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 .
The prevention or delay of type 2 diabetes.
D iabetes is one of the most costly and burdensome chronic diseases of our time and is a condition that is increasing in epidemic proportions in the U.S. and throughout the world ( 1 ) . The complications result ing from the disease are a significant cause of morbidity and mortality and are associated with the damage or failure of various organs such as the eyes , kidneys , and nerves . Individuals with type 2 diabetes are also at a significantly higher risk for coronary heart disease , peripheral vascular disease , and stroke , and they have a greater likelihood of having hypertension , dyslipidemia , and obesity ( 2–6 ) . There is also growing evidence that at glucose levels above normal but below the diabetes threshold diagnostic now referred to as pre-diabetes , there is a substantially increased risk of cardiovascular disease ( CVD ) and death ( 5,7–10 ) . In these individuals , CVD risk factors are also more prevalent ( 5–7,9,11–14 ) , which further increases the risk but is not sufficient to totally explain it . In contrast to the clear benefit of glucose lowering to prevent or retard the progression of microvascular complications associated with diabetes ( 15– 18,21 ) , it is less clear whether the high rate of CVD in people with impaired glucose homeostasis , i.e. , those with impaired fasting glucose ( IFG ) , impaired glucose tolerance ( IGT ) , or diabetes , is caused by elevated blood glucose levels or will respond to treatments that lower blood glucose . Epidemiological studies have shown a clear relationship ( 19,20 ) , whereas intervention trials in people with diabetes suggest , but have not demonstrated , a clear benefit of glycemic control ( 15,16,21,22 ) . Additionally , there are no studies that have investigated a benefit of glucose lowering on macrovascular disease in subjects with only pre-diabetes ( IFG or IGT ) but not diabetes . Although the treatment of diabetes has become increasingly sophisticated , with over a dozen pharmacological agents available to lower blood glucose , a multitude of ancillary supplies and equipment available , and a clear recognition by health care professionals and patients that diabetes is a serious disease , the normalization of blood glucose for any appreciable period of time is seldom achieved ( 23 ) . In addition , in well-controlled socalled “ intensively ” treated patients , serious complications still occur ( 15–18,21 ) , and the economic and personal burden of diabetes remains . Furthermore , microvascular disease is already present in many individuals with undiagnosed or newly diagnosed type 2 diabetes ( 11,24– 28 ) . Given these facts , it is not surprising that studies have been initiated in the last decade to determine the feasibility and benefit of various strategies to prevent or delay the onset of  type 2 diabetes .  Two early reports ( 29,30 ) suggested that changes in lifestyle can prevent diabetes , but weaknesses in study design limited their general relevance . Recently , however , four well- design ed r and omized controlled trials have been reported ( 31–35 ) . In the Finnish study ( 31 ) , 522 middleaged ( mean age 55 years ) obese ( mean BMI 31 kg/m ) subjects with IGT were r and omized to receive either brief diet and exercise counseling ( control group ) or intensive individualized instruction on weight reduction , food intake , and guidance on increasing physical activity ( intervention group ) . After an average follow-up of 3.2 years , there was a 58 % relative reduction in the incidence of diabetes in the intervention group compared with the control subjects . A strong correlation was also seen between the ability to stop the progression to diabetes and the degree to which subjects were able to achieve one or more of the following : lose weight ( goal of 5.0 % weight reduction ) , reduce fat intake ( goal of 30 % of calories ) , reduce saturated fat intake ( goal of 10 % of calories ) , increase fiber intake ( goal of 15 g/1,000 kcal ) , and exercise ( goal of 150 min/week ) . No untoward effects of the lifestyle interventions were observed . In the Diabetes Prevention Program ( DPP ) ( 32–34 ) , the 3,234 enrolled subjects were slightly younger ( mean age 51 years ) and more obese ( mean BMI 34 kg/m ) but had nearly identical glucose intolerance compared with subjects in the Finnish study . About 45 % of the participants were from minority groups ( e.g , AfricanAmerican , Hispanic ) , and 20 % were 60 years of age . Subjects were r and omized to one of three intervention groups , which included the intensive nutrition and exercise counseling ( “ lifestyle ” ) group or either of two masked medication treatment groups : the biguanide metformin group or the placebo group . The latter interventions were combined with st and ard diet and exercise recommendations . After an average follow-up of 2.8 years ( range 1.8–4.6 years ) , a 58 % relative reduction in the progression to diabetes was observed in the lifestyle group ( absolute incidence 4.8 % ) , and a 31 % relative reduction in the progression of diabetes was observed in the metformin group ( absolute incidence 7.8 % ) compared with control subjects ( absolute incidence 11.0 % ) . ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ●
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 .