A randomized lifestyle intervention with 5-year follow-up in subjects with impaired glucose tolerance: Pronounced short-term impact but long-term adherence problems

Abstract

Aims: To compare data on cardiovascular risk factor changes in lipids, insulin, proinsulin, fibrinolysis, leptin and C-reactive protein, and on diabetes incidence, in relation to changes in lifestyle. Methods: The study was a randomized lifestyle intervention trial conducted in northern Sweden between 1995 and 2000, in 168 individuals with impaired glucose tolerance (IGT) and body mass index above 27 at start. The intensive intervention group (n = 83) was subjected to a 1-month residential lifestyle programme. The usual care group (n = 85) participated in a health examination ending with a single counselling session. Follow-up was conducted at 1, 3 and 5 years. Results: At 1-year follow-up, an extensive cardio-metabolic risk factor reduction was demonstrated in the intensive intervention group, along with a 70% decrease of progress to type 2 diabetes. At 5-year follow-up, most of these beneficial effects had disappeared. Reported physical activity and fibre intake as well as high-density lipoprotein cholesterol were still increased, and fasting insulin and proinsulin were lower. Conclusions: The intervention affected several important cardio-metabolic risk variables beneficially, and reduced the risk for type 2 diabetes, but the effects persisted only as long as the new lifestyle was maintained. Increased physical activity seemed to be the behaviour that was most easy to preserve.

Keywords

Cardiovascular risk factors diabetes mellitus diet intervention physical activity

Get full access to this article

View all access options for this article.

References

Wild S. , Roglic G. , Green A. , Sicree R. , King H. Global prevalence of diabetes. Estimates for the year 2000 and projections for 2030. Diabetes Care 2004;27:1047-53.

Norhammar A. , Tenerz Å. , Nilsson G. , Hamsten A. , Efendic S. , Rydén L. , et al. Glucose metabolism in patients with acute myocardial infarction and no previous diagnosis of diabetes mellitus: a prospective study. Lancet 2002;359:2140-4.

Ahima RS , Flier JS Adipose tissue as an endocrine organ. Trends Endocrinol Metab 2000;11:327-32.

Frayn KN , Karpe F. , Fielding BA , Macdonald IA , Coppack SW Integrative physiology of human adipose tissue. Int J Öbes 2003;27:875-88.

Kilander L. , Berglund L. , Boberg M. , Vessby B. , Lithell H. Education, lifestyle factors and mortality from cardiovascular disease and cancer. A 25-year follow-up of Swedish 50-year-old men. Int J Epidemiol 2001;30:1119-26.

Anderson AS Nutrition interventions in women in low-income groups in the UK. Proc Nutr Soc 2007;66:25-32.

Tuomilehto J. , Lindström J. , Eriksson JG , Valle TT , Hämäläinen H. , Lanne-Parikka P. , et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 2001; 344: 1343-50.

The Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002; 346:393-403.

Ruge T. , Nyström L. , Lindahl B. , Hallmans G. , Norberg M. , Weinehall L. , et al. Recruiting high-risk individuals to a diabetes prevention program. How hard can it be? Diabetes Care 2007;30:e61.

10.

Weinehall L. , Westman G. , Hellsten G. , Boman K. , Hallmans G. , Pearson TA , et al. Shifting the distribution of risk: results of a community intervention in a Swedish programme for the prevention of cardiovascular disease. J Epidemiol Community Health 1999;53:243-50.

11.

Lindahl B. , Nilsson TK , Jansson J-H. , Asplund K. , Hallmans G. Improved fibrinolysis by intense lifestyle intervention. A randomized trial in subjects with impaired glucose tolerance. J Intern Med 1999;246:105-12.

12.

Johansson I. , Hallmans G. , Wikman A. , Biessy C. , Riboli E. , Kaaks R. Validation and calibration of food-frequency questionnaire measurements in the Northern Sweden Health and Disease cohort . Public Health Nutr 2002; 5:487-96.

13.

WHÖ Expert Committee on Diabetes Mellitus. Technical report series 727. Geneva : World Health Örganization, 1985 .

14.

Andersen L. , Dinesen B. , Jorgensen PN , Poulsen F. , Roder ME Enzyme immunoassay for intact human insulin in serum or plasma. Clin Chem 1993;39:578-82.

15.

Kjems LL , Roder ME , Dinesen B. , Hartling SG , Jorgensen PN , Binder C. Highly sensitive enzyme immunoassay of proinsulin immunoreactivity with use of two monoclonal antibodies. Clin Chem 1993 ;39:2146-50.

16.

Wallace TM , Levy JC , Matthews DR Use and abuse of HÖMA modeling . Diabetes Care 2004;27:1487-95.

17.

Chmielewska J. , Rånby M. , Wiman B. Evidence for a rapid inhibitor to tissue plasminogen activator in plasma. Thromb Res 1983;31:427-36.

18.

Cejka J. An enzyme-linked immunoassay for von Willebrand factor. Clin Chem 1982;32:1132-5.

19.

Öster G. , Thompson D. , Edelsberg J. , Bird AP , Colditz GA Lifetime health and economic benefits of weight loss among obese persons . Am J Public Health 1999;89:1536-42.

20.

Vidal J. Updated review on the benefits of weight loss. Int J Öbes 2002;26 Suppl 4:S25-8.

21.

Hämäläinen H. , Rönnemaa T. , Virtanen A. , Lindström J. , Eriksson JG , Valle TT , et al. Improved fibrinolysis by an intensive lifestyle intervention in subjects with impaired glucose tolerance. The Finnish Diabetes Prevention Study. Diabetologia 2005 ;48:2248-53.

22.

The Diabetes Prevention Program Research Group. Intensive lifestyle intervention or metformin on inflammation and coagulation in participants with impaired glucose tolerance . Diabetes 2005;54:1566-72.

23.

Lindström J. , Lanne-Parikka P. , Peltonen M. , Aunola S. , Eriksson JG , Hemiö K. , et al. Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: follow-up of the Finnish Diabetes Prevention Study. Lancet 2006;368:1673-9.

24.

Rothwell PM External validity of randomised controlled trials: `To whom do the results of this trial apply?'. Lancet 2005;365:82-93.