Journal Article

Determinants for the Effectiveness of Lifestyle Intervention in the Finnish Diabetes Prevention Study

Sirkka Aunola, Jaana Lindström, Markku Peltonen, Matti Uusitupa, Johan G. Eriksson, Jaakko Tuomilehto, Helena Hämäläinen, Pirjo Ilanne-Parikka, Sirkka Keinänen-Kiukaanniemi

2008

Overview

Determinants for the Effectiveness of Lifestyle Intervention in the Finnish Diabetes Prevention Study Jaana Lindström , PHD 1 2 , Markku Peltonen , PHD 1 , Johan G. Eriksson , MD, PHD 1 2 , Sirkka Aunola , PHD 3 , Helena Hämäläinen , MD, PHD 4 , Pirjo Ilanne-Parikka , MD 5 , Sirkka Keinänen-Kiukaanniemi , MD, PHD 6 , Matti Uusitupa , MD, PHD 7 , Jaakko Tuomilehto , MD, MPH, PHD 1 2 and for the Finnish Diabetes Prevention Study (DPS) Group * 1 Diabetes Unit, Department of Health Promotion and Chronic Disease Prevention, National Public Health Institute, Helsinki, Finland 2 Department of Public Health, University of Helsinki, Helsinki, Finland 3 Laboratory for Population Research, Department of Health and Functional Capacity, National Public Health Institute, Turku, Finland 4 Research Department, Social Insurance Institution, Turku, Finland 5 Research Unit of Tampere University Hospital and the Diabetes Center, Finnish Diabetes Association, Tampere, Finland 6 Institute of Health Sciences (General Practice), University of Oulu, Unit of General Practice, Oulu University Hospital and Health Centre of Oulu, Oulu, Finland 7 School of Public Health and Clinical Nutrition, Department of Clinical Nutrition, University of Kuopio, Kuopio, Finland Corresponding author: Jaana Lindström, National Public Health Institute, Mannerheimintie 166, 00300 Helsinki, Finland. E-mail: jaana.lindstrom{at}ktl.fi Abstract OBJECTIVE —Intensive lifestyle intervention significantly reduced diabetes incidence among the participants in the Finnish Diabetes Prevention Study. We investigated whether and to what extent risk factors for type 2 diabetes and other baseline characteristics of the study participants modified the effectiveness of the lifestyle intervention. RESEARCH DESIGN AND METHODS —Overweight, middle-aged volunteers with impaired glucose tolerance were randomly assigned to intensive lifestyle intervention ( n = 265) or to a control group ( n = 257) for a median of 4 years. Diabetes status was ascertained annually with repeated oral glucose tolerance testing. Incidence rates of diabetes and hazard ratios (HRs) comparing the intervention group with the control group were calculated by sex and baseline tertiles of age, BMI, waist circumference, plasma glucose concentration at fasting and 2 h after a glucose load, fasting serum insulin and insulin resistance index, and categories of composite baseline Finnish Diabetes Risk Score (FINDRISC). Interactions between the intervention assignment and baseline risk factors on diabetes risk were analyzed. RESULTS —The intervention was most effective among the oldest individuals (HRs 0.77, 0.49, and 0.36 by increasing age tertiles, respectively; P interaction = 0.0130) and those with a high baseline FINDRISC (HRs 1.09, 0.84, 0.34, and 0.22 by increasing risk score category, respectively; P interaction = 0.0400). The effect of the intervention on diabetes risk was not modified by other baseline characteristics or risk factors. CONCLUSIONS —The FINDRISC may be useful in identifying high-risk groups most likely to benefit from intensive lifestyle intervention to prevent type 2 diabetes. DPS, the Finnish Diabetes Prevention Study FINDRISC, the Finnish Diabetes Risk Score HOMA-IR, homeostasis model assessment of insulin resistance IGT, impaired glucose tolerance NNT, number needed to treat OGTT, oral glucose tolerance test Footnotes Published ahead of print at http://care.diabetesjournals.org on 5 February 2008. DOI: 10.2337/dc07-2162. Clinical trial reg. no. NCT00518167, clinicaltrials.gov. * ↵ * A complete list of the members of the Finnish Diabetes Prevention Study Group can be found in the appendix . The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C Section 1734 solely to indicate this fact. Accepted January 21, 2008. Received November 12, 2007. DIABETES CARE

• Publisher: American Diabetes Association
• Subject: Adult / Biological and medical sciences / blood glucose / blood serum / Body Mass Index / Body Size / Care and treatment / complications / Diabetes / Diabetes Mellitus / Diabetes Mellitus - epidemiology / Diabetes Mellitus - prevention & control / Diabetes. Impaired glucose tolerance / Disease Progression / Drugs / Effectiveness / Endocrine pancreas. Apud cells (diseases) / Endocrinopathies / epidemiology / Etiopathogenesis. Screening. Investigations. Target tissue resistance / fasting / Female / Finland / Finland - epidemiology / glucose / Glucose Intolerance / Glucose Intolerance - complications / glucose tolerance / Health aspects / Heart Rate / Humans / Incidence / insulin / insulin resistance / Intervention / Life Style / lifestyle / Lifestyles / Male / Medical sciences / Metabolic diseases / Middle Aged / middle-aged adults / Miscellaneous / noninsulin-dependent diabetes mellitus / Nutrition / overweight / Overweight - physiopathology / physiopathology / Plasma / Prevention / prevention & control / Proportional Hazards Models / Public health / Public health. Hygiene / Public health. Hygiene-occupational medicine / Randomized Controlled Trials as Topic / Risk assessment / Risk Factors / Studies / Surveys and Questionnaires / Type 2 diabetes / volunteers / waist circumference