3 mmol/l, p < 0.05) were significantly lower in the intervention group after the first year of intervention. Favourable changes were also found in blood pressure, serum lipids and anthropometric indices in the intervention group. Conclusion/interpretation. The interim results show the efficacy and feasibility of the lifestyle intervention programme. [Diabetologia (1999) 42: 793±801]

Understanding of diabetes prevention studies: questionnaire survey of professionals in diabetes care

“…The Finnish Diabetes Prevention Study included HbA 1c as a secondary outcome measure [21] but did not report results in the main publication [10]. Neither blood glucose nor HbA 1c values were reported in the core publication of the STOP-NIDDM Acarbose prevention study [13].…”

Anti-inflammatory effect of lifestyle changes in the Finnish Diabetes Prevention Study

“…The study design has been described in detail elsewhere [25,27]. Briefly, the study population consisted of 522 men and women aged 40-65 years who were overweight or obese (BMI≥25 kg/m 2 ) and had IGT (2 h OGTT plasma glucose 7.8-11.0 mmol/l [140-200 mg/dl] and fasting plasma glucose <7.8 mmol/l [<140 mg/dl] at baseline).…”

“…Anthropometric, clinical and lifestyle assessments Measurements of height, weight, waist circumference and blood pressure have been described in detail previously [25]. At baseline and at each annual visit, all participants underwent a 2 h OGTT and completed the validated Kuopio Ischaemic Heart Disease Risk Factor Study (KIHD) 12 month Leisure Time Physical Activity (LTPA) Questionnaire [28,29] and a 3 day food diary [30].…”

“…Serum IL-6 concentrations were determined by ELISA using recombinant IL-6 and an antibody pair from Sanquin (Amsterdam, the Netherlands) [15]. Concentrations of plasma glucose, serum insulin, total cholesterol and LDL-cholesterol were assessed by means of standard methods in the central laboratory in Helsinki as described in detail previously [4,25]. Insulin resistance measured by homeostasis model assessment was calculated as follows: HOMA-IR=fasting glucose (mmol/l)×fasting insulin (pmol/l)/135.…”

“…Since participants in the Finnish DPS underwent extensive phenotyping, including anthropometric, metabolic and lifestyle factors at baseline and at follow-up visits [25][26][27], data from this study allows us to assess the effect of lifestyle changes on proinflammatory mediators in more detail compared with data from most other studies. Therefore, using data from the Finnish DPS, focusing specifically on CRP and IL-6, we investigated (1) whether lifestyle intervention affected these markers of subclinical inflammation, (2) whether changes in circulating levels of CRP and IL-6 were associated with changes in anthropometric and metabolic measures, and (3) which changes in dietary intake, exercise or weight were most strongly associated with the anti-inflammatory effect of the lifestyle intervention.…”