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Prevention of type 2 diabetes in a primary healthcare setting: Three-year results of lifestyle intervention in Japanese subjects with impaired glucose tolerance

DOI: 10.1186/1471-2458-11-40

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Through health checkups in communities and workplaces, 304 middle-aged IGT subjects with a mean body mass index (BMI) of 24.5 kg/m2 were recruited and randomized to the intervention group or control group. The lifestyle intervention was carried out for 3 years by public health nurses using the curriculum and educational materials provided by the study group.After 1 year, the intervention had significantly improved body weight (-1.5 ± 0.7 vs. -0.7 ± 2.5 kg in the control; p = 0.023) and daily non-exercise leisure time energy expenditure (25 ± 113 vs. -3 ± 98 kcal; p = 0.045). Insulin sensitivity assessed by the Matsuda index was improved by the intervention during the 3 years. The 3-year cumulative incidence tended to be lower in the intervention group (14.8% vs.8.2%, log-rank test: p = 0.097). In a sub-analysis for the subjects with a BMI > 22.5 kg/m2, a significant reduction in the cumulative incidence was found (p = 0.027).The present lifestyle intervention program using existing healthcare resources is beneficial in preventing diabetes in Japanese with IGT. This has important implications for primary healthcare-based diabetes prevention.UMIN000003136The incidence of type 2 diabetes is increasing in Japan [1]. Although Japanese have a lower prevalence of obesity than Westerners, a tendency to gain weight due to lifestyle changes coupled with an aging of the population seems to be closely related to the rapid expansion of the diabetic population [1]. There is thus an urgent need for effective public health strategies to combat this situation in Japan.There is now substantial evidence that the development of type 2 diabetes can be prevented or delayed in high-risk subjects through lifestyle intervention [2-8]. The Finnish Diabetes Prevention Study (DPS) [4] and the US Diabetes Prevention Program (DPP) [5] have clearly shown that, in obese subjects with impaired glucose tolerance (IGT), lifestyle changes associated with a 5-7% decrease in body weight resulted in a 58


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