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 .
Cardiovascular mortality, all-cause mortality, and diabetes incidence after lifestyle intervention for people with impaired glucose tolerance in the Da Qing Diabetes Prevention Study: a 23-year follow-up study.
BACKGROUND Lifestyle interventions among people with impaired glucose tolerance reduce the incidence of diabetes , but their effect on all-cause and cardiovascular disease mortality is unclear . We assessed the long-term effect of lifestyle intervention on long-term outcomes among adults with impaired glucose tolerance who participated in the Da Qing Diabetes Prevention Study . METHODS The study was a cluster r and omised trial in which 33 clinics in Da Qing , China-serving 577 adults with impaired glucose tolerance-were r and omised ( 1:1:1:1 ) to a control group or lifestyle intervention groups ( diet or exercise or both ) . Patients were enrolled in 1986 and the intervention phase lasted for 6 years . In 2009 , we followed up participants to assess the primary outcomes of cardiovascular mortality , all-cause mortality , and incidence of diabetes in the intention-to-treat population . FINDINGS Of the 577 patients , 439 were assigned to the intervention group and 138 were assigned to the control group ( one refused baseline examination ) . 542 ( 94 % ) of 576 participants had complete data for mortality and 568 ( 99 % ) contributed data to the analysis . 174 participants died during the 23 years of follow-up ( 121 in the intervention group vs 53 in the control group ) . Cumulative incidence of cardiovascular disease mortality was 11.9 % ( 95 % CI 8.8 - 15.0 ) in the intervention group versus 19.6 % ( 12.9 - 26.3 ) in the control group ( hazard ratio [ HR ] 0.59 , 95 % CI 0.36 - 0.96 ; p=0.033 ) . All-cause mortality was 28.1 % ( 95 % CI 23.9 - 32.4 ) versus 38.4 % ( 30.3 - 46.5 ; HR 0.71 , 95 % CI 0.51 - 0.99 ; p=0.049 ) . Incidence of diabetes was 72.6 % ( 68.4 - 76.8 ) versus 89.9 % ( 84.9 - 94.9 ; HR 0.55 , 95 % CI 0.40 - 0.76 ; p=0.001 ) . INTERPRETATION A 6-year lifestyle intervention programme for Chinese people with impaired glucose tolerance can reduce incidence of cardiovascular and all-cause mortality and diabetes . These findings emphasise the long-term clinical benefits of lifestyle intervention for patients with impaired glucose tolerance and provide further justification for adoption of lifestyle interventions as public health measures to control the consequences of diabetes . FUNDING Centers for Disease Control and Prevention , WHO , the China-Japan Friendship Hospital , Da Qing First Hospital
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 .