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Volume 344:1343-1350 May 3, 2001 Number 18 Next

	Full Text PDF Editorial by Tataranni, P. A. Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background Type 2 diabetes mellitus is increasingly common, primarily because of increases in the prevalence of a sedentary lifestyle and obesity. Whether type 2 diabetes can be prevented by interventions that affect the lifestyles of subjects at high risk for the disease is not known.

Methods We randomly assigned 522 middle-aged, overweight subjects (172 men and 350 women; mean age, 55 years; mean body-mass index [weight in kilograms divided by the square of the height in meters], 31) with impaired glucose tolerance to either the intervention group or the control group. Each subject in the intervention group received individualized counseling aimed at reducing weight, total intake of fat, and intake of saturated fat and increasing intake of fiber and physical activity. An oral glucose-tolerance test was performed annually; the diagnosis of diabetes was confirmed by a second test. The mean duration of follow-up was 3.2 years.

Results The mean (±SD) amount of weight lost between base line and the end of year 1 was 4.2±5.1 kg in the intervention group and 0.8±3.7 kg in the control group; the net loss by the end of year 2 was 3.5±5.5 kg in the intervention group and 0.8±4.4 kg in the control group (P<0.001 for both comparisons between the groups). The cumulative incidence of diabetes after four years was 11 percent (95 percent confidence interval, 6 to 15 percent) in the intervention group and 23 percent (95 percent confidence interval, 17 to 29 percent) in the control group. During the trial, the risk of diabetes was reduced by 58 percent (P<0.001) in the intervention group. The reduction in the incidence of diabetes was directly associated with changes in lifestyle.

Conclusions Type 2 diabetes can be prevented by changes in the lifestyles of high-risk subjects.

Source Information

From the Diabetes and Genetic Epidemiology Unit, Department of Epidemiology and Health Promotion, National Public Health Institute, Helsinki (J.T., J.L., J.G.E., T.T.V.); the Department of Public Health, University of Helsinki (J.T.); the Research and Development Center, Social Insurance Institution, Turku (H.H., M.R.); the Department of Internal Medicine, Finnish Diabetes Association and Tampere University Hospital, Tampere (P.I.-P.); the Department of Public Health Science and General Practice, University of Oulu, and the Unit of General Practice, Oulu University Hospital, Oulu (S.K.-K., M.L.); the Department of Clinical Nutrition, University of Kuopio, Kuopio (A.L., M.U.); and the Institute of Nursing and Health Care, Tampere (V.S.) — all in Finland.

Other authors were Sirkka Aunola, Ph.D., Research and Development Center, Social Insurance Institution, Turku; Zygimantas Cepaitis, Dipl.Eng., and Vladislav Moltchanov, Ph.D., Diabetes and Genetic Epidemiology Unit, Department of Epidemiology and Health Promotion, National Public Health Institute, Helsinki; Martti Hakumäki, M.D., Ph.D., Department of Clinical Nutrition, University of Kuopio, Kuopio; Marjo Mannelin, M.S., and Vesa Martikkala, M.S., Department of Sports Medicine, Oulu Deaconess Institute, Oulu; and Jouko Sundvall, M.S., Department of Biochemistry, National Public Health Institute, Helsinki — all in Finland.

Address reprint requests to Professor Tuomilehto at the National Public Health Institute, Department of Epidemiology and Health Promotion, Diabetes and Genetic Epidemiology Unit, Mannerheimintie 166, FIN-00300 Helsinki, Finland, or at jaakko.tuomilehto{at}ktl.fi.

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