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 .
10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study.
BACKGROUND In the 2.8 years of the Diabetes Prevention Program ( DPP ) r and omised clinical trial ,  diabetes incidence  in high-risk adults was reduced by 58 % with intensive lifestyle intervention and by 31 % with metformin , compared with placebo . We investigated the persistence of these effects in the long term . METHODS All active DPP participants were eligible for continued follow-up . 2766 of 3150 ( 88 % ) enrolled for a median additional follow-up of 5.7 years ( IQR 5.5 - 5.8 ) . 910 participants were from the lifestyle , 924 from the metformin , and 932 were from the original placebo groups .  On the basis of the benefits from the intensive lifestyle intervention in the DPP , all three groups were offered group-implemented lifestyle intervention . Metformin treatment was continued in the original metformin group ( 850 mg twice daily as tolerated ) , with participants unmasked to assignment , and the original lifestyle intervention group was offered additional lifestyle support . The primary outcome was development of diabetes according to American Diabetes Association criteria . Analysis was by intention-to-treat . This study is registered with Clinical Trials.gov , number NCT00038727 . FINDINGS During the 10.0-year ( IQR 9.0 - 10.5 ) follow-up since r and omisation to DPP , the original lifestyle group lost , then partly regained weight . The modest weight loss with metformin was maintained . Diabetes incidence rates during the DPP were 4.8 cases per 100 person-years ( 95 % CI 4.1 - 5.7 ) in the intensive lifestyle intervention group , 7.8 ( 6.8 - 8.8 ) in the metformin group , and 11.0 ( 9.8 - 12.3 ) in the placebo group . Diabetes incidence rates in this follow-up study were similar between treatment groups : 5.9 per 100 person-years ( 5.1 - 6.8 ) for lifestyle , 4.9 ( 4.2 - 5.7 ) for metformin , and 5.6 ( 4.8 - 6.5 ) for placebo . Diabetes incidence in the 10 years since DPP r and omisation was reduced by 34 % ( 24 - 42 ) in the lifestyle group and 18 % ( 7 - 28 ) in the metformin group compared with placebo . INTERPRETATION During follow-up after DPP , incidences in the former placebo and metformin groups fell to equal those in the former lifestyle group , but the cumulative incidence of diabetes remained lowest in the lifestyle group . Prevention or delay of diabetes with lifestyle intervention or metformin can persist for at least 10 years . FUNDING National Institute of Diabetes and Digestive and Kidney Diseases ( NIDDK )
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 .