Lifestyle Intervention in High- and Low-Risk Prediabetes
Diabetes Journal: ADA publications
Several randomized clinical trials have shown the possibility of preventing or delaying the onset of type 2 diabetes in nondiabetic adults at high risk of developing the disease. Successful interventions have included drugs (not further discussed here) and lifestyle interventions emphasizing weight loss and increased physical activity.
TAKE-HOME MESSAGE
In this multicenter randomized controlled analysis, the effectiveness of a lifestyle intervention among individuals with prediabetes was assessed in a total of 1105 individuals with prediabetes stratified into high- and low-risk phenotypes based on insulin secretion, insulin sensitivity, and liver fat content parameters.
In the high-risk population, intensification of a lifestyle intervention via the increase of counseling frequency and weekly physical exercise yielded a superior improvement of the primary outcome (postprandial glucose metabolism after 1 year of intervention). These participants were also more likely to have reduced secondary outcomes, such as liver fat content and cardiometabolic risk.
An intensified lifestyle intervention had a higher probability of normalizing glucose tolerance among individuals at high risk of diabetes compared with that observed for individuals with a conventional lifestyle intervention.
Doctors Liked to Read More
Objectives:
Lifestyle intervention (LI) can prevent type 2 diabetes, but response to LI varies depending on risk subphenotypes. Authors tested whether individuals with prediabetes with low risk (LR) benefit from conventional LI and individuals with high risk (HR) benefit from an intensification of LI in a multicenter randomized controlled intervention over 12 months with 2 years' follow-up.
Method:
A total of 1,105 individuals with prediabetes based on American Diabetes Association glucose criteria were stratified into an HR or LR phenotype based on previously described thresholds of insulin secretion, insulin sensitivity, and liver fat content. LR individuals were randomly assigned to conventional LI according to the Diabetes Prevention Program (DPP) protocol or control and HR individuals to conventional or intensified LI with doubling of required exercise.
Results:
A total of 908 (82%) participants completed the study. In HR individuals, the difference between conventional and intensified LI in post challenge glucose change was -0.29 mmol/L. Liver fat (-1.34 percentage points and cardiovascular risk underwent larger reductions with intensified than with conventional LI. During a follow-up of 3 years, intensified compared with conventional LI had a higher probability of normalizing glucose tolerance.
Conclusion:
In conclusion, it is possible in HR individuals with prediabetes to improve glycemic and cardiometabolic outcomes by intensification of LI. Individualized, risk phenotype-based LI may be beneficial for the prevention of diabetes.
Comments
You must login to write comment