HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) All Versions of this Article: dc07-2162v1 31/5/857    most recent Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Google Scholar Articles by Lindström, J. PubMed PubMed Citation Articles by Lindström, J. Social Bookmarking                What's this?

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

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

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.

Abbreviations: 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

CiteULike    Del.icio.us    Digg    Reddit    Technorati    What's this?