Effects of insulin resistance and insulin secretion on the efficacy of interventions to retard development of type 2 diabetes mellitus: the DA Qing IGT and Diabetes Study. Glycemic load, exercise, and monitoring blood glucose (GEM): A paradigm shift in the treatment of type 2 diabetes mellitus. Prevalence and correlates of diabetes mellitus and impaired glucose tolerance among adults in Luzon, Philippines. [Effect of lifestyle interventions on reduction of cardiovascular disease events and its mortality in pre-diabetic patients:long-term follow-up of Da Qing Diabetes Prevention Study]. Effect of a Low–Resource-Intensive Lifestyle Modification Program Incorporating Gymnasium-Based and Home-Based Resistance Training on Type 2 Diabetes Risk in Australian Adults Effect of Intervention in Subjects with High Risk of Diabetes Mellitus in Pakistan Prevention of type 2 diabetes by lifestyle intervention: a Japanese trial in IGT males. Shenzhu Tiaopi granule combined with lifestyle intervention therapy for impaired glucose tolerance: a randomized controlled trial. Effect of baseline HbA1c level on the development of diabetes by lifestyle intervention in primary healthcare settings: insights from subanalysis of the Japan Diabetes Prevention Program Prevention of type 2 diabetes in a primary healthcare setting: Three-year results of lifestyle intervention in Japanese subjects with impaired glucose tolerance Effectiveness of lifestyle change plus dental care program in improving glycemic and periodontal status in aging patients with diabetes: a cluster, randomized, controlled trial. General effect on high-risk persons when general practitioners are trained in intensive treatment of type 2 diabetes Impact of intensive lifestyle and metformin therapy on cardiovascular disease risk factors in the diabetes prevention program. Physical Activity/Exercise and Type 2 Diabetes Long-term effects of a randomised trial of a 6-year lifestyle intervention in impaired glucose tolerance on diabetes-related microvascular complications: the China Da Qing Diabetes Prevention Outcome Study Prevention of type 2 diabetes in adults with impaired glucose tolerance: the European Diabetes Prevention RCT in Newcastle upon Tyne, UK Effects of Exenatide and Lifestyle Modification on Body Weight and Glucose Tolerance in Obese Subjects With and Without Pre-Diabetes Prevention of diabetes in women with a history of gestational diabetes: effects of metformin and lifestyle interventions. Improvement in diet habits, independent of physical activity helps to reduce incident diabetes among prediabetic Asian Indian men. Lifestyle Intervention and Adipokine Levels in Subjects at High Risk for Type 2 Diabetes Evaluation of a diabetes patient education program consisting of a three-day hospitalization and a six-month follow-up by telephone counseling for mild type 2 diabetes and IGT Randomised controlled trial evaluating lifestyle interventions in people with impaired glucose tolerance. Early lifestyle intervention in patients with non-insulin-dependent diabetes mellitus and impaired glucose tolerance.
OBJECTIVE To investigate the effects of insulin resistance ( IR ) and insulin secretion ( IS ) on the development of diabetes mellitus in individuals with impaired glucose tolerance ( IGT ) who underwent lifestyle interventions .  METHODS 284 out of 577 individuals with IGT identified by population -based screening in Da Qing , China , who were r and omized to undergo diet change and /or increased physical activity  had baseline fasting and 2 h post-load insulin determinations . They were followed for 6 years for the development of diabetes . IR and IS were assessed using calculated indices based on fasting plasma insulin and glucose . The interactions of IR , IS , obesity and plasma glucose and the effects of the lifestyle interventions were evaluated using Cox Proportional Hazards analysis . RESULTS Both IR and IS were significantly associated with the development of diabetes . Lifestyle interventions were more effective in those with lower IT and higher IS at baseline . Diet plus exercise interventions result ed in significantly lower incidence of diabetes , even after controlling for IR , IS , BMI and 2hrPG . CONCLUSION Both IR and beta-cell function were predictors of diabetes in Chinese with IGT . Lifestyle intervention reduced the incidence of DM and these interventions were more effective in those with less IR AIMS This preliminary RCT investigated whether an integrated lifestyle modification program that focuses on reducing postpr and ial blood glucose through replacing high with low glycemic load foods and increasing routine physical activities guided by systematic self-monitoring of blood glucose ( GEM ) could improve metabolic control of adults with type 2 diabetes mellitus , without compromising other physiological parameters . METHODS Forty-seven adults ( mean age 55.3 years ) who were diagnosed with type 2 diabetes mellitus for less than 5 years ( mean 2.1 years ) , had HbA1c ≥ 7 % ( mean 8.4 % ) and were not taking blood glucose lowering medications , were r and omized to routine care or five 1-h instructional sessions of GEM .  Assessment s at baseline and 6 months included a physical exam , metabolic and lipid panels , and psychological question naires . RESULTS The GEM intervention led to significant improvements in HbA1c ( decreasing from 8.4 to 7.4 % [ 69 - 57 mmol/mol ] compared with 8.3 to 8.3 % [ 68 - 68 mmol/mol ] for routine care ; Interaction p<.01 ) and psychological functioning without compromising other physiological parameters . CONCLUSIONS Consistent with a patient-centered approach , GEM appears to be an effective lifestyle modification option for adults recently diagnosed with type 2 diabetes mellitus Recognizing the problem posed by diabetes mellitus , the National Diabetes Commission was created by Republic Act 8191 in 1996 . The Commission identified the need for a Second National Diabetes Survey to have an up date d estimate of the magnitude of the disease in the country and to have the needed information for developing a diabetes prevention and control program . This paper reports the prevalence of  diabetes mellitus and impaired glucose tolerance ( IGT ) in adults and the factors associated with the prevalence of these conditions . A cross-sectional population -based study assessed the occurrence of diabetes and impaired glucose tolerance among a r and om sample of 7044 adults , aged 20 - 65 years who were residents of urban and rural areas in Luzon .  Blood glucose level  was measured by OGTT using the current WHO criteria . The crude diabetes prevalence of 5.1 % represented a 54 % increase over the figure ( 3.3 % ) for a similar population in Luzon in 1982 . An increase was also noted in the magnitude of IGT which almost doubled from 4.1 % in 1982 to 8.1 % in the present survey . Only one in three diabetics reported that they had diabetes . The frequency of diabetes and IGT in urban and rural areas were about the same , although a substantial increase from the earlier survey was noted in rural areas . Women registered a higher prevalence for both conditions than men . Aside from age and gender , the other correlates of diabetes mellitus were hypertension , family history of diabetes , WHR , BMI , and physical inactivity . IGT had similar correlates as diabetes except physical inactivity . The present findings which are consistent with those of other studies underscore the role of lifestyle behaviors in diabetes and should be the target of intervention to prevent further increase in disease frequency OBJECTIVE To investigate if a six-year intensive lifestyle intervention in people with pre-diabetes lead to reduction of cardiovascular events and cardiovascular disease ( CVD ) mortality in subsequent 23 years . METHODS Five hundreds and nineteen subjects with normal glucose tolerance ( NGT ) and 577 subjects with impaired glucose tolerance ( IGT ) in Da Qing city were recruited in the study in 1986 . The IGT subjects r and omly assigned to either the no-intervention group or one of three lifestyle intervention groups ( diet , exercise , or diet plus exercise ) to receive a 6-year lifestyle intervention . In 2009 , the participants were followed up to assess the primary outcomes of cardiovascular events and CVD mortality by a question naire and medical records . RESULTS Subjects in IGT no-intervention group had the highest incidences of cardiovascular events ( 44.44 % ) and CVD mortality ( 20.00 % ) , while those in NGT group had the lowest incidences of cardiovascular events ( 29.59 % ) and CVD mortality ( 7.52 % ) after 23-year follow-up . The incidences of cardiovascular events and CVD mortality in IGT intervention subjects were 37.84 % and 12.53 % , respectively . The multivariable analyses showed that , after controlling of age , gender , BMI smoking , blood pressure and cardiovascular event at baseline , the CVD mortality and incidence of cardiovascular events in IGT no-intervention group was 1.89 ( HR = 1.89 , 95%CI 1.11 - 3.22 , P = 0.02 ) and 1.38 ( HR = 1.38 , 95%CI 1.01 - 1.90 , P = 0.04 ) times of those in NGT group . However , the CVD mortality and incidence of cardiovascular events were not different in the IGT intervention group compared with those in the NGT group ( HR = 1.39 , 95%CI 0.89 - 2.18 , P = 0.15 and HR = 1.25 , 95%CI 0.98 - 1.59 , P = 0.07 , respectively ) . CONCLUSIONS Subjects with IGT were at high risk for cardiovascular events and mortality . A six-year lifestyle intervention in this population can reduce both the incidence of cardiovascular event and CVD mortality OBJECTIVE —The purpose of this study was to assess the effectiveness of a low – re source -intensive lifestyle modification program incorporating resistance training and to compare a gymnasium-based with a home-based resistance training program on diabetes diagnosis status and risk . RESEARCH DESIGN AND METHODS —A quasi-experimental two-group study was undertaken with 122 participants with diabetes risk factors ; 36.9 % had impaired glucose tolerance ( IGT ) or impaired fasting glucose ( IFG ) at baseline . The intervention included a 6-week group self-management education program , a gymnasium-based or home-based 12-week resistance training program , and a 34-week maintenance program . Fasting plasma glucose ( FPG ) and 2-h plasma glucose , blood lipids , blood pressure , body composition , physical activity , and diet were assessed at baseline and week 52 . RESULTS —Mean 2-h plasma glucose and FPG fell by 0.34 mmol/l ( 95 % CI −0.60 to −0.08 ) and 0.15 mmol/l ( −0.23 to −0.07 ) , respectively . The proportion of participants with IFG or IGT decreased from 36.9 to 23.0 % ( P = 0.006 ) . Mean weight loss was 4.07 kg ( −4.99 to −3.15 ) . The only significant difference between resistance training groups was a greater reduction in systolic blood pressure for the gymnasium-based group ( P = 0.008 ) . CONCLUSIONS —This intervention significantly improved diabetes diagnostic status and reduced diabetes risk to a degree comparable to that of other low – re source -intensive lifestyle modification programs and more intensive interventions applied to individuals with IGT . The effects of home-based and gymnasium-based resistance training did not differ significantly Aims . To observe the rate of conversion from impaired glucose tolerance ( IGT ) to diabetes following lifestyle modification ( LSM ) or a combination of lifestyle and metformin compared to a control population with 18-month followup . Methods . Forty screening camps were organized , which 5000 people attended . Around 2300 persons filled the question naire and 1825 subjects were identified as high risk . Of 1739 subjects who took the oral glucose tolerance test , 317 subjects were identified as IGT . The 317 IGT subjects were r and omized into three groups : control group was given st and ard medical advice , LSM group was given intensive lifestyle modification advice , while LSM + drug group was given intensive lifestyle advice and metformin 500 mg twice daily . Results . At the end , 273 subjects completed the study , giving a compliance rate of 86 % . Total of 47 incident cases of diabetes were diagnosed ( overall incidence was 4 cases per 1000 person-months with the incidence of 8.6 cases in control group , 2.5 cases in the LSM , and 2.3 cases in the LSM + drug groups ) . Conclusions . Study showed that lifestyle intervention had a major impact in preventing diabetes among IGT subjects in this region . Adding drug did not show any improved results . We recommend lifestyle advice and followup should be incorporated in primary health care Prevention of type 2 diabetes by intensive lifestyle intervention design ed to achieve and maintain ideal body weight was assessed in subjects with impaired glucose tolerance ( IGT ) . Male subjects with IGT recruited from health-screening examinees were r and omly assigned in a 4:1 ratio to a st and ard intervention group ( control group ) and intensive intervention group ( intervention group ) . The final numbers of subjects were 356 and 102 , respectively . The subjects in the control group and in the intervention group were advised to maintain body mass index ( BMI ) of < 24.0 kg/m2 and of < 22.0 kg/m2 , respectively , by diet and exercise . In the intervention group , detailed instructions on lifestyle were repeated every 3 - 4 months during hospital visits . Diabetes was judged to have developed when two or more consecutive fasting plasma glucose ( FPG ) values exceeded 140 mg/dl . A 100 g oral glucose tolerance test was performed every 6 months to detect improvement of glucose tolerance . The subjects were seen in an ordinary outpatient clinic . The cumulative 4-year incidence of diabetes was 9.3 % in the control group , versus 3.0 % in the intervention group , and the reduction in risk of diabetes was 67.4 % ( P < 0.001 ) . Body weight decreased by 0.39 kg in the control group and by 2.18 kg in the intervention group ( P < 0.001 ) . The control group was subclassified according to increase and decrease in body weight . The incidence of diabetes was positively correlated with the changes in body weight , and the improvement in glucose tolerance was negatively correlated . Subjects with higher FPG at baseline developed diabetes at a higher rate than those with lower FPG . Higher 2h plasma glucose values and higher BMI values at baseline were also associated with a higher incidence of diabetes , but the differences were not significant . Subjects with a low insulinogenic index ( DeltaIRI/DeltaPG 30 min after an oral glucose load ) developed diabetes at a significantly higher rate than those with a normal insulinogenic index . Comparison of the BMI data and incidence of diabetes in five diabetes prevention studies by lifestyle intervention revealed a linear correlation between the incidence of diabetes and the BMI values , with the exception of the DaQing Study . However , the slope of the reduction in incidence of diabetes in the intensive intervention groups was steeper than expected simply on the basis of the reduction of BMI , suggesting that the effect of lifestyle intervention can not be solely ascribed to the body weight reduction . We conclude that lifestyle intervention aim ed at achieving ideal body weight in men with IGT  is effective and can be conducted in an outpatient clinic setting OBJECTIVE The purpose of the study was to evaluate the clinical effects of the Shenzhu Tiaopi granule ( SZTP ) combined with a lifestyle intervention in patients with impaired glucose tolerance ( IGT ) , who also had a spleen deficiency and damp overabundance syndrome ( SDDOS ) . METHODS After a one-month washout period , a total of 514 patients were r and omly assigned to the control ( lifestyle intervention ) and experimental ( SZTP plus lifestyle intervention ) groups , with 257 patients in each group . Patients in the control group received the lifestyle intervention ( diet and exercise ) for 12 months , while the patients in the experimental group were treated with SZTP plus the lifestyle intervention for 12 months . The Traditional Chinese Medicinal ( TCM ) symptom scores were observed in each group before and after treatment ; the conversion rates from IGT to diabetes mellitus ( DM ) were also measured . RESULTS Following 12 months of treatment , the conversion rate from IGT to DM in the experimental group was significantly lower than in the control group ( 8.52 % vs. 15.28 % , P<0.05 ) . A significantly higher number of patients with IGT reverted to normal blood glucose levels in the experimental group than in the control group ( 42.15 % vs. 32.87 % , P<0.05 ) . In addition , after following the treatment for 12 months , the TCM symptoms of patients in the experimental group were markedly alleviated , as compared to the control group ( P<0.01 ) . CONCLUSION The combination of SZTP and lifestyle intervention showed a reduction in the conversion from IGT to DM , and an increase in the conversion from IGT to normal blood glucose levels Objectives To determine the effects of a lifestyle intervention on the development of type 2 diabetes mellitus ( T2DM ) among participants with impaired glucose tolerance ( IGT ) , in particular in the subgroup with baseline glycated hemoglobin ( HbA1c ) levels ≥5.7 % , in primary healthcare setting s. Design R and omized controlled trial . Setting 32 healthcare centers in Japan . Participants Participants with IGT , aged 30–60 years , were r and omly assigned to either an intensive lifestyle intervention group ( ILG ) or a usual care group ( UCG ) . Interventions During the initial 6 months , participants in the ILG received four group sessions on healthy lifestyles by public health providers . An individual session was further conducted biannually during the 3 years . Participants in the UCG received usual care such as one group session on healthy lifestyles . Outcome measures The primary endpoint was the development of T2DM based on an oral glucose tolerance test . Results The mean follow-up period was 2.3 years . The annual incidence of T2DM were 2.7 and 5.1/100 person-years of follow-up in the ILG ( n=145 ) and UCG ( n=149 ) , respectively . The cumulative incidence of T2DM was significantly lower in the ILG than in the UCG among participants with HbA1c levels ≥5.7 % ( log-rank=3.52 , p=0.06 ; Breslow=4.05 , p=0.04 ; Tarone-Ware=3.79 , p=0.05 ) , while this was not found among participants with HbA1c levels < 5.7 % . Conclusions Intensive lifestyle intervention in primary healthcare setting is effective in preventing the development of T2DM in IGT participants with HbA1c levels ≥5.7 % , relative to those with HbA1c levels < 5.7 % . Trial registration number UMIN000003136 Background A r and omized control trial was performed to test whether a lifestyle intervention program , carried out in a primary healthcare setting using existing re sources , can reduce the incidence of type 2 diabetes in Japanese with impaired glucose tolerance ( IGT ) . The results of 3 years ' intervention are summarized . Methods Through health checkups in communities and workplaces , 304 middle-aged IGT subjects with a mean body mass index ( BMI ) of 24.5 kg/m2 were recruited and r and omized to the intervention group or control group . The lifestyle intervention was carried out for 3 years by public health nurses using the curriculum and educational material s provided by the study group . Results After 1 year , the intervention had significantly improved body weight ( -1.5 ± 0.7 vs. -0.7 ± 2.5 kg in the control ; p = 0.023 ) and daily non-exercise leisure time energy expenditure ( 25 ± 113 vs. -3 ± 98 kcal ; p = 0.045 ) . Insulin sensitivity assessed by the Matsuda index was improved by the intervention during the 3 years . The 3-year cumulative incidence tended to be lower in the intervention group ( 14.8 % vs.8.2 % , log-rank test : p = 0.097 ) . In a sub- analysis for the subjects with a BMI > 22.5 kg/m2 , a significant reduction in the cumulative incidence was found ( p = 0.027 ) . Conclusions The present lifestyle intervention program using existing healthcare re sources is beneficial in preventing diabetes in Japanese with IGT . This has important implication s for primary healthcare-based diabetes prevention . Trial registration BACKGROUND Currently , there is an increased prevalence of diabetes mellitus among the aging adult population . To minimize adverse effects on glycemic control , prevention and management of general and oral complications in patients with diabetes are essential . The objective of this study is to assess the effectiveness of the lifestyle change plus dental care ( LCDC ) program to improve glycemic and periodontal status in aging patients with diabetes . METHODS A cluster , r and omized , controlled trial was conducted in Health Centers 54 ( intervention ) and 59 ( control ) from October 2013 to April 2014 . Sixty-six patients with diabetes per health center were included . At baseline , the intervention group attended 20-minute lifestyle and oral health education , individual lifestyle counseling , application of a self-regulation manual , and individual oral hygiene instruction . At month 3 , the intervention group received individual lifestyle counseling and oral hygiene instruction . The intervention group received booster education every visit by viewing a 15-minute educational video . The control group received a routine program . Participants were assessed at baseline and 3- and 6-month follow-up for glycemic and periodontal status . Data were analyzed by using descriptive statistic , χ(2 ) test , Fisher exact test , t test , and repeated- measures analysis of variance . RESULTS After the 6-month follow-up , participants in the intervention group had significantly lower glycated hemoglobin , fasting plasma glucose , plaque index , gingival index , probing depth , and attachment loss when compared with the control group . CONCLUSION The combination of lifestyle change and dental care in one program improved both glycemic and periodontal status in older patients with diabetes Objective . Within the frame of a r and omized clinical trial to examine whether training of general practitioners ( the intervention group ) in intensive lifestyle modification and pharmacological treatment of patients with type 2 diabetes has a spillover effect on individuals with impaired fasting glycaemia ( IFG ) or impaired glucose tolerance ( IGT ) . Design . A high-risk screening study for type 2 diabetes with an intervention programme , where general practice s were r and omized to provide st and ard treatment versus intensive lifestyle modification and pharmacological treatment to newly diagnosed diabetic patients . Setting . General practice s in Denmark . Subjects . Of 1821 individuals identified with IFG or IGT , results from oral glucose tolerance tests after one and three years were available in 1510 individuals . Main outcome measures . Progression rates from IFG and IGT to diabetes and effect of intervention were estimated in a regression model using interval censoring . Results . A total of 442 persons developed diabetes .  There was no significant overall effect of intervention on progression rates . For risk factors , no difference in rate of change was found between r and omization groups , but a difference was found between general practice s within the same r and omization groups . Conclusion . General practitioners identify a high number of incident diabetes cases in individuals with IFG or IGT found by high-risk screening . Intervention at the general practitioner 's level in intensive treatment type 2 diabetes does not have a significant spillover effect reducing the risk of diabetes from pre-diabetic conditions . This could indicate that intervention strategies should be specifically targeted at individuals with IFG or IGT , either by training general practitioners or directly at the individual level OBJECTIVE The Diabetes Prevention Program demonstrated the ability to delay or prevent type 2 diabetes in participants with impaired glucose tolerance ( IGT ) . Participants with IGT are at high risk for cardiovascular disease ( CVD ) , with a marked increase in the number and severity of CVD risk factors . We prospect ively assessed the impact of our interventions on hypertension , dyslipidemia , and CVD events . RESEARCH DESIGN AND METHODS The study group consisted of 3,234 individuals with IGT r and omly assigned to receive intensive lifestyle intervention , metformin , or placebo . Annual assessment of blood pressure , lipids , electrocardiogram , and CVD events was undertaken . RESULTS Hypertension was present in 30 % of participants at study entry and then increased in the placebo and metformin groups , although it significantly decreased with intensive lifestyle intervention . Triglyceride levels fell in all treatment groups , but fell significantly more with intensive lifestyle intervention . Total cholesterol and LDL cholesterol levels were similar among treatment groups . Intensive lifestyle intervention significantly increased the HDL cholesterol level and reduced the cumulative incidence of the proatherogenic LDL phenotype B. At 3 years of follow-up , the use for pharmacologic therapy to achieve established goals in the intensive lifestyle group was 27 - 28 % less for hypertension and 25 % less for hyperlipidemia compared with placebo and metformin groups . Over an average of 3 years , 89 CVD events from 64 participants were positively adjudicated study wide , with no differences among treatment groups . CONCLUSIONS Lifestyle intervention improves CVD risk factor status compared with placebo and metformin therapy . Although no differences in CVD events were noted after 3 years , achieved risk factor modifications suggest that longer intervention may reduce CVD event rates For decades , exercise has been considered a cornerstone of diabetes management , along with diet and medication . However , high- quality evidence on the importance of exercise and fitness in diabetes was lacking until recent years . The present document summarizes the most clinical ly relevant recent advances related to people with type 2 diabetes and the recommendations that follow from these . Our recently published technical review on physical activity/exercise and type 2 diabetes ( 1 ) includes greater detail on individual studies , on prevention of diabetes , and on the physiology of exercise . The present statement focuses on type 2 diabetes . Issues primarily germane to type 1 diabetes will be covered in a subsequent technical review and ADA Statement . The levels of evidence used are defined by the ADA in ref . 2 . Two r and omized trials each found that lifestyle interventions including ∼150 min/week of physical activity and  diet-induced weight loss of 5–7 % reduced the risk of progression from impaired glucose tolerance ( IGT ) to type 2 diabetes by 58 % ( 3,4 ) . A cluster-r and omized trial found that diet alone , exercise alone , and combined diet and exercise were equally effective in reducting the progression from IGT to diabetes ( 5 ) . Therefore , there is firm and consistent evidence that programs of increased physical activity  and modest weight loss reduce the incidence of type 2 diabetes in individuals with IGT . Boule et al. ( 6 ) undertook a systematic review and meta- analysis on the effects of structured exercise interventions in clinical trials of ≥8 weeks duration on HbA1c ( A1C ) and body mass in people with type 2 diabetes . Postintervention A1C was significantly lower in exercise than control groups ( 7.65 vs. 8.31 % , weighted mean difference −0.66 % ; P < 0.001 ) . In contrast , postintervention body weight did not differ between the exercise and control groups . Meta-regression confirmed that the beneficial effect of exercise on A1C Aims /hypothesisWe determined the effects of 6 years of lifestyle intervention in persons with impaired glucose tolerance ( IGT ) on the development of retinopathy , nephropathy and neuropathy over a 20 year period . Methods In 1986 , 577 adults with IGT from 33 clinics in Da Qing , China were r and omly assigned by clinic to a control group or one of three lifestyle intervention groups ( diet , exercise , and diet plus exercise ) . Active intervention was carried out from 1986 to 1992 . In 2006 we conducted a 20 year follow-up study of the original participants to compare the incidence of microvascular complications in the combined intervention group vs the control group . Results Follow-up information was obtained on 542 ( 94 % ) of the 577 original participants . The cumulative incidence of severe retinopathy was 9.2 % in the combined intervention group and 16.2 % in the control group ( p = 0.03 , log-rank test ) . After adjusting for clinic and age , the incidence of severe retinopathy was 47 % lower in the intervention group than the control group ( hazard rate ratio 0.53 , 95 % CI 0.29–0.99 , p = 0.048 ) . No significant differences were found in the incidence of severe nephropathy ( hazard rate ratio 1.05 , 95 % CI 0.16–7.05 , intervention vs control , p = 0.96 ) or in the prevalence of neuropathy ( 8.6 % vs 9.1 % , p = 0.89 ) among the 20 year survivors . Conclusions /interpretationLifestyle intervention for 6 years in IGT was associated with a 47 % reduction in the incidence of severe , vision-threatening retinopathy over a 20 year interval , primarily due to the reduced incidence of diabetes in the intervention group . However , similar benefits were not seen for nephropathy or neuropathy Abstract Background Diabetes prevalence is increasing . The Finnish Diabetes Prevention Study ( DPS ) showed a 58 % reduction in Type 2 Diabetes ( T2D ) incidence in adults with impaired glucose tolerance ( IGT ) . The European Diabetes Prevention Study ( EDIPS ) extends the DPS to different European population s , using the same study design . In the Newcastle arm of this study ( EDIPS-Newcastle ) , we tested the hypothesis that T2D can be prevented by lifestyle intervention and explored secondary outcomes in relation to diabetes incidence . Methods We recruited 102 participants ( 42 men and 60 women , mean age 57 years , mean BMI 34 kgm-2 ) with IGT to EDIPS-Newcastle and r and omised to Intervention and usual care Control groups .  The intervention included individual motivational interviewing aim ed at : weight reduction , increase in physical activity , fibre and carbohydrate intake and reduction of fat intake ( secondary outcomes ) . The primary outcome was diagnosis of T2D . Results Mean duration of follow-up was 3.1 years . T2D was diagnosed in 16 participants ( I = 5 , C = 11 ) . Absolute incidence of T2D was 32.7 per 1000 person-years in the Intervention-group and 67.1 per 1000 person-years in the Control-group . The overall incidence of diabetes was reduced by 55 % in the Intervention-group , compared with the Control-group : RR 0.45 ( 95%CI 0.2 to 1.2).Explanatory survival analysis of secondary outcomes showed that those who sustained beneficial changes for two or more years reduced their risk of developing T2D . Conclusion Our results are consistent with other diabetes prevention trials . This study was design ed as part of a larger study and although the sample size limits statistical significance , the results contribute to the evidence that T2D can be prevented by lifestyle changes in adults with IGT . In explanatory analysis small sustained beneficial changes in weight , physical activity or dietary factors were associated with reduction in T2D incidence . Trial Registration International St and ard R and omised Controlled Trial Number registry ( IS RCT N)Registry number : IS RCT N 15670600 http://www.controlled-trials.com/is rct n/ search .html?srch=15670600%26sort=3%26dir = OBJECTIVE To assess the effects of exenatide on body weight and glucose tolerance in nondiabetic obese subjects with normal or impaired glucose tolerance ( IGT ) or impaired fasting glucose ( IFG ) . RESEARCH DESIGN AND METHODS Obese subjects ( n = 152 ; age 46 ± 12 years , female 82 % , weight 108.6 ± 23.0 kg , BMI 39.6 ± 7.0 kg/m2 , IGT or IFG 25 % ) were r and omized to receive exenatide ( n = 73 ) or placebo ( n = 79 ) , along with lifestyle intervention , for 24 weeks . RESULTS Exenatide-treated subjects lost 5.1 ± 0.5 kg from baseline versus 1.6 ± 0.5 kg with placebo ( exenatide − placebo , P < 0.001 ) . Placebo-subtracted difference in percent weight reduction was −3.3 ± 0.5 % ( P < 0.001 ) . Both groups reduced their daily calorie intake  ( exenatide , −449 cal ; placebo , −387 cal ) . IGT or IFG normalized at end point in 77 and 56 % of exenatide and placebo subjects , respectively . CONCLUSIONS Exenatide plus lifestyle modification decreased caloric intake and result ed in weight loss in nondiabetic obesity with improved glucose tolerance in subjects with IGT and IFG CONTEXT A past history of gestational diabetes mellitus ( GDM ) confers a very high risk of postpartum development of diabetes , particularly type 2 diabetes . OBJECTIVE The Diabetes Prevention Program ( DPP ) sought to identify individuals with impaired glucose tolerance ( IGT ) and intervene in an effort to prevent or delay their progression to diabetes . This analysis examined the differences between women enrolled in DPP with and without a reported history of GDM . DESIGN The DPP was a r and omized , controlled clinical trial . SETTING The study was a multicenter , National Institutes of Health-sponsored trial carried out at 27 centers including academic and Indian Health Services sites . PATIENTS A total of 2190 women were r and omized into the DPP and provided information for past history of GDM . This analysis addressed the differences between those 350 women providing a past history of GDM and those 1416 women with a previous live birth but no history of GDM . INTERVENTIONS Subjects were r and omized to either st and ard lifestyle and placebo or metformin therapy or to an intensive lifestyle intervention . MAIN OUTCOMES The primary outcome was the time to development of diabetes ascertained by semiannual fasting plasma glucose and annual oral glucose tolerance testing . Assessment s of insulin secretion and insulin sensitivity were also performed . RESULTS Whereas entering the study with similar glucose levels , women with a history of GDM r and omized to placebo had a crude incidence rate of diabetes 71 % higher than that of women without such a history . Among women reporting a history of GDM , both intensive lifestyle and metformin therapy reduced the incidence of diabetes by approximately 50 % compared with the placebo group , whereas this reduction was 49 and 14 % , respectively in parous women without GDM . These data suggest that metformin may be more effective in women with a GDM history as compared with those without . CONCLUSIONS Progression to diabetes is more common in women with a history of GDM compared with those without GDM history despite equivalent degrees of IGT at baseline . Both intensive lifestyle and metformin are highly effective in delaying or preventing diabetes in women with IGT and a history of GDM AIMS To assess the beneficial effects of the components of lifestyle intervention in reducing incidence of diabetes in Asian Indian men with impaired glucose tolerance ( IGT ) in India . METHODS This analysis was based on a 2 year prospect i ve , r and omized controlled primary prevention trial in a cohort of Asian Indian men with IGT ( n=537 ) ( Clinical Trial No : NCT00819455 ) . Intervention and control groups were given st and ard care advice at baseline . Additionally , the intervention group received frequent , mobile phone based text message reminders on healthy lifestyle principles .  Dietary intake and physical activity habits were recorded by vali date d question naires . The lifestyle goals were : reductions in consumption of carbohydrates , oil , portion size and body mass index of at least 1 unit ( 1 kg/m(2 ) ) from baseline and maintenance of good physical activity . The association between diabetes and lifestyle goals achieved was assessed using multiple logistic regression analyses . Changes in insulin sensitivity ( Matsuda 's insulin sensitivity index ) and oral disposition index during the follow-up were assessed . RESULTS At the end of the study , 123 ( 23.8 % ) participants developed diabetes  . The mean lifestyle score was higher in the intervention group compared with control ( 2.59 ± 1.13 vs. 2.28 ± 1.17 ; P=0.002 ) . Among the 5 lifestyle variables , significant improvements in the 3 dietary goal were seen with intervention . Concomitant improvement in insulin sensitivity and oral disposition index was noted . Higher lifestyle score was associated with lower risk of developing diabetes ( odds ratio : 0.54 [ 95 % CI : 0.44 - 0.70 ] ; P<0.0001 ) . CONCLUSIONS Beneficial effects of intervention were associated with increased compliance to lifestyle goals . The plausible mechanism is through improvement in insulin sensitivity and beta cell preservation OBJECTIVE —We investigated whether circulating adipokine concentrations can be altered by lifestyle intervention according to general recommendations in subjects at risk for diabetes as well as the potential of leptin , adiponectin , and resistin as biomarkers for lifestyle-induced improvements in glucose metabolism and insulin resistance . RESEARCH DESIGN AND METHODS —In the Study on Lifestyle intervention and Impaired glucose tolerance Maastricht , 147 men and women with impaired glucose tolerance ( IGT ) were r and omized to either a combined diet- and -exercise intervention or a control program . At baseline and after 1 year , an oral glucose tolerance test , an exercise test , and anthropometric measurements were performed . After 1 year , complete data of 103 subjects ( 50 intervention and 53 control subjects ) were obtained . RESULTS —Lifestyle intervention reduced plasma leptin concentrations ( −14.2 % ) in IGT subjects but did not alter plasma adiponectin ( −0.3 % ) or resistin ( −6.5 % ) concentrations despite marked improvements in glucose tolerance and insulin resistance . CONCLUSIONS —Changes in leptin concentration were related to improvements in insulin sensitivity independent of changes in body composition The purpose of this study was to evaluate the efficacy and feasibility of a newly developed diabetes patient education program consisting of a three-day hospitalization and a six-month follow-up by telephone counseling for patients with mild type 2 diabetes or impaired glucose tolerance ( IGT ) by a r and omized controlled trial ( RCT ) method . Fifty-two patients with mild type 2 diabetes or IGT ( HbAlc<8 ) were r and omly assigned to either an intervention group or a control group . The current care was continued for the control group and the new education program was provided in addition to the current care for the intervention group . Changes in weight , blood glucose in a 75g-oral glucose tolerance test ( 75g-OGTT ) , and HbAlc were measured in June 1997 as baseline data and again in Dec. 1997 . Scores for knowledge of diabetes , dietary habits , physical activity , health practice index , diabetes quality of life ( DQOL ) , and self-efficacy were also obtained . After six months , the intervention group showed a statistically significant weight loss and blood glucose reduction in the 75g-OGTT test , but the control group did not . A significant improvement in lifestyle was observed in the intervention group , especially in terms of dietary habits and physical activity . The knowledge test scores increased in both groups . There were no significant differences in HbAlc , DQOL , or self-efficacy between the two groups . The results of this study show that the combination of a three-day hospitalization and a six-month follow-up by telephone counseling is effective in metabolic control and improvement of lifestyle for patients with mild type 2 diabetes or IGT . The reasons for the effectiveness were considered to be that l)changes in lifestyle were based on autonomous decision-making ; 2)regular , consistent counseling was provided by the nurse in charge of each patient ; 3)extended follow-up is more effective than initial education in preventing a rebound of weight or metabolic control AIM To evaluate the effectiveness of lifestyle interventions in people with impaired glucose tolerance ( IGT ) . METHODS Participants with IGT ( n=78 ) , diagnosed on two consecutive oral glucose tolerance tests ( OGTTs ) , were r and omly assigned to a 2-year lifestyle intervention or to a control group . Main outcome measures were changes from baseline in : nutrient intake ; physical activity ; anthropometry , glucose tolerance and insulin sensitivity . Measurements were repeated at 6 , 12 and 24 months follow-up . RESULTS After 24 months follow-up , there was a significant fall in total fat consumption ( difference in change between groups ( Delta intervention-Delta control)= -17.9 , 95 % confidence interval ( CI ) -33.6 to -2.1g/day ) as a result of the intervention . Body mass was significantly lower in the intervention group compared with controls after 6 months ( -1.6 , 95 % CI -2.9 to -0.4 kg ) and 24 months ( -3.3 , 95 % CI -5.7 to -0.89 kg ) . Whole body insulin sensitivity , assessed by the short insulin tolerance test ( ITT ) , improved after 12 months in the intervention group ( 0.52 , 95 % CI 0.15 - 0.89%/min ) . CONCLUSIONS These findings complement the findings of the Finnish Diabetes Prevention Study and the American Diabetes Prevention Study , both of which tested intensive interventions , by showing that pragmatic lifestyle interventions result in improvements in obesity and whole body insulin sensitivity in individuals with IGT , without change in other cardiovascular risk factors Non-insulin-dependent diabetes mellitus ( NIDDM ) is preceded by impaired glucose tolerance ( IGT ) lasting for years before manifesting as overt hyperglycaemia . Both genetic and environmental factors contribute to the development of IGT and NIDDM . Obesity , physical inactivity and high-fat diet have been found to predict IGT and NIDDM . Therefore , a diet and exercise intervention from diagnosis of NIDDM could improve the treatment outcome and prognosis of patients with NIDDM . Furthermore , because subjects with IGT are at increased risk for diabetes and atherosclerotic vascular disease , it is reasonable to assume that in terms of reducing the incidence and longterm consequences of NIDDM an intervention at this phase is more effective than in overt diabetes . Although the nonpharmacological approach is generally accepted as the first-line treatment of NIDDM its efficacy has often been question ed . Therefore , it is important to carry out long-term controlled studies to find out to what extent lifestyle modification could improve the metabolic control and level of major cardiovascular risk factors known to be associated with poor outcome in NIDDM . This kind of study also gave relevant experience in planning studies aim ing at primary prevention of NIDDM . One-year dietary and exercise intervention on newly diagnosed NIDDM patients in Kuopio , Finl and result ed in a better metabolic control and a moderate reduction in cardiovascular risk factors as compared to the conventional treatment group . After the second year of follow-up only 12.5 % in the intervention group were receiving  oral antidiabetic drugs  vs. 34.8 % in the conventional treatment group . Weight reduction and a reduced use of saturated fats appeared to be the main determinants of successful treatment results . Good aerobic capacity was associated with an increase in HDL cholesterol . A multicentre primary prevention study on IGT patients is continuing in Finl and applying the same principles of intervention as used in the study on newly diagnosed NIDDM patients . Pilot results show that glucose tolerance can be improved by lifestyle changes
D and PA+D  interventions had larger effects on glucose reduction  than PA alone .
Lifestyle  interventions significantly improved FPG , HbA1c , FI , HOMA-IR , and bodyweight among adults without IGT or diabetes , and might reduce progression of hyperglycemia to type 2 diabetes mellitus
This study systematic ally assessed the effectiveness of lifestyle interventions on glycemic indicators among adults ( ⩾18years ) without IGT or diabetes .