Journal Article

Delaying progression to type 2 diabetes among high-risk Spanish individuals is feasible in real-life primary healthcare settings using intensive lifestyle intervention

Costa, B., Bolíbar, B., Cos, X., Barrio, F., Basora, J., Lindström, J., Solé, C., Solà-Morales, O., Salas-Salvadó, J., Tuomilehto, J., Piñol, J.-L., Castell, C., Cabré, J.-J.

2012

Overview

Aims/hypothesis To assess the feasibility and effectiveness of an active real-life primary care lifestyle intervention in preventing type 2 diabetes within a high-risk Mediterranean population. Methods A prospective cohort study was performed in the setting of Spanish primary care. White-European individuals without diabetes aged 45–75 years ( n  = 2,054) were screened using the Finnish Diabetes Risk Score (FINDRISC) and a subsequent 2 h OGTT. Where feasible, high-risk individuals who were identified were allocated sequentially to standard care, a group-based or an individual level intervention (intensive reinforced DE-PLAN [Diabetes in Europe—Prevention using Lifestyle, Physical Activity and Nutritional] intervention). The primary outcome was the development of diabetes according to WHO criteria. Analyses after 4-year follow-up were performed based on the intention-to-treat principle with comparison of standard care and the combined intervention groups. Results The standard care ( n  = 219) and intensive intervention ( n  = 333) groups were comparable in age (62.0/62.2 years), sex (64.4/68.2% women), BMI (31.3/31.2 kg/m 2 ), FINDRISC score (16.2/15.8 points), fasting (5.3/5.2 mmol/l), 2 h plasma glucose (7.1/6.9 mmol/l) and self-reported interest to make lifestyle changes at baseline. Diabetes was diagnosed in 124 individuals: 63 (28.8%) in the standard care group and 61 (18.3%) in the intensive intervention group. During a 4.2-year median follow-up, the incidences of diabetes were 7.2 and 4.6 cases per 100 person-years, respectively (36.5% relative risk reduction, p  < 0.005). The number of participants needed to be treated by intensive intervention for 4 years to reduce one case of diabetes was 9.5. Conclusions/interpretation Intensive lifestyle intervention is feasible in a primary care setting and substantially reduces diabetes incidence among high-risk individuals. Clinical trial registration: ClinicalTrial.gov NCT01519505 Funding: Commission of the European Communities, Institute of Health Carlos III, Spanish Ministry of Health and Department of Health, Generalitat de Catalunya.

• Publisher: Springer-Verlag,Springer,Springer Nature B.V
• Subject: Aged / Biological and medical sciences / Clinical trials / Commissions / Diabetes / Diabetes mellitus / Diabetes Mellitus, Type 2 - epidemiology / Diabetes Mellitus, Type 2 - ethnology / Diabetes Mellitus, Type 2 - prevention & control / Diabetes. Impaired glucose tolerance / Disease prevention / Disease Progression / Endocrine pancreas. Apud cells (diseases) / Endocrinopathies / Etiopathogenesis. Screening. Investigations. Target tissue resistance / European Continental Ancestry Group - statistics & numerical data / Exercise / Fasting / Feasibility studies / Female / Glucose / Health care / Human Physiology / Humans / Incidence / Internal Medicine / Intervention / Lifestyles / Male / Medical sciences / Medicine / Medicine & Public Health / Metabolic Diseases / Middle Aged / Nutrition / Physical activity / Plasma / Preventive medicine / Primary care / Primary Health Care - methods / Public health / Questionnaires / Risk / Risk reduction / Risk Reduction Behavior / Spain - epidemiology