title: Effects of lifestyle intervention and meal replacement on glycaemic and body-weight control in Chinese subjects with impaired glucose regulation: a 1-year randomised controlled trial. Community-Based Lifestyle Intervention for Reducing Blood Pressure and Glucose among Middle-Aged and Older Adults in China: A Pilot Study Translating the Diabetes Prevention Program into the community. The DEPLOY Pilot Study. A short message service (SMS) intervention to prevent diabetes in Chinese professional drivers with pre-diabetes: a pilot single-blinded randomized controlled trial. Efficacy of a virtual assistance‐based lifestyle intervention in reducing risk factors for Type 2 diabetes in young employees in the information technology industry in India: LIMIT, a randomized controlled trial One-Year Results of a Synthetic Intervention Model for the Primary Prevention of T2D among Elderly Individuals with Prediabetes in Rural China 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study. Outcome of intensive integrated intervention in participants with impaired glucose regulation in China Intensive Patient Education Improves Glycaemic Control in Diabetes Compared to Conventional Education: A Randomised Controlled Trial in a Nigerian Tertiary Care Hospital Rationale, Design, and Baseline Characteristics of Beijing Prediabetes Reversion Program: A Randomized Controlled Clinical Trial to Evaluate the Efficacy of Lifestyle Intervention and/or Pioglitazone in Reversion to Normal Glucose Tolerance in Prediabetes Effectiveness of mobile phone messaging in prevention of type 2 diabetes by lifestyle modification in men in India: a prospective, parallel-group, randomised controlled trial. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. The Indian Diabetes Prevention Programme shows that lifestyle modification and metformin prevent type 2 diabetes in Asian Indian subjects with impaired glucose tolerance (IDPP-1) [Effect of lifestyle interventions on reduction of cardiovascular disease events and its mortality in pre-diabetic patients:long-term follow-up of Da Qing Diabetes Prevention Study]. Implementation of a diabetes prevention program in public housing communities. Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: follow-up of the Finnish Diabetes Prevention Study Long-term nutrition education reduces several risk factors for type 2 diabetes mellitus in Brazilians with impaired glucose tolerance. Effects of Diet and Exercise in Preventing NIDDM in People With Impaired Glucose Tolerance: The Da Qing IGT and Diabetes Study Development of a community participation program for diabetes mellitus prevention in a primary care unit, Thailand. Reducing risk behaviors linked to noncommunicable diseases in Mongolia: a randomized controlled trial. Empowerment Program for People With Prediabetes: A Randomized Controlled Trial The long-term effect of lifestyle interventions to prevent diabetes in the China Da Qing Diabetes Prevention Study: a 20-year follow-up study A model of translational research for diabetes prevention in low and middle-income countries: The Diabetes Community Lifestyle Improvement Program (D-CLIP) trial. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. Effects of a dietary modification on 2 h postprandial blood glucose in Thai population at risk of type 2 diabetes: An application of the Stages of Change Model. Long-term outcomes from a multiple-risk-factor diabetes trial for Latinas: ¡Viva Bien! 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. Effect of aerobic exercise and diet on liver fat in pre-diabetic patients with non-alcoholic-fatty-liver-disease: A randomized controlled trial
abstract: The purpose of the present study was to evaluate the impact of a lifestyle intervention programme , combined with a daily low-glycaemic index meal replacement , on body-weight and glycaemic control in subjects with impaired glucose regulation ( IGR ) . Subjects with IGR were r and omly assigned to an intervention group ( n 46 ) and a control group ( n 42 ) . Both groups received health counselling at baseline . The intervention group also received a daily meal replacement and intensive lifestyle intervention to promote healthy eating habits during the first 3 months of the study , and follow-up visits performed monthly until the end of the 1-year study . Outcome measurements included changes in plasma glucose , glycated Hb ( HbA1c ) , plasma lipids , body weight , blood pressure and body composition ( such as body fat mass and visceral fat area ) . The results showed that body-weight loss after 1 year was significant in the intervention group compared with the control group ( -1·8 ( SEM 0·35 ) v. -0·6 ( SEM 0·40 ) 2·5 kg , P<0·05 ) . The 2 h plasma glucose concentration decreased 1·24 mmol/l in the intervention group and increased 0·85 mmol/l in the control group ( P<0·05 ) compared with their baseline , respectively . A 5 kg body-weight loss at 1 year was associated with a decrease of 1·49 mmol/l in 2 h plasma glucose ( P<0·01 ) . The incidence of normal glucose regulation ( NGR ) in the two groups was significantly different ( P=0·001 ) . In conclusion , the combination of regular contact , lifestyle advice and meal replacement is beneficial in promoting IGR to NGR Although evidence suggests that lifestyle interventions can reduce blood pressure ( BP ) and glucose levels , there is little information about the feasibility of such interventions when implemented in community setting s. This study evaluated the effectiveness of a community-based lifestyle intervention on BP and glucose in the middle-aged and older Chinese population . By using a cluster r and omisation approach , 474 participants from two communities were assigned to the intervention group which received intensive health education and behavioural intervention , or the control group which received conventional education . Linear mixed models were used to compare between-group differences on change in BP and fasting glucose after 6 , 12 and 24 months . At the 12-month follow-up , the intervention group experienced significantly reductions in systolic BP ( −4.9 vs. 2.4 mmHg ; mean difference [ MD ] −7.3 mmHg ; p < 0.001 ) , diastolic BP ( −1.9 vs. 1.9 mmHg ; MD −3.8 mmHg ; p < 0.001 ) and fasting glucose ( −0.59 vs. 0.08 mmol/L ; MD −0.67 mmol/L ; p < 0.001 ) . These differences were sustained at the 24-month follow-up . With only two communities , it was not possible to adjust for potential clustering by site . This approach of lifestyle interventions conducted through primary care services may be a potential solution for combating hypertension and diabetes in a re source -limited country context in China BACKGROUND The Diabetes Prevention Program ( DPP ) found that an intensive lifestyle intervention can reduce the development of diabetes by more than half in adults with prediabetes , but there is little information about the feasibility of offering such an intervention in community setting s. This study evaluated the delivery of a group-based DPP lifestyle intervention in partnership with the YMCA . METHODS This pilot cluster-r and omized trial was design ed to compare group-based DPP lifestyle intervention delivery by the YMCA to brief counseling alone ( control ) in adults who attended a diabetes risk-screening event at one of two semi-urban YMCA facilities and who had a BMI > or=24 kg/m2 , > or=2 diabetes risk factors , and a r and om capillary blood glucose of 110 - 199 mg/dL. Multivariate regression was used to compare between-group differences in changes in body weight , blood pressures , HbA1c , total cholesterol , and HDL-cholesterol after 6 and 12 months . RESULTS Among 92 participants , controls were more often women ( 61 % vs 50 % ) and of nonwhite race ( 29 % vs 7 % ) . After 6 months , body weight decreased by 6.0 % ( 95 % CI=4.7 , 7.3 ) in intervention participants and 2.0 % ( 95 % CI=0.6 , 3.3 ) in controls ( p<0.001 ; difference between groups ) . Intervention participants also had greater changes in total cholesterol ( -22 mg/dL vs + 6 mg/dL controls ; p<0.001 ) . These differences were sustained after 12 months , and adjustment for differences in race and gender did not alter these findings . With only two matched YMCA sites , it was not possible to adjust for potential clustering by site . CONCLUSIONS The YMCA may be a promising channel for wide-scale dissemination of a low-cost approach to lifestyle diabetes prevention AIM To determine the efficacy of delivering short-message service ( SMS ) to provide diabetes-related information in reducing the risk of developing diabetes in Chinese professional drivers with pre-diabetes . METHODS A pilot single-blinded r and omized controlled trial was conducted in Hong Kong between 05/2009 and 04/2012 . Professional drivers with impaired glucose tolerance ( IGT ) were r and omly allocated to either a SMS group receiving messages comprising knowledge and lifestyle modification on diabetes or to a control group with usual care . Primary outcomes were the incidence rate of diabetes mellitus over 12 and 24 months period . RESULTS Fifty-four , out of 104 professional drivers recruited , were r and omly allocated to intervention group . Fewer subjects developed diabetes at 12 months in intervention group ( 5.56 % ) compared to control group ( 16.00 % ) . Relative risk ( RR ) of diabetes onset was 0.35 ( 95%CI : 0.10–1.24 ) and the number needed to treat ( NNT ) for preventing one diabetes was 9.57 . At 24 months , RR increased to 0.62 ( 95%CI : 0.24–1.61 ) with a NNT of 10.58 . Logistic regression showed a significant odds ratio of 0.04 ( P = 0.021 ) for intervention group compared to control group at 12-month follow-up for completers and a non-significant odds ratio of 0.34 ( P = 0.303 ) at 24-month follow-up . CONCLUSIONS The SMS program proved to have potential to reduce the risk of developing diabetes at 12 months but additional measures should be integrated to prevent or delay disease progression AIMS To investigate a virtual assistance-based lifestyle intervention to reduce risk factors for Type 2 diabetes in young employees in the information technology industry in India . METHODS LIMIT ( Lifestyle Modification in Information Technology ) was a parallel-group , partially blinded , r and omized controlled trial . Employees in the information technology industry with ≥3 risk factors ( family history of cardiometabolic disease , overweight/obesity , high blood pressure , impaired fasting glucose , hypertriglyceridaemia , high LDL cholesterol and low HDL cholesterol ) from two industries were r and omized to a control or an intervention ( 1:1 ) group . After initial lifestyle advice , the intervention group additionally received reinforcement through mobile phone messages ( three per week ) and e-mails ( two per week ) for 1 year . The primary outcome was change in prevalence of overweight/obesity , analysed by intention to treat . RESULTS Of 437 employees screened ( mean age 36.2 ± 9.3 years ; 74.8 % men ) , 265 ( 61.0 % ) were eligible and r and omized into control ( n=132 ) or intervention ( n=133 ) group . After 1 year , the prevalence of overweight/obesity reduced by 6.0 % in the intervention group and increased by 6.8 % in the control group ( risk difference 11.2 % ; 95 % CI 1.2 - 21.1 ; P=0.042 ) . There were also significant improvements in lifestyle measurements , waist circumference , and total and LDL cholesterol in the intervention group . The number-needed-to-treat to prevent one case of overweight/obesity in 1 year was 9 ( 95 % CI 5 - 82 ) , with an incremental cost of INR10665 ( £ 112.30 ) per case treated/prevented . A total of 98 % of participants found the intervention acceptable . CONCLUSIONS A virtual assistance-based lifestyle intervention  was effective , cost-effective and acceptable in reducing risk factors for diabetes in young employees in the information technology industry , and is potentially scalable Objective : The objective of this study was to evaluate the effectiveness of a synthetic intervention model aim ed at preventing type 2 diabetes and controlling plasma glucose , body weight and waist circumference in elderly individuals with prediabetes in rural China . Methods : We r and omly assigned 434 ( 180 men and 254 women ; mean age , 69 years ; mean body mass index , 23.6 kg/m2 ) with prediabetes to either the intervention group or the control group . Each participant in the intervention group received synthetic intervention for 1 year . Results : The incidence of diabetes was 4.2 % in the intervention group , versus 19.7 % in the control group at the end of 1 year ( p < 0.001 ) . Compared with the control group , the intervention group experienced a great decrease in fasting glucose ( −3.9 vs. 2.2 mg/dL , p < 0.001 ) , body weight ( −3.2 vs. 1.7 kg , p < 0.001 ) , waist circumference ( −2.4 vs. 1.0 cm , p < 0001 ) , total cholesterol ( −9.1 vs. −4.6 mg/dL. p = 0.014 ) and HbA1c ( −1.0 vs. 0.1 mg % , p = 0.002 ) at the end of 1 year . Conclusions : The incidence of diabetes of the control group was higher than that of the intervention group . Besides , the synthetic intervention contributes to weight loss and glucose decrease , and may be effective in reducing the risk of diabetes among elderly individuals with prediabetes in rural China 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 ) Introduction This study investigated the outcomes and identified influencing factors of intensive integrated intervention over 2 years in Chinese patients with impaired glucose regulation ( IGR ) . Methods Adults in Beijing , China , were screened for IGR using the 75 g oral glucose tolerance test . Participants with IGR received lifestyle and health education ; those who still had IGR after 1 year were r and omly assigned to either a routine care group or to an intensive integrated intervention group . Results Of 2344 adults screened , 463 had IGR . Of these , 210 adults had IGR after 1 year and were therefore recruited and r and omized to an intensive integrated intervention group ( n=106 ) or a control group ( n=104 ) . The percentage of patients who reached the set targets of plasma glucose , blood pressure , body mass index , or triglycerides was significantly higher in the intensive integrated intervention group . None of the patients within the intensive integrated intervention group progressed to diabetes , whereas eight ( 9.3 % ) cases of the control group developed type 2 diabetes mellitus ( T2DM ) . Logistic regression analysis showed that both an increase in waist circumference and systolic blood pressure ( SBP ) were positively correlated with the development of T2DM , whereas improvement in islet beta cell function was negatively correlated with the development of T2DM . Conclusions Intensive integrated intervention may significantly decrease the conversion rate of IGR to T2DM , and increase the conversion ratio to normal glucose tolerance . The increase of waist circumference or SBP and the deterioration of islet beta cell function may be important risk factors for progression from prediabetes to diabetes Background Diabetes is now a global epidemic , but most cases are now in low- and middle-income countries . Diabetes self-management education ( DSME ) is key to enabling patients to manage their chronic condition and can reduce the occurrence of costly and devastating complications . However , there is limited evidence on the effectiveness of different DSME programmes in re source limited setting s. Methods We conducted an unblinded , parallel-group , individually-r and omised controlled trial at the University of Calabar Teaching Hospital ( Nigeria ) to evaluate whether an intensive and systematic DSME programme , using structured guidelines , improved glycaemic control compared to the existing ad hoc patient education ( clinical practice was unchanged ) . Eligible patients ( ≥18 years , HbA1c > 8.5 % and physically able to participate ) were r and omly allocated by permuted block r and omisation to participate for six months in either an intensive or conventional education group . The primary outcome was HbA1c ( % ) at six-months . Results We r and omised 59 participants to each group and obtained six-month HbA1c outcomes from 53 and 51 participants in the intensive and conventional education groups , respectively . Intensive group participants had a mean six-month HbA1c ( % ) of 8.4 ( 95 % CI : 8 to 8.9 ) , while participants in the conventional education group had a mean six-month HbA1c ( % ) of 10.2 ( 95 % CI : 9.8 to 10.7 ) . The difference was statistically ( P < 0.0001 ) and clinical ly significant , with intensive group participants having HbA1c outcomes on average -1.8 ( 95 % CI : -2.4 to -1.2 ) percentage points lower than conventional group participants . Results were robust to adjustment for a range of covariates and multiple imputation of missing outcome data . Conclusions This study demonstrates the effectiveness of a structured , guideline -based DSME intervention in a LMIC setting versus a pragmatic comparator . The intervention is potentially replicable at other levels of the Nigerian healthcare system and in other LMICs , where nurses/diabetes educators can run the programme . Trial Registration Pan African Clinical Trial Registry Background . Patients with prediabetes are at high risk for diabetes and cardiovascular disease ( CVD ) . No study has explored whether intervention could revert prediabetes to normal glycemic status as the primary outcome . Beijing Prediabetes Reversion Program ( BPRP ) would evaluate whether intensive lifestyle modification and /or pioglitazone could revert prediabetic state to normoglycemia and improve the risk factors of CVD as well . Methods . BPRP is a r and omized , multicenter , 2 × 2 factorial design study . Participants diagnosed as prediabetes were r and omized into four groups ( conventional/intensive lifestyle intervention and 30 mg pioglitazone/placebo ) with a three-year follow-up . The primary endpoint was conversion into normal glucose tolerance . The trial would recruit 2000 participants ( 500 in each arm ) . Results . Between March 2007 and March 2011 , 1945 participants were r and omized . At baseline , the individuals were 53 ± 10 years old , with median BMI 26.0 ( 23.9 , 28.2 ) kg/m2 and HbA1c 5.8 ( 5.6 , 6.1)% . 85 % of the participants had IGT and 15 % had IFG . Parameters relevant to glucose , lipids , blood pressure , lifestyle , and other metabolic markers were similar between conventional and intensive lifestyle intervention group at baseline . Conclusion . BPRP was the first study to determine if lifestyle modification and /or pioglitazone could revert prediabetic state to normoglycemia in Chinese population . Major baseline parameters were balanced between two lifestyle intervention groups . This trial is registered with www.chictr.org.cn : ChiCTR-PRC-06000005 BACKGROUND Type 2 diabetes can often be prevented by lifestyle modification ; however , successful lifestyle intervention programmes are labour intensive . Mobile phone messaging is an inexpensive alternative way to deliver educational and motivational advice about lifestyle modification . We aim ed to assess whether mobile phone messaging that encouraged lifestyle change could reduce incident type 2 diabetes  in Indian Asian men with impaired glucose tolerance . METHODS We did a prospect i ve , parallel-group , r and omised controlled trial between Aug 10 , 2009 , and Nov 30 , 2012 , at ten sites in southeast India . Working Indian men ( aged 35 - 55 years ) with impaired glucose tolerance were r and omly assigned ( 1:1 ) with a computer-generated r and omisation sequence to a mobile phone messaging intervention or st and ard care ( control group ) . Participants in the intervention group received frequent mobile phone messages compared with controls who received st and ard lifestyle modification advice at baseline only . Field staff and participants were , by necessity , not masked to study group assignment , but allocation was concealed from laboratory personnel as well as principal and co-investigators . The primary outcome was incidence of type 2 diabetes , analysed by intention to treat . This trial is registered with Clinical Trials.gov , number NCT00819455 . RESULTS We assessed 8741 participants for eligibility . 537 patients were r and omly assigned to either the mobile phone messaging intervention ( n=271 ) or st and ard care ( n=266 ) . The cumulative incidence of type 2 diabetes was lower in those who received mobile phone messages than in controls : 50 ( 18 % ) participants in the intervention group developed type 2 diabetes compared with 73 ( 27 % ) in the control group ( hazard ratio 0·64 , 95 % CI 0·45 - 0·92 ; p=0·015 ) . The number needed to treat to prevent one case of type 2 diabetes was 11 ( 95 % CI 6 - 55 ) . One patient in the control group died suddenly at the end of the first year . We recorded no other serious adverse events . INTERPRETATION Mobile phone messaging is an effective and acceptable method to deliver advice and support towards lifestyle modification to prevent type 2 diabetes in men at high risk . FUNDING The UK India Education and Research Initiative , the World Diabetes Foundation BACKGROUND Type 2 diabetes mellitus is increasingly common , primarily because of increases in the prevalence of a sedentary lifestyle and obesity . Whether type 2 diabetes can be prevented by interventions that affect the lifestyles of subjects at high risk for the disease is not known . METHODS We r and omly assigned 522 middle-aged , overweight subjects ( 172 men and 350 women ; mean age , 55 years ; mean body-mass index [ weight in kilograms divided by the square of the height in meters ] , 31 ) with impaired glucose tolerance to either the intervention group or the control group . Each subject in the intervention group received individualized counseling aim ed at reducing weight , total intake of fat , and intake of saturated fat and increasing intake of fiber and physical activity . An oral glucose-tolerance test was performed annually ; the diagnosis of diabetes was confirmed by a second test . The mean duration of follow-up was 3.2 years . RESULTS The mean ( + /-SD ) amount of weight lost between base line and the end of year 1 was 4.2+/-5.1 kg in the intervention group and 0.8+/-3.7 kg in the control group ; the net loss by the end of year 2 was 3.5+/-5.5 kg in the intervention group and 0.8+/-4.4 kg in the control group ( P<0.001 for both comparisons between the groups ) . The cumulative incidence of diabetes after four years was 11 percent ( 95 percent confidence interval , 6 to 15 percent ) in the intervention group and 23 percent ( 95 percent confidence interval , 17 to 29 percent ) in the control group . During the trial , the risk of diabetes was reduced by 58 percent ( P<0.001 ) in the intervention group . The reduction in the incidence of diabetes was directly associated with changes in lifestyle . CONCLUSIONS Type 2 diabetes can be prevented by changes in the lifestyles of high-risk subjects Aims /hypothesisLifestyle modification helps in the primary prevention of diabetes in multiethnic American , Finnish and Chinese population s. In a prospect i ve community-based study , we tested whether the progression to diabetes could be influenced by interventions in native Asian Indians with IGT who were younger , leaner and more insulin resistant than the above population s. Methods We r and omised 531 ( 421 men 110 women ) subjects with IGT ( mean age 45.9±5.7 years , BMI 25.8±3.5 kg/m2 ) into four groups . Group 1 was the control , Group 2 was given advice on lifestyle modification ( LSM ) , Group 3 was treated with metformin ( MET ) and Group 4 was given LSM plus MET . The primary outcome measure was type 2 diabetes as diagnosed using World Health Organization criteria . Results The median follow-up period was 30 months , and the 3-year cumulative incidences of diabetes were 55.0 % , 39.3 % , 40.5 % and 39.5 % in Groups 1–4 , respectively . The relative risk reduction was 28.5 % with LSM ( 95 % CI 20.5–37.3 , p=0.018 ) , 26.4 % with MET ( 95 % CI 19.1–35.1 , p=0.029 ) and 28.2 % with LSM + MET ( 95 % CI 20.3–37.0 , p=0.022 ) , as compared with the control group . The number needed to treat to prevent one incident case of diabetes was 6.4 for LSM , 6.9 for MET and 6.5 for LSM + MET . Conclusions /interpretationProgression of IGT to diabetes is high in native Asian Indians .  Both LSM and MET significantly reduced the incidence of diabetes  in Asian Indians with IGT ; there was no added benefit from combining them OBJECTIVE To investigate if a six-year intensive lifestyle intervention in people with pre-diabetes lead to reduction of cardiovascular events and cardiovascular disease ( CVD ) mortality in subsequent 23 years . METHODS Five hundreds and nineteen subjects with normal glucose tolerance ( NGT ) and 577 subjects with impaired glucose tolerance ( IGT ) in Da Qing city were recruited in the study in 1986 . The IGT subjects r and omly assigned to either the no-intervention group or one of three lifestyle intervention groups ( diet , exercise , or diet plus exercise ) to receive a 6-year lifestyle intervention . In 2009 , the participants were followed up to assess the primary outcomes of cardiovascular events and CVD mortality by a question naire and medical records . RESULTS Subjects in IGT no-intervention group had the highest incidences of cardiovascular events ( 44.44 % ) and CVD mortality ( 20.00 % ) , while those in NGT group had the lowest incidences of cardiovascular events ( 29.59 % ) and CVD mortality ( 7.52 % ) after 23-year follow-up . The incidences of cardiovascular events and CVD mortality in IGT intervention subjects were 37.84 % and 12.53 % , respectively . The multivariable analyses showed that , after controlling of age , gender , BMI smoking , blood pressure and cardiovascular event at baseline , the CVD mortality and incidence of cardiovascular events in IGT no-intervention group was 1.89 ( HR = 1.89 , 95%CI 1.11 - 3.22 , P = 0.02 ) and 1.38 ( HR = 1.38 , 95%CI 1.01 - 1.90 , P = 0.04 ) times of those in NGT group . However , the CVD mortality and incidence of cardiovascular events were not different in the IGT intervention group compared with those in the NGT group ( HR = 1.39 , 95%CI 0.89 - 2.18 , P = 0.15 and HR = 1.25 , 95%CI 0.98 - 1.59 , P = 0.07 , respectively ) . CONCLUSIONS Subjects with IGT were at high risk for cardiovascular events and mortality . A six-year lifestyle intervention in this population can reduce both the incidence of cardiovascular event and CVD mortality OBJECTIVE The purpose of this study was to describe the process of implementing a diabetes prevention program provided by homecare nurses to residents of public housing communities . DESIGN AND SAMPLE A cluster r and omization pilot study was conducted comparing enhanced st and ard care ( 2 interactive classes on diabetes prevention ) to a diabetes prevention program ( 7 interactive classes and behavioral support ) . The sample ( n = 67 ) was primarily female ( 79 % ) , nonwhite ( 76 % ) , unpartnered ( 83 % ) , with a mean age of 40 years , and an average of 3 children . Mixed methods were used to evaluate the implementation process . MEASURES Data were collected on attendance , attrition , and protocol implementation . Interviews were conducted with nurses and community health workers who assisted with program implementation . RESULTS Homecare nurses were able to implement a diabetes prevention program in public housing communities , with a protocol implementation of 83 % across classes and groups . Attendance was suboptimal with 60 % for the enhanced st and ard care group and 54 % for the diabetes prevention group . Nurses and community health workers were re source ful and positive about program implementation . CONCLUSION Linking existing re sources , such as a homecare agency with a public housing community , is one approach to disseminate diabetes prevention programs BACKGROUND Lifestyle interventions can prevent the deterioration of impaired glucose tolerance to manifest type 2 diabetes , at least as long as the intervention continues . In the extended follow-up of the Finnish Diabetes Prevention Study , we assessed the extent to which the originally-achieved lifestyle changes and risk reduction remain after discontinuation of active counselling . METHODS Overweight , middle-aged men ( n=172 ) and women ( n=350 ) with impaired glucose tolerance were r and omly assigned to intensive lifestyle intervention or control group . After a median of 4 years of active intervention period , participants who were still free of diabetes were further followed up for a median of 3 years , with median total follow-up of 7 years . Diabetes incidence , bodyweight , physical activity , and dietary intakes of fat , saturated fat , and fibre were measured . FINDINGS During the total follow-up , the incidence of type 2 diabetes was 4.3 and 7.4 per 100 person-years in the intervention and control group , respectively ( log-rank test p=0.0001 ) , indicating 43 % reduction in relative risk . The risk reduction was related to the success in achieving the intervention goals of weight loss , reduced intake of total and saturated fat and increased intake of dietary fibre , and increased physical activity . Beneficial lifestyle changes achieved by participants in the intervention group were maintained after the discontinuation of the intervention , and the corresponding incidence rates during the post-intervention follow-up were 4.6 and 7.2 ( p=0.0401 ) , indicating 36 % reduction in relative risk . INTERPRETATION Lifestyle intervention in people at high risk for type 2 diabetes result ed in sustained lifestyle changes and a reduction in diabetes incidence , which remained after the individual lifestyle counselling was stopped The aim of this study was to evaluate the effects of a nutrition education program ( NEP ) on anthropometric , dietetic , and metabolic parameters in high-risk subjects for type 2 diabetes mellitus . Fifty-one participants , both sexes , were r and omly assigned to either the control ( 58.8 % ) or the intervention ( NEP ) group . The intervention group received frequent individual and group nutritional counseling from a team of nutritionists . Participants were assessed at baseline ( M0 ) and after 12 months ( M1 ) for anthropometric , dietetic , and metabolic parameters . The hypothesis was that high-risk subjects for type 2 diabetes mellitus participating in NEP would show an improvement in these parameters . At M1 , the intervention group showed a significant decline in body weight ( -3.4 % ) , body mass index ( -5.7 % ) , cholesterol intake ( -49.5 % ) , fasting glycemia ( -14.0 % ) , fasting insulin ( -9.0 % ) , postpr and ial glycemia ( -21.0 % ) , postpr and ial insulin ( -71.0 % ) , total serum cholesterol ( -23.0 % ) , and glycated hemoglobin ( -24.0 % ) . A decrease in energy intake ( 5 % , P = .06 ) and low-density lipoprotein cholesterol ( 25 % , P = .07 ) was observed in the interventional group , although it did not reach statistical significance . In contrast , the control group presented a significantly higher energy intake ( 19 % , P = .04 ) and a nonsignificant increase in consumption of all macronutrients . The long-term NEP was found to improve anthropometric , dietary , and metabolic parameters in high-risk subjects for type 2 diabetes mellitus OBJECTIVE Individuals with impaired glucose tolerance ( IGT ) have a high risk of developing NIDDM . The purpose of this study was to determine whether diet and exercise interventions in those with IGT may delay the development of NIDDM , i.e. , reduce the incidence of NIDDM , and thereby reduce the overall incidence of diabetic complications , such as cardiovascular , renal , and retinal disease , and the excess mortality attributable to these complications . RESEARCH DESIGN AND METHODS In 1986 , 110,660 men and women from 33 health care clinics in the city of Da Qing , China , were screened for IGT and NIDDM . Of these individuals , 577 were classified ( using World Health Organization criteria ) as having IGT . Subjects were r and omized by clinic into a clinical trial , either to a control group or to one of three active treatment groups : diet only , exercise only , or diet plus exercise . Follow-up evaluation examinations were conducted at 2-year intervals over a 6-year period to identify subjects who developed NIDDM . Cox 's proportional hazard analysis was used to determine if the incidence of NIDDM varied by treatment assignment . RESULTS The cumulative incidence of diabetes at 6 years was 67.7 % ( 95 % CI , 59.8–75.2 ) in the control group compared with 43.8 % ( 95 % CI , 35.5–52.3 ) in the diet group , 41.1 % ( 95 % CI , 33.4–49.4 ) in the exercise group , and 46.0 % ( 95 % CI , 37.3–54.7 ) in the diet-plus-exercise group ( P < 0.05 ) . When analyzed by clinic , each of the active intervention groups differed significantly from the control clinics ( P < 0.05 ) . The relative decrease in rate of development of diabetes in the active treatment groups was similar when subjects were stratified as lean or overweight ( BMI < or ≥ 25 kg/m2 ) . In a proportional hazards analysis adjusted for differences in baseline BMI and fasting glucose , the diet , exercise , and diet-plus-exercise interventions were associated with 31 % ( P < 0.03 ) , 46 % ( P < 0.0005 ) , and 42 % ( P < 0.005 ) reductions in risk of developing diabetes , respectively . CONCLUSIONS Diet and /or exercise interventions led to a significant decrease in the incidence of diabetes over a 6-year period among those with IGT The purpose of this study was to create and test a prevention model for diabetes mellitus in a primary care unit in Thail and . This study used a three-stage approach : a situational analysis was conducted by a focus group discussion , a model was developed in a brainstorming session with stakeholders , and the model was tested by community participation . Qualitative and quantitative methods were used to collect and analyze the data . The focus group discussion found that co-operation between health volunteers and primary care unit personnel in relation to diabetes screening , as well as defining the role of nurse practitioners who provide diabetic treatment , was important . The proactive model that was used for preventing diabetes mellitus was a health promotion program . It was trialed with 160 persons with prediabetes for 3 months . After the intervention , the mean score for exercise activity  among the persons with prediabetes was significantly higher , while the mean score of the Body Mass Index , waist circumference , and systolic blood pressure were significantly lower than before the intervention . This meant that community participation provided proactive services to Thai persons with prediabetes OBJECTIVES We tested the efficacy of a 6-session , evidence -based health promotion intervention aim ed at reducing noncommunicable disease ( NCD ) risk behaviors . METHODS Two hundred male and female factory workers in Ulaanbaatar , Mongolia were r and omly assigned to groups receiving either the health promotion intervention or a time-matched financial literacy control intervention . RESULTS The health promotion intervention increased daily fruit and vegetable intake and physical activity , increased readiness for NCD risk behavior reduction and health promotion knowledge , and reduced the number of daily alcoholic drinks and diabetes symptoms 3 months after the intervention . CONCLUSIONS The findings support the efficacy of the intervention to reduce risk behaviors associated with NCDs . Dissemination of the intervention may improve productivity , reduce costs of health services , and better the quality of life for Mongolians Background : Practicing a health-promoting lifestyle is believed to be effective for delaying or preventing the onset of diabetes . However , although empowerment interventions have proven effective for encouraging the adoption of a health-promoting lifestyle in people with diabetes , these interventions are rarely promoted to people with prediabetes . Purpose : The aims of this study were to develop an empowerment program for people with prediabetes and to examine its efficacy in terms of the adoption of a health-promoting lifestyle and improvements in blood sugar , body mass index , and self-efficacy . Methods : A r and omized controlled trial was conducted between May and December 2013 . A convenience sample of people with a fasting blood sugar level of 100–125 mg/dl during the previous 3 months was recruited from the health examination center of a hospital in Kaohsiung , Taiwan . Participants were assigned to either the experimental group or the control group using block r and omization with a block size of 8 . The experimental group ( n = 38 ) participated in a 4-month empowerment program ( the ABC empowerment program ) , which encouraged participants to practice a health-promoting lifestyle in three phases : awareness raising , behavior building , and results checking . The control group ( n = 40 ) received routine clinical care . Statistical analyses included descriptive statistics , independent t test , paired t test , and generalized estimated equations . Results : After controlling for the differences at baseline and considering the interaction between group and time from baseline to 1 week and 3 months after completing the intervention , the generalized estimating equation showed significantly larger improvements in a health-promoting lifestyle , blood sugar , and self-efficacy in the experimental group than in the control group ( p < .01 ) . Furthermore , the experimental group achieved a larger reduction in body mass index than the control group at 3 months after completing the intervention ( p = .001 ) . Conclusions / Implication s for Practice : The empowerment program was shown to have short-term , positive effects on behavioral , physical , and psychosocial outcomes in a Taiwan population with prediabetes . The results of this study provide a useful reference not only for healthcare personnel when implementing empowerment interventions in people with prediabetes but also for nursing educators and healthcare policymakers BACKGROUND Intensive lifestyle interventions can reduce the incidence of  type 2 diabetes in people with impaired glucose tolerance , but how long these benefits extend beyond the period of active intervention , and whether such interventions reduce the risk of cardiovascular disease ( CVD ) and mortality , is unclear . We aim ed to assess whether intensive lifestyle interventions have a long-term effect on the risk of diabetes , diabetes-related macrovascular and microvascular complications , and mortality . METHODS In 1986 , 577 adults with impaired glucose tolerance from 33 clinics in China were r and omly assigned to either the  control group or to one of three lifestyle intervention groups ( diet , exercise , or diet plus exercise ) . Active intervention took place over 6 years until 1992 . In 2006 , study participants were followed-up to assess the long-term effect of the interventions . The primary outcomes were diabetes incidence , CVD incidence and mortality , and all-cause mortality . FINDINGS Compared with control participants , those in the combined lifestyle intervention groups had a 51 % lower incidence of diabetes ( hazard rate ratio [ HRR ] 0.49 ; 95 % CI 0.33 - 0.73 ) during the active intervention period and a 43 % lower incidence ( 0.57 ; 0.41 - 0.81 ) over the 20 year period , controlled for age and clustering by clinic . The average annual incidence of diabetes was 7 % for intervention participants versus 11 % in control participants , with 20-year cumulative incidence of 80 % in the intervention groups and 93 % in the control group . Participants in the intervention group spent an average of 3.6 fewer years with diabetes than those in the control group . There was no significant difference between the intervention and control groups in the rate of first CVD events ( HRR 0.98 ; 95 % CI 0.71 - 1.37 ) , CVD mortality ( 0.83 ; 0.48 - 1.40 ) , and all-cause mortality ( 0.96 ; 0.65 - 1.41 ) , but our study had limited statistical power to detect differences for these outcomes . INTERPRETATION Group-based lifestyle interventions over 6 years can prevent or delay diabetes for up to 14 years after the active intervention . However , whether lifestyle intervention also leads to reduced CVD and mortality remains unclear AIMS The Diabetes Community Lifestyle Improvement Program ( D-CLIP ) aims to implement and evaluate in a controlled , r and omized trial the effectiveness , cost-effectiveness , and sustainability of a culturally appropriate , low-cost , and sustainable lifestyle intervention for the prevention of type 2 diabetes mellitus in India . METHODS D-CLIP , a translational research project adapted from the methods and curriculum developed and tested for efficacy in the Diabetes Prevention Program , utilizes innovated methods ( a step-wise model of diabetes prevention with lifestyle and metformin added when needed ; inclusion of individuals with isolated glucose tolerance , impaired fasting glucose , and both ; classes team-taught by professionals and trained community educators ) with the goals of increasing diabetes prevention , community acceptability , and long-term dissemination and sustainability of the program . The study outcomes are : diabetes incidence ( primary measure of effectiveness ) , cost-effectiveness , changes in anthropometric measures , plasma lipids , blood pressure , blood glucose , and HbA(1c , ) Program acceptability and sustainability will be assessed using a mixed methods approach . CONCLUSION D-CLIP , a low-cost , community-based , research program , addresses the key components of translational research and can be used as a model for prevention of chronic diseases in other low and middle-income country setting BACKGROUND Type 2 diabetes affects approximately 8 percent of adults in the United States . Some risk factors -- elevated plasma glucose concentrations in the fasting state and after an oral glucose load , overweight , and a sedentary lifestyle -- are potentially reversible . We hypothesized that modifying these factors with a lifestyle-intervention program or the administration of metformin would prevent or delay the development of diabetes . METHODS We r and omly assigned 3234 nondiabetic persons with elevated fasting and post-load plasma glucose concentrations to placebo , metformin ( 850 mg twice daily ) , or a lifestyle-modification program  with the goals of at least a 7 percent weight loss and at least 150 minutes of physical activity per week . The mean age of the participants was 51 years , and the mean body-mass index ( the weight in kilograms divided by the square of the height in meters ) was 34.0 ; 68 percent were women , and 45 percent were members of minority groups . RESULTS The average follow-up was 2.8 years . The incidence of diabetes was 11.0 , 7.8 , and 4.8 cases per 100 person-years in the placebo , metformin , and lifestyle groups , respectively . The lifestyle intervention reduced the incidence by 58 percent ( 95 percent confidence interval , 48 to 66 percent ) and metformin by 31 percent ( 95 percent confidence interval , 17 to 43 percent ) , as compared with placebo ; the lifestyle intervention was significantly more effective than metformin . To prevent one case of diabetes during a period of three years , 6.9 persons would have to participate in the lifestyle-intervention program , and 13.9 would have to receive metformin . CONCLUSIONS Lifestyle changes and treatment with metformin both reduced the incidence of diabetes in persons at high risk . The lifestyle intervention was more effective than metformin The purpose of this study was to investigate the effect of a dietary modification intervention programme by applying the Stages of Change Model in 2 h postpr and ial capillary glucose reduction among Thai population . A r and omized control trial was conducted for people at risk of type 2 diabetes for a period of 8 weeks . The intervention programme consisted of evaluating an individual 's stage of change after being provided dietary information regarding kind of food and portions , discussion with a role model , and keeping a food diary record . By the end of the intervention programme , most participants in the experimental group were in the action stage ( n = 36 ) , whereas those in the control group were in the preparation stage ( n = 32 ) . Body mass index , blood pressure , food consumption behaviour and the 2 h postpr and ial blood glucose ( PPG ) in the experimental group had improved ( P < 0.05 ) . When performing regression analysis , intervention participation and the 2 h PPG at the baseline accounted for approximately 54 % of total variance in predicting the 2 h PPG . This study yielded evidence for the benefits of using the Stages of Change Model as a framework in a dietary modification programme among people at risk of type 2 diabetes Latinas with type 2 diabetes are in need of culturally sensitive interventions to make recommended long-term lifestyle changes and reduce heart disease risk . To test the longer-term ( 24-month ) effects of a previously successful , culturally adapted , multiple-health-behavior-change program , ¡ Viva Bien ! , 280 Latinas were r and omly assigned to usual care or ¡ Viva Bien!.  Treatment included group meetings to promote a culturally adapted Mediterranean diet , physical activity , supportive re sources , problem solving , stress-management practice s , and smoking cessation . ¡ Viva Bien ! participants achieved and maintained some lifestyle improvements from baseline through 24 months , including significant improvements for psychosocial outcomes , fat intake , social – environmental support , body mass index , and hemoglobin A1c . Effects tended to diminish over time . The ¡ Viva Bien ! multiple-behavior program was effective in improving and maintaining some psychosocial , behavioral , and biological outcomes related to heart health across 24 months for Latinas with type 2 diabetes , a high-risk , underserved population ( Clinical Trials.gov number , NCT00233259 ) 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 The study aim ed to assess whether aerobic exercise ( AEx ) training and a fibre-enriched diet can reduce hepatic fat content ( HFC ) and increase glycaemic control in pre-diabetic patients with non-alcoholic fatty liver disease ( NAFLD ) . Six-hundred- and -three patients from seven clinics in Yangpu district , Shanghai , China were recruited . Of them 115 individuals aged 50–65-year fulfilled the inclusion criteria ( NAFLD with impaired fasting glucose or impaired glucose tolerance ) and were r and omly assigned into exercise ( AEx n = 29 ) , diet ( Diet n = 28 ) , exercise plus diet ( AED n = 29 ) , or no-intervention ( NI n = 29 ) groups . Progressive supervised AEx training ( 60–75 % VO2max intensity ) was given 2 - 3 times/week in 30–60 min/sessions , and the diet intervention was provided as lunch with 38 % carbohydrate and diet fibre of 12 g/day for 8.6-month . HFC was assessed by 1H MRS . We found that HFC was significantly reduced in the AEx ( −24.4 % ) , diet ( −23.2 % ) , and AED ( −47.9 % ) groups by contrast to the 20.9 % increase in the NI group ( p = 0.001 for all ) after intervention . However , only AED group significantly decreased HbA1c ( −4.4 % , p = 0.01 ) compared with the NI group ( −0.6 % ) . Aerobic exercise training combined with fibre-enriched diet can reduce HFC more effectively than either exercise or increased fibre-intake alone in pre-diabetic patients with NAFLD
target: Conclusion Based on available literature , evidence suggests that community-based interventions may reduce the incidence rate of T2DM and may positively affect anthropometric indices and HbA1C .
  Due to the heterogeneity observed between trials we recommend more well- design ed RCTs with longer follow-up duration s be executed , to confirm whether community-based interventions lead to reduced T2DM events in the at-risk population of LMIC setting
background: Background The increasing prevalence of type 2 diabetes mellitus ( T2DM ) can have a substantial impact in low- and middle-income countries ( LMICs ) .
  Community-based programs addressing diet , physical activity , and health behaviors have shown significant benefits on the prevention and management of T2DM , mainly in high-income countries .
  However , their effects on preventing T2DM in the at-risk population of LMICs have not been thoroughly evaluated .