Small effect sizes and potentially transient effect were reported in some studies , and some review ers noted that durability of intervention impact was potentially sensitive to duration of intervention and adherence to behaviour change .
Behaviour change , vascular disease and mortality outcome data were infrequently reported , and evidence of the impact of intervention on these outcomes was minimal .
Relatively long- duration lifestyle interventions can limit or delay progression to diabetes under trial conditions .
However , outcomes from more time-limited interventions , and those applied in routine clinical setting s , appear more variable , in keeping with the findings of recent pragmatic trials .
There is little evidence of intervention impact on vascular outcomes or mortality end points in any context . '
Real-world ' implementation of lifestyle interventions for diabetes prevention may be expected to lead to modest outcomes
OBJECTIVES To review the clinical outcomes of combined diet and physical activity interventions for population s at high risk of type 2 diabetes .
Ten-Year Mortality and Cardiovascular Morbidity in the Finnish Diabetes Prevention Study—Secondary Analysis of the Randomized Trial
Background The Finnish Diabetes Prevention Study ( DPS ) was a r and omized controlled trial , which showed that it is possible to prevent type 2 diabetes by lifestyle changes . The aim of the present study was to examine whether the lifestyle intervention had an effect on the ten-year mortality and cardiovascular morbidity in the DPS participants originally r and omized either into an intervention or control group . Furthermore , we compared these results with a population -based cohort comprising individuals of varying glucose tolerance states . Methods and Findings Middle-aged , overweight people with IGT ( n = 522 ) were r and omized into intensive intervention ( including physical activity , weight reduction and dietary counseling ) , or control “ mini-intervention ” group . Median length of the intervention period was 4 years and the mean follow-up was 10.6 years . The population -based reference study cohort included 1881 individuals ( 1570 with normal glucose tolerance , 183 with IGT , 59 with screen-detected type 2 diabetes , 69 with previously known type 2 diabetes ) with the mean follow-up of 13.8 years .  Mortality and cardiovascular morbidity data were collected from the national Hospital Discharge Register and Causes of Death Register . Among the DPS participants who consented for register linkage ( n = 505 ) , total mortality ( 2.2 vs. 3.8 per 1000 person years , hazard ratio HR = 0.57 , 95 % CI 0.21–1.58 ) and cardiovascular morbidity ( 22.9 vs. 22.0 per 1000 person years , HR = 1.04 , 95 % CI 0.72–1.51 ) did not differ significantly between the intervention and control groups . Compared with the population -based cohort with impaired glucose tolerance , adjusted HRs were 0.21 ( 95 % CI 0.09–0.52 ) and 0.39 ( 95 % CI 0.20–0.79 ) for total mortality , and 0.89 ( 95 % CI 0.62–1.27 ) and 0.87 ( 0.60–1.27 ) for cardiovascular morbidity in the intervention and control groups of the DPS , respectively . The risk of death in DPS combined cohort was markedly lower than in FINRISK IGT cohort ( adjusted HR 0.30 , 95 % CI 0.17–0.54 ) , but there was no significant difference in the risk of CVD ( adjusted HR 0.88 , 95 % CI 0.64–1.21 ) . Conclusions Lifestyle intervention among persons with IGT did not decrease cardiovascular morbidity  during the first 10 years of follow-up . However , the statistical power may not be sufficient to detect small differences between the intervention and control groups . Low total mortality among participants of the DPS compared with individuals with IGT in the general population could be ascribed to a lower cardiovascular risk profile at baseline and regular follow-up . Trial Registration Clinical Trials.gov
Small effect sizes and potentially transient effect were reported in some studies , and some review ers noted that durability of intervention impact was potentially sensitive to duration of intervention and adherence to behaviour change .
Behaviour change , vascular disease and mortality outcome data were infrequently reported , and evidence of the impact of intervention on these outcomes was minimal .
Relatively long- duration lifestyle interventions can limit or delay progression to diabetes under trial conditions .
However , outcomes from more time-limited interventions , and those applied in routine clinical setting s , appear more variable , in keeping with the findings of recent pragmatic trials .
There is little evidence of intervention impact on vascular outcomes or mortality end points in any context . '
Real-world ' implementation of lifestyle interventions for diabetes prevention may be expected to lead to modest outcomes
OBJECTIVES To review the clinical outcomes of combined diet and physical activity interventions for population s at high risk of type 2 diabetes .