A significant positive effect of the interventions on weight was reported by all study types .
The meta- analysis showed that lifestyle interventions achieved weight and waist circumference reductions after one year .
However , no clear effects on biochemical or clinical parameters were observed , possibly due to short follow-up periods or lack of power of the studies meta-analysed .
Changes in dietary parameters or physical activity were generally not reported .
Most studies assessing feasibility were supportive of implementation of lifestyle interventions in routine clinical care .
Conclusion Lifestyle interventions for patients at high risk of diabetes , delivered by a variety of healthcare providers in routine clinical setting s , are feasible but appear to be of limited clinical benefit one year after intervention .
Despite convincing evidence from structured intensive trials , this systematic review showed that translation into routine practice has less effect on diabetes risk reduction
Background The clinical effectiveness of intensive lifestyle interventions in preventing or delaying diabetes in people at high risk has been established from r and omised trials of structured , intensive interventions conducted in several countries over the past two decades .
The challenge is to translate them into routine clinical setting s. The objective of this review is to determine whether lifestyle interventions delivered to high-risk adult patients in routine clinical care setting s are feasible and effective in achieving reductions in risk factors for diabetes .
XENical in the prevention of diabetes in obese subjects (XENDOS) study: a randomized study of orlistat as an adjunct to lifestyle changes for the prevention of type 2 diabetes in obese patients.
OBJECTIVE It is well established that the risk of developing type 2 diabetes is closely linked to the presence and duration of overweight and obesity . A reduction in the incidence of type 2 diabetes with lifestyle changes has previously been demonstrated . We hypothesized that adding a weight-reducing agent to lifestyle changes may lead to an even greater decrease in body weight , and thus the incidence of type 2 diabetes , in obese patients . RESEARCH DESIGN AND METHODS In a 4-year , double-blind , prospect i ve study , we r and omized 3,305 patients to lifestyle changes plus either orlistat 120 mg or placebo , three times daily . Participants had a BMI > /=30 kg/m2 and normal ( 79 % ) or impaired ( 21 % ) glucose tolerance ( IGT ) . Primary endpoints were time to onset of type 2 diabetes and change in body weight . Analyses were by intention to treat . RESULTS Of orlistat-treated patients , 52 % completed treatment compared with 34 % of placebo recipients ( P < 0.0001 ) . After 4 years ' treatment , the cumulative incidence of diabetes was 9.0 % with placebo and 6.2 % with orlistat , corresponding to a risk reduction of 37.3 % ( P = 0.0032 ) . Exploratory analyses indicated that the preventive effect was explained by the difference in subjects with IGT . Mean weight loss after 4 years was significantly greater with orlistat ( 5.8 vs. 3.0 kg with placebo ; P < 0.001 ) and similar between orlistat recipients with impaired ( 5.7 kg ) or normal glucose tolerance ( NGT ) ( 5.8 kg ) at baseline . A second analysis in which the baseline weights of subjects who dropped out of the study was carried forward also demonstrated greater weight loss in the orlistat group ( 3.6 vs. 1.4 kg ; P < 0.001 ) . CONCLUSIONS Compared with lifestyle changes alone , orlistat plus lifestyle changes result ed in a greater reduction in the incidence of type 2 diabetes over 4 years and produced greater weight loss in a clinical ly representative obese population . Difference in diabetes incidence was detectable only in the IGT subgroup ; weight loss was similar in subjects with IGT or NGT [ correction ]
A significant positive effect of the interventions on weight was reported by all study types .
The meta- analysis showed that lifestyle interventions achieved weight and waist circumference reductions after one year .
However , no clear effects on biochemical or clinical parameters were observed , possibly due to short follow-up periods or lack of power of the studies meta-analysed .
Changes in dietary parameters or physical activity were generally not reported .
Most studies assessing feasibility were supportive of implementation of lifestyle interventions in routine clinical care .
Conclusion Lifestyle interventions for patients at high risk of diabetes , delivered by a variety of healthcare providers in routine clinical setting s , are feasible but appear to be of limited clinical benefit one year after intervention .
Despite convincing evidence from structured intensive trials , this systematic review showed that translation into routine practice has less effect on diabetes risk reduction
Background The clinical effectiveness of intensive lifestyle interventions in preventing or delaying diabetes in people at high risk has been established from r and omised trials of structured , intensive interventions conducted in several countries over the past two decades .
The challenge is to translate them into routine clinical setting s. The objective of this review is to determine whether lifestyle interventions delivered to high-risk adult patients in routine clinical care setting s are feasible and effective in achieving reductions in risk factors for diabetes .