Long-term outcomes of lifestyle intervention to prevent type 2 diabetes in people at high risk in primary health care
Rintamäki, Reeta; Rautio, Nina; Peltonen, Markku; Jokelainen, Jari; Keinänen-Kiukaanniemi, Sirkka; Oksa, Heikki; Saaristo, Timo; Puolijoki, Hannu; Saltevo, Juha; Tuomilehto, Jaakko; Uusitupa, Matti; Moilanen, Leena (2021-03-23)
Reeta Rintamäki, Nina Rautio, Markku Peltonen, Jari Jokelainen, Sirkka Keinänen-Kiukaanniemi, Heikki Oksa, Timo Saaristo, Hannu Puolijoki, Juha Saltevo, Jaakko Tuomilehto, Matti Uusitupa, Leena Moilanen, Long-term outcomes of lifestyle intervention to prevent type 2 diabetes in people at high risk in primary health care, Primary Care Diabetes, Volume 15, Issue 3, 2021, Pages 444-450, ISSN 1751-9918, https://doi.org/10.1016/j.pcd.2021.03.002
© 2021 The Authors. Published by Elsevier Ltd on behalf of Primary Care Diabetes Europe. This is an open access article under the CC BY-NC-ND license (http:// creativecommons.org/licenses/by-nc-nd/4.0/).
https://creativecommons.org/licenses/by-nc-nd/4.0/
https://urn.fi/URN:NBN:fi-fe202201179021
Tiivistelmä
Abstract
Aims: The Finnish National Diabetes Prevention Program (FIN-D2D) was the first large-scale diabetes prevention program in a primary health care setting in the world. The risk reduction of type 2 diabetes was 69% after one-year intervention in high-risk individuals who were able to lose 5% of their weight. We investigated long-term effects of one-year weight change on the incidence of type 2 diabetes, cardiovascular events, and all-cause mortality.
Methods: A total of 10,149 high-risk individuals for type 2 diabetes were identified in primary health care centers and they were offered lifestyle intervention to prevent diabetes. Of these individuals who participated in the baseline screening, 8353 had an oral glucose tolerance test (OGTT). Complete follow-up data during one-year intervention were available for 2730 individuals and those were included in the follow-up analysis. The long-term outcome events were collected from national health registers after the median follow-up of 7.4 years.
Results: Among individuals who lost weight 2.5−4.9% and 5% or more during the first year, the hazard ratio for the incidence of drug-treated diabetes was 0.63 (95% CI 0.49−0.81, p = 0.0001), and 0.71 (95% CI 0.56−0.90, p = 0.004), respectively, compared with those with stable weight. There were no significant differences in cardiovascular events or all-cause mortality among study participants according to one-year weight changes.
Conclusions: High-risk individuals for type 2 diabetes who achieved a moderate weight loss by one-year lifestyle counseling in primary health care had a long-term reduction in the incidence of drug-treated type 2 diabetes. The observed moderate weight loss was not associated with a reduction in cardiovascular events.
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