Lifestyle intervention delays diabetes and reduces mortality

Image: PD 

1. Diet and/or exercise intervention in people with impaired glucose tolerance significantly delayed mortality and diabetes onset when compared to control groups that did not receive interventions. 

Evidence Rating Level: 1 (Excellent) 

Study Rundown: Individuals diagnosed with impaired glucose tolerance are at increased risk of developing diabetes and other co-morbidities that impact both life expectancy and quality of life. While lifestyle interventions among people with impaired glucose tolerance is known to reduce the incidence of diabetes, whether mortality is also improved was less clear. The current study is a 23-year follow-up study from the first randomized controlled trial to investigate the effects of 6-year lifestyle interventions (e.g., diet and/or exercise) in individuals with impaired glucose tolerance. The study reported approximately 40% reduction in cardiovascular disease mortality and about 25% reduction in all-cause mortality in the treated group compared with the control group. Interestingly, the reduction in mortality seen with lifestyle intervention was observed mainly in women, with little change in mortality observed in men. This is the first randomized controlled study to show that lifestyle intervention in people with impaired glucose tolerance can have significant positive impacts on diabetes incidence and mortality, with important implications for national public health.

The study was funded by Centers for Disease Control and Prevention, WHO, the China-Japan Friendship Hospital, and Da Qing First Hospital, China.

Click to read the study, published today in The Lancet

Relevant Reading: Effects of Diet and Exercise in Preventing NIDDM in People with Impaired Glucose Tolerance: The Da Qing IGT and Diabetes Study

In-Depth [randomized controlled trial]: This 23-year follow-up study for a randomized control trial had initially randomly assigned 577 individuals with impaired glucose intolerance to one of the following 4 interventions for 6 years: none (control), diet only, exercise only, or diet and exercise. To obtain sufficient power for analyses, data from all three intervention groups were pooled and compared to the control group.

Compared to the control group, the intervention group had significantly reduced incidence of diabetes (72.6% vs. 89.9%, p = 0.001), cardiovascular disease mortality (11.9% vs. 19.6%, p = 0.033) and all-cause mortality (28.1% vs. 38.4%, p = 0.049). Further stratifying these groups by sex revealed that lifestyle intervention in males did not significantly reduce cardiovascular disease mortality or all-cause mortality; nevertheless, diabetes incidence was significantly reduced (71.3% vs. 87.3%, p = 0.004). In contrast, lifestyle intervention in female patients was associated with significant reductions in cardiovascular mortality (6.0% vs. 17.0%, p = 0.01), all-cause mortality (15.0% vs. 28.8%, p = 0.02) and diabetes incidence (74.0% vs. 93.2%, p = 0.006).

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