Aims

The Finnish National Diabetes Prevention Program (FIN-D2D) was the first large-scale diabetes prevention program in a primary health care setting in the world. The risk reduction of type 2 diabetes was 69% after one-year intervention in high-risk individuals who were able to lose 5% of their weight. We investigated long-term effects of one-year weight change on the incidence of type 2 diabetes, cardiovascular events, and all-cause mortality.

Methods

A total of 10,149 high-risk individuals for type 2 diabetes were identified in primary health care centers and they were offered lifestyle intervention to prevent diabetes. Of these individuals who participated in the baseline screening, 8353 had an oral glucose tolerance test (OGTT). Complete follow-up data during one-year intervention were available for 2730 individuals and those were included in the follow-up analysis. The long-term outcome events were collected from national health registers after the median follow-up of 7.4 years.

Results

Among individuals who lost weight 2.5−4.9% and 5% or more during the first year, the hazard ratio for the incidence of drug-treated diabetes was 0.63 (95% CI 0.49−0.81, p = 0.0001), and 0.71 (95% CI 0.56−0.90, p = 0.004), respectively, compared with those with stable weight. There were no significant differences in cardiovascular events or all-cause mortality among study participants according to one-year weight changes.

Conclusions

High-risk individuals for type 2 diabetes who achieved a moderate weight loss by one-year lifestyle counseling in primary health care had a long-term reduction in the incidence of drug-treated type 2 diabetes. The observed moderate weight loss was not associated with a reduction in cardiovascular events.

中文翻译：

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生活方式干预在初级卫生保健高危人群中预防 2 型糖尿病的长期结果

宗旨

芬兰国家糖尿病预防计划 (FIN-D2D) 是世界上第一个在初级卫生保健机构中开展的大规模糖尿病预防计划。对体重减轻 5% 的高危人群进行一年干预后，2 型糖尿病的风险降低了 69%。我们调查了一年体重变化对 2 型糖尿病发病率、心血管事件和全因死亡率的长期影响。

方法

在初级卫生保健中心共确定了 10,149 名 2 型糖尿病高危个体，并为他们提供了生活方式干预以预防糖尿病。在参与基线筛查的这些人中，8353 人进行了口服葡萄糖耐量试验 (OGTT)。一年干预期间的完整随访数据可用于 2730 个人，这些数据包括在随访分析中。中位随访 7.4 年后，从国家健康登记册中收集长期结局事件。

结果

在第一年体重减轻 2.5-4.9% 和 5% 或更多的个体中，药物治疗糖尿病发生率的风险比为 0.63（95% CI 0.49-0.81，p = 0.0001）和 0.71（95% CI 0.56−0.90, p = 0.004)，分别与体重稳定的人相比。根据一年的体重变化，研究参与者的心血管事件或全因死亡率没有显着差异。

结论

在初级卫生保健中通过一年生活方式咨询实现中等体重减轻的 2 型糖尿病高危个体长期降低了药物治疗的 2 型糖尿病发病率。观察到的适度体重减轻与心血管事件的减少无关。