Evaluation of a multicomponent workplace health promotion program conducted in Japan for improving employees' cardiovascular disease risk factors. The Finnish Diabetes Prevention Study. Pharmacist Assisted Medication Program Enhancing the Regulation of Diabetes (PAMPERED) study. Improving Diabetes Care in Practice Effect of home blood glucose monitoring on the management of patients with non-insulin dependent diabetes mellitus in the primary care setting. Impact of a Community Health Workers–Led Structured Program on Blood Glucose Control Among Latinos With Type 2 Diabetes: The DIALBEST Trial Effect of pharmaceutical care on clinical outcomes of outpatients with type 2 diabetes mellitus Blood glucose testing and primary prevention of Type 2 diabetes-evaluation of the effect of evidence-based patient information: a randomized controlled trial. A randomized trial of a primary care-based disease management program to improve cardiovascular risk factors and glycated hemoglobin levels in patients with diabetes. Prevention of Type 2 Diabetes by lifestyle intervention in an Australian primary health care setting: Greater Green Triangle (GGT) Diabetes Prevention Project Blood pressure and glucose control in subjects with diabetes: new analyses from ADVANCE Effectiveness of a Supportive Telephone Counseling Intervention in Type 2 Diabetes Patients: Randomized Controlled Study A Pilot Study to Assess the Feasibility of the Spanish Diabetes Self-Management Program in the Basque Country Pharmacist's intervention in the control of blood sugar levels in randomised diabetes patients at a primary health care setting in Benin City. The association between self-monitoring of blood glucose, hemoglobin A1C and testing patterns in community pharmacies The Finnish Diabetes Prevention Study (DPS): Lifestyle intervention and 3-year results on diet and physical activity. Long-term effects of the Diabetes Prevention Program interventions on cardiovascular risk factors: a report from the DPP Outcomes Study.
BACKGROUND The long-term effectiveness of multicomponent worksite health promotion programs targeting cardiovascular disease risk factors remains unclear in Japan . This study was conducted to evaluate the effectiveness of such a health promotion program consisting of a main program provided over 4 days and a follow-up program provided over 1 year . METHODS The subjects of this r and omized controlled trial were male employees working for a building maintenance company in Japan . The intervention group ( n = 152 ) and the control group ( n = 150 ) consisted of employees having abnormal findings in at least one of the following items at baseline health examination : body mass index ( BMI ) , systolic ( SBP )  or  diastolic blood pressure , total cholesterol , HDL cholesterol , triglycerides , and fasting blood glucose . Evaluation was conducted at 18 months after the main program . RESULTS BMI , SBP , total cholesterol , and triglycerides improved significantly in the intervention group compared with the control group ( P < 0.05 ) . When comparisons were limited to those who showed abnormality at baseline , BMI , total cholesterol , and triglycerides improved significantly in the intervention group ( P < 0.05 ) . CONCLUSIONS The multicomponent health promotion program provided to employees was shown to be effective in improving obesity , high blood pressure , and hyperlipidemia when evaluated 18 months after the main intervention program The aim of the Finnish Diabetes Prevention Study is to assess the efficacy of an intensive diet-exercise programme in preventing or delaying  type 2 diabetes in individuals with impaired glucose tolerance ( IGT ) and to evaluate the effect of the programme on the risk factors of atherosclerotic vascular diseases and the incidence of cardiovascular events . In this ongoing study , a total of 523 overweight subjects with IGT based on two oral glucose tolerance tests were r and omized to either an intervention group or a control group . The main measure in the intervention group is individual dietary advice aim ed at reducing weight and intake of saturated fat and increasing intake of dietary fibre . The intervention subjects are individually guided to increase their level of physical activity .  The control group receives general information about the benefits of weight reduction , physical activity and healthy diet in the prevention of diabetes . A pilot study began in 1993 , and recruitment ended in 1998 . By the end of April 1999 there were 65 new cases of diabetes , 34 drop-outs and one death . The weight reduction was greater ( -4.6 kg ) at 1 year in the intervention group ( n = 152 ) than in the control group ( n = 143 , -0.9 kg , P < 0.0001 ) , and this difference was sustained in the second year of follow-up . At 1 year 43.4 % and at 2 years 41.8 % of the intervention subjects had achieved a weight reduction of at least 5 kg , while the corresponding figures for the control subjects were 14.0 and 12.0 % ( P < 0.001 between the groups ) . At 1 year the intervention group showed significantly greater reductions in 2 h glucose , fasting and 2 h insulin , systolic and diastolic blood pressure , and serum triglycerides . Most of the beneficial changes in cardiovascular risk factors were sustained for 2 years . These interim results of the ongoing Finnish Diabetes Prevention Study demonstrate the efficacy and feasibility of the lifestyle intervention programme OBJECTIVES To demonstrate that pharmacists working with physicians and other providers in an ambulatory care setting can improve glucose , blood pressure , and lipid control for patients with type 2 diabetes and to report patient adherence to screening and general preventive measures . DESIGN Prospect i ve , r and omized , clinical practice study . SETTING Burlington , MA , between January 2001 and August 2003 . PATIENTS 164 patients patients with type 2 diabetes older than 18 years with glycosylated hemoglobin ( A1C ) greater than 8 % . INTERVENTION Pharmacist-patient clinic visits included obtaining a comprehensive medication review ; performing targeted physical assessment ; ordering laboratory tests ; review ing , modifying , and monitoring patients ' medication therapy and providing detailed counseling on all therapies ; facilitating self-monitoring of blood glucose ; and providing reinforcement of dietary guidelines and exercise . MAIN OUTCOME MEASURE Effect of clinical pharmacists working with physicians in an ambulatory setting on health measures ( e.g. , A1C , blood pressure , cholesterol ) of patients with diabetes . RESULTS Baseline characteristics were similar between the two groups . After 1 year , significant improvements occurred for A1C and low-density lipoprotein ( LDL ) cholesterol in the intervention group compared with the control group ( A1C , 7.7 % vs. 8.4 % ; LDL , 93.7 vs. 105.1 mg/dL ; P < 0.05 ) . Systolic blood pressure improved for all study patients without a difference between the two groups . Diastolic blood pressure improved significantly in the intervention group compared with the control group ( 73.4 mm Hg vs. 77.6 mm Hg , P < 0.05 ) . Significantly more intervention patients were screened for retinopathy , neuropathy , and microalbuminuria than control patients ( P < 0.05 ) . CONCLUSION For all indices measured , this study demonstrated that collaborative diabetes management with a clinical pharmacist can improve overall care OBJECTIVE —The purpose of this study was to determine whether implementation of a multicomponent organizational intervention can produce significant change in diabetes care and outcomes in community primary care practice s. RESEARCH DESIGN AND METHODS —This was a group-r and omized , controlled clinical trial evaluating the practical effectiveness of a multicomponent intervention ( TRANSLATE )  in 24 practice s. The intervention included implementation of an electronic diabetes registry , visit reminders , and patient-specific physician alerts . A site coordinator facilitated previsit planning and a monthly review of performance with a local physician champion . The principle outcomes were the percentage of patients achieving target values for the composite of systolic blood pressure ( SBP ) < 130 mmHg , LDL cholesterol < 100 mg/dl , and A1C < 7.0 % at baseline and 12 months . Six process measures were also followed . RESULTS —Over 24 months , 69,965 visits from 8,405 adult patients with type 2 diabetes were recorded from 238 health care providers in 24 practice s from 17 health systems .  Diabetes process measures increased significantly more in intervention than in control practice s , giving net increases as follows : foot examinations 35.0 % ( P < 0.0.001 ) ; annual eye examinations 25.9 % ( P < 0.001 ) ; renal testing 28.5 % ( P < 0.001 ) ; A1C testing 8.1%(P < 0.001 ) ; blood pressure monitoring 3.5 % ( P = 0.05 ) ; and LDL testing 8.6 % ( P < 0.001 ) . Mean A1C adjusted for age , sex , and comorbidity decreased significantly in intervention practice s ( P < 0.02 ) . At 12 months , intervention practice s had significantly greater improvement in achieving recommended clinical values for SBP , A1C , and LDL than control clinics ( P = 0.002 ) . CONCLUSIONS — Introduction of a multicomponent organizational intervention in the primary care setting significantly increases the percentage of type 2 diabetic patients achieving recommended clinical outcomes The purpose of the study was to determine whether blood glucose monitoring strips influence the management of patients with non-insulin dependent diabetes ( NIDDM ) in the primary care setting . The medical records of 115 patients with NIDDM taking a sulfonylurea drug ( oral hypoglycemic agent ) during the review period were r and omly selected for review . Patients were divided into two groups : those who did not receive a prescription for blood glucose monitoring strips during 1995 and 1996 and those who did for the same 2 years . The main outcome measures were hemoglobin A1c , blood sugar , number of laboratory tests ordered , and number and type of treatment interventions . No statistically significant differences between groups were noted for any measured parameter . Glucose control was independent of number of strips dispensed . Home glucose monitoring strips did not affect the management of patients with NIDDM taking a sulfonylurea agent in the primary care setting OBJECTIVE Latinos with type 2 diabetes ( T2D ) face major healthcare access and disease management disparities . We examined the impact of the  Diabetes Among Latinos Best Practice s Trial ( DIALBEST ) , a community health worker (CHW)–led structured intervention for improving glycemic control among Latinos with T2D . RESEARCH DESIGN AND METHODS A total of 211 adult Latinos with poorly controlled T2D were r and omly assigned to a st and ard of healthcare ( n = 106 ) or CHW ( n = 105 ) group . The CHW intervention comprised 17 individual sessions delivered at home by CHWs over a 12-month period . Sessions addressed T2D complications , healthy lifestyles , nutrition , healthy food choices and diet for diabetes , blood glucose self-monitoring , and medication adherence . Demographic , socioeconomic , lifestyle , anthropometric , and biomarker ( HbA1c , fasting blood glucose , and lipid profile ) data were collected at baseline and 3 , 6 , 12 , and 18 months ( 6 months postintervention ) . Groups were equivalent at baseline . RESULTS Participants had  high HbA1c at baseline ( mean 9.58 % [ 81.2 mmol/mol ] ) . Relative to participants in the control group , CHWs had a positive impact on net HbA1c improvements at 3 months ( −0.42 % [ −4.62 mmol/mol ] ) , 6 months ( −0.47 % [ −5.10 mmol/mol ] ) , 12 months ( −0.57 % [ −6.18 mmol/mol ] ) , and 18 months ( −0.55 % [ −6.01 mmol/mol ] ) . The overall repeated- measures group effect was statistically significant ( mean difference −0.51 % [ −5.57 mmol/mol ] , 95 % CI −0.83 , −0.19 % [ −9.11 , −2.03 mmol/mol ] , P = 0.002 ) . CHWs had an overall significant effect on fasting glucose concentration that was more pronounced at the 12- and 18-month visits . There was no significant effect on blood lipid levels , hypertension , and weight . CONCLUSIONS DIALBEST is an effective intervention for improving blood glucose control among Latinos with T2D Background In the People ’s Republic of China , out patients have limited time with their physicians . Thus , compared to in patients , out patients have lower medication adherence and are less knowledgeable about their disease . Objective The objective of this study was to evaluate the effect of pharmaceutical care on clinical outcomes of out patients with type 2 diabetes mellitus ( T2DM ) . Patients and methods A r and omized , controlled , prospect i ve clinical trial was conducted recruiting a total of 240 T2DM out patients from Zhongda Hospital , Southeast University . The control group ( CG ) received only common care from medical staff , whereas the inter vention group ( IG ) received extra pharmaceutical care from clinical pharmacists . Biochemical data such as  blood pressure ( BP ) , fasting blood glucose ( FBG ) , glycosylated hemoglobin A1 ( HbA1c ) , and blood lipid  were collected before and after 6-month intervention . The primary end points in this study were FBG and HbA1c . Results After the intervention , most of the baseline clinical outcomes of the patients in IG significantly improved , while only body mass index , diastolic BP , low-density lipoprotein cholesterol , and total cholesterol ( TC ) improved significantly in patients in the CG . Compared to CG , in IG , there were significant improvements in FBG , HbA1c , TC , the target attainment rates of HbA1c , and BP . Conclusion Pharmaceutical care provided by clinical pharmacists could improve the control of diabetes of out patients , and clinical pharmacists could play an important role in diabetes management AIMS To compare the effect of our newly developed online evidence -based patient information vs. st and ard patient information about sub-threshold elevated blood glucose levels and primary prevention of diabetes on informed patient decision making . METHODS We invited visitors to the cooperating health insurance company , Techniker Krankenkasse , and the German Diabetes Center websites to take part in a web-based r and omized controlled trial . The population after r and omization comprised 1120 individuals aged between 40 and 70 years without known diabetes , of whom 558 individuals were r and omly assigned to the intervention group receiving evidence -based patient information , and 562 individuals were r and omly assigned to the control group receiving st and ard information from the Internet . The primary endpoint was acquired knowledge of elevated blood glucose level issues and the secondary outcomes were attitude to metabolic testing , intention to undergo metabolic testing , decisional conflict and satisfaction with the information . RESULTS Overall , knowledge of elevated glucose level issues and the intention to undergo metabolic testing were high in both groups . Participants who had received evidence -based patient information , however , had significantly higher knowledge scores . The secondary outcomes in the evidence -based patient information subgroup that completed the 2-week follow-up period yielded significantly lower intention to undergo metabolic testing , significantly more critical attitude towards metabolic testing and significantly higher decisional conflict than the control subgroup ( n=466 ) . Satisfaction with the information was not significantly different between both groups . CONCLUSIONS Evidence -based patient information significantly increased knowledge about elevated glucose levels , but also increased decisional conflict and critical attitude to screening and treatment options . The intention to undergo metabolic screening decreased . Future studies are warranted to assess uptake of metabolic testing and satisfaction with this decision in a broader population of patients with unknown diabetes PURPOSE To assess the efficacy of a pharmacist-led , primary care-based , disease management program to improve cardiovascular risk factors and glycated hemoglobin ( A(1C ) ) levels in vulnerable patients with poorly controlled diabetes . METHODS A r and omized controlled trial of 217 patients with type 2 diabetes and poor glycemic control ( A(1C ) level > or=8.0 % ) was conducted at an academic general medicine practice from February 2001 to April 2003 . Intervention patients received intensive management from clinical pharmacists , as well as from a diabetes care coordinator who provided diabetes education , applied algorithms for managing glucose control and decreasing cardiovascular risk factors , and addressed barriers to care . Control patients received a one-time management session from a pharmacist followed by usual care from their primary care provider . Outcomes were recorded at baseline and at 6 and 12 months . Primary outcomes included blood pressure , A(1C ) level , cholesterol level , and aspirin use . Secondary outcomes included diabetes knowledge , satisfaction , use of clinical services , and adverse events . RESULTS For the 194 patients ( 89 % ) with 12-month data , the intervention group had significantly greater improvement than did the control group for systolic blood pressure ( -9 mm Hg ; 95 % confidence interval [ CI ] : -16 to -3 mm Hg ) and A(1C ) level ( -0.8 % ; 95 % CI : -1.7 % to 0 % ) . Change in total cholesterol level was not significant . At 12 months , aspirin use was 91 % in the intervention group versus 58 % among controls ( P < 0.0001 ) . Intervention patients had greater improvements in diabetes knowledge and satisfaction than did control patients . There were no significant differences in use of clinical services or adverse events . CONCLUSION Our comprehensive disease management program reduced cardiovascular risk factors and A(1C ) levels among vulnerable patients with type 2 diabetes and poor glycemic control Background R and omised controlled trials demonstrate a 60 % reduction in  type 2 diabetes incidence through lifestyle modification programmes . The aim of this study is to determine whether such programmes are feasible in primary health care . Methods An intervention study including 237 individuals 40–75 years of age with moderate or high risk of developing type 2 diabetes . A structured group programme with six 90 minute sessions delivered during an eight month period by trained nurses in Australian primary health care in 2004–2006 . Main outcome measures taken at baseline , three , and 12 months included weight , height , waist circumference , fasting plasma glucose and lipids , plasma glucose two hours after oral glucose challenge , blood pressure , measures of psychological distress and general health outcomes . To test differences between baseline and follow-up , paired t-tests and Wilcoxon rank sum tests were performed . Results At twelve months participants ' mean weight reduced by 2.52 kg ( 95 % confidence interval 1.85 to 3.19 ) and waist circumference by 4.17 cm ( 3.48 to 4.87 ) . Mean fasting glucose reduced by 0.14 mmol/l ( 0.07 to 0.20 ) , plasma glucose two hours after oral glucose challenge by 0.58 mmol/l ( 0.36 to 0.79 ) , total cholesterol by 0.29 mmol/l ( 0.18 to 0.40 ) , low density lipoprotein cholesterol by 0.25 mmol/l ( 0.16 to 0.34 ) , triglycerides by 0.15 mmol/l ( 0.05 to 0.24 ) and diastolic blood pressure by 2.14 mmHg ( 0.94 to 3.33 ) . Significant improvements were also found in most psychological measures . Conclusion This study provides evidence that a type 2 diabetes prevention programme using lifestyle intervention is feasible in primary health care setting s , with reductions in risk factors approaching those observed in clinical trials . Trial NumberCurrent Controlled Trials IS RCT Objectives To evaluate among individuals with diabetes whether major microvascular and macrovascular events are reduced by : ( 1 ) blood pressure lowering with a perindopril/indapamide combination compared with placebo ; ( 2 ) intensive glucose control ( targeting a haemoglobin A1c level of ≤6.5 % ) with a gliclazide MR-based regimen , compared with usual care . Methods Participants with diabetes aged 55 years and older with at least one additional vascular risk factor were r and omly assigned , using a 2 × 2 factorial design , to additional blood pressure lowering versus placebo and intensive versus st and ard glucose control . The primary outcomes were macrovascular ( cardiovascular death , non-fatal myocardial infa rct ion or non-fatal stroke ) and microvascular ( new or worsening nephropathy or retinopathy ) events jointly and separately . Results A total of 11 140 participants were r and omly assigned to the blood pressure and glucose-lowering arms , which ended after 4.3 and 5.5 years , respectively . The effects of the two interventions were independent and additive on prespecified endpoints . Compared with placebo , additional blood pressure lowering of 5.6/2.2 mmHg was associated with reductions of 9 % in the primary endpoint ( P = 0.041 ) , 18 % in cardiovascular death ( P = 0.027 ) , 14 % in total mortality ( P = 0.025 ) , and 21 % in total renal events ( P < 0.01 ) . Compared with st and ard glucose control , intensive control ( mean in-trial 0.67 percentage point reduction in haemoglobin A1c level ) was associated with reductions of 10 % in the primary endpoint ( P = 0.013 ) , 14 % in major microvascular events ( P = 0.01 ) and 11 % in total renal events ( P < 0.001 ) . Conclusion Additional blood pressure lowering and intensive glucose control , as achieved in ADVANCE , produce independent benefits and , when combined , substantially reduced cardiovascular mortality and all-cause mortality and improved renal outcomes Objectives This r and omized controlled trial investigated whether a patient-centered supportive counseling intervention comprising monthly telephone-based counseling sessions by practice nurses over 12 months improved diabetes-related medical and psycho-social outcomes above usual care in type 2 diabetes patients with poor glycemic control at baseline ( HbA1c > 7.5 % ) in a primary care setting . Research Design Patients were individually r and omized into intervention ( n = 103 ) and usual care group ( n = 101 ) . The primary outcome was change in HbA1c-concentration after 12 and 18 months . Secondary outcomes were lipid levels , blood pressure , health-related quality of life and symptoms of depression . Follow-up- measurements were carried out after 6 , 12 and 18 months to assess potential immediate and maintained effects of the intervention . For the multivariate analysis , hierarchical linear models were computed for each outcome to assess within-group changes in outcomes over time and between-group differences in patterns of change . Results HbA1c ( in % ) decreased significantly from baseline to 12-month follow-up measurement both in the intervention ( −0.44 ) and the usual care group ( −0.51 ) , but there was no significant between-group intervention effect . Significant improvements in the intervention group along with significant between-group differences were seen for health-related quality of life and , transiently , for systolic blood pressure and depression . Conclusions Although we found no beneficial effect of the supportive telephone counseling in terms of a reduction of HbA1c above usual care , our findings suggest some beneficial effects on cardiovascular risk factors , quality of life and depression . Continuous efforts might be needed to sustain improvements in patient outcomes . Trial Registration Clinical Trials.gov Purpose . The purpose of this study was to assess the feasibility of the  Spanish Diabetes Self-Management Program ( SDSMP )  in the primary care setting of the Basque Health Service and offer initial estimations of the r and omized controlled trial ( RCT ) effects . Methods . Ten health centers ( HCs ) participated in a single-arm pilot study with a 6-month follow-up period between February 2011 and June 2012 . Recruitment was performed via invitation letters , health professionals , and the local media . Each intervention group consisted of 8–15 people . The ability of each HC in forming up to 2 groups , participants ' compliance with the course , and coordination and data collection issues were evaluated . Glycated haemoglobin ( HbA1c ) was the main outcome variable . Secondary outcomes were cardiovascular risk factors , drugs consumption , medical visits , quality of life , self-efficacy , physical exercise , and diet . Results . Two HCs did not organize a course . A total of 173 patients initiated the program , 2 dropped out without baseline data , and 90 % completed it . No pre-post HbA1c differences existed . Certain improvements were observed in blood pressure control , self-efficacy , physical activity , and some dietary habits . Conclusion . The SDSMP is feasible in our setting . Our experience can be of interest when planning and conducting this program in similar health setting s. The trial is registered with Clinical Trials.gov identifier NCT01642394 BACKGROUND The extended roles of  pharmacists in Nigeria in the improvement of quality of health care at the primary health care ( PHC ) level is currently poorly executed even though pharmacists have been proven to be involved in interventional activities in health care delivery . OBJECTIVE To evaluate pharmacists ' intervention in the control of blood sugar levels of diabetes patients in a PHC setting in Benin City , Nigeria . METHODS At baseline , the fasting blood sugar ( FBS ) , glycosylated hemoglobin ( HbA1c ) , body mass index ( BMI ) and blood pressure ( BP ) of r and omly selected 170 diabetic patients in a primary health care centre were evaluated . This was followed-up with intervention by the pharmacists through counselling on lifestyle modification , self-medication and drug adherence on monthly basis for three consecutive months after which the FBS , HbA1c , BMI and BP were re-evaluated . RESULTS indicated significant reduction in BMI , HbA1c and FBS from 27.1 + /- 4.2 kg/m2 , 8.1 + /- 3.0 % and 10.0 + /- 4.2 mmol/l to 23.5 + /- 3.5 kg/m2 , 7.1 + /- 1.8 % and 8.5 + /- 2.1 mmol/l , respectively ( p < 0.001 ) was observed following the intervention by the pharmacists . CONCLUSION Direct involvement of pharmacists in the care of diabetic patients in PHC setting s can significantly improve the quality of life provided to these patients and hence reduce mortality result ing from the disease . Recruitment of reasonable number of pharmacists should always be considered in health policies for PHC setting s in developing countries Objectives : To determine if pharmacists providing advice on self-monitoring of blood glucose ( SMBG ) to new meter users , based on the Canadian Diabetes Association ( CDA ) Clinical Practice Guidelines ( CPGs ) , result ed in improvements in A1C . SMBG testing patterns and pharmacist interactions were also observed . Methods : A cluster r and omized , pilot study was performed , with pharmacies r and omized to an intervention or control group . The intervention group provided SMBG education according to the CDA CPGs at baseline , 2 weeks , 1 month and 3 months ; the control group provided usual care . The primary endpoint was the mean change in A1C measured at 6 months . Secondary endpoints included a description of SMBG patterns and lifestyle changes and were determined via a self-administered question naire . Results : Thirty-six participants ( 26 intervention , 10 control ) were recruited from 9 pharmacies across Saskatchewan , Canada . Mean A1C decreased by −1.69 and −0.70 in the intervention and control groups , respectively ( p = 0.376 ) . A total of 12 of 26 ( 46.2 % ) participants in the intervention group indicated they performed SMBG ≥7 times per week ; 75 % ( 9/12 ) of these were controlled by lifestyle or metformin alone . When applicable , most participants in the intervention group indicated they perform SMBG with exercise ( 62.5 % ) , during illness ( 62.5 % ) and with hypoglycemic symptoms ( 81.3 % ) compared with 33.3 % , 42.9 % and 42.9 % in the control group , respectively . Most participants in the intervention group ( 20/26 ; 76.9 % ) reported making lifestyle changes as a result of speaking with the pharmacist , with all indicating that they maintained these changes at 6 months . Conclusions : The results of this pilot study indicate that a larger study examining pharmacist interventions related to SMBG is feasible . Future studies are required to determine patient motivations and further evaluate the role of pharmacists in ensuring best practice s to positively influence guideline -based blood glucose monitoring OBJECTIVE To describe the 1 ) lifestyle intervention used in the Finnish Diabetes Prevention Study , 2 ) short- and long-term changes in diet and exercise behavior , and 3 ) effect of the intervention on glucose and lipid metabolism . RESEARCH DESIGN AND METHODS There were 522 middle-aged , overweight subjects with impaired glucose tolerance who were r and omized to either a usual care control group or an intensive lifestyle intervention group .  The control group received general dietary and exercise advice at baseline and had an annual physician 's examination . The subjects in the intervention group received additional individualized dietary counseling from a nutritionist . They were also offered circuit-type resistance training sessions and advised to increase overall physical activity .  The intervention was the most intensive during the first year , followed by a maintenance period . The intervention goals were to reduce body weight , reduce dietary and saturated fat , and increase physical activity and dietary fiber . RESULTS The intervention group showed significantly greater improvement in each intervention goal . After 1 and 3 years , weight reductions were 4.5 and 3.5 kg in the intervention group and 1.0 and 0.9 kg in the control group , respectively . Measures of glycemia and lipemia improved more in the intervention group . CONCLUSIONS The intensive lifestyle intervention produced long-term beneficial changes in diet , physical activity , and clinical and biochemical parameters and reduced diabetes risk . This type of intervention is a feasible option to prevent type 2 diabetes and should be implemented in the primary health care system AIMS Whether long-term cardiovascular risk is reduced by the Diabetes Prevention Program interventions is unknown . The aim of this study was to determine the long-term differences in cardiovascular disease risk factors and the use of lipid and blood pressure medications by the original Diabetes Prevention Program intervention group . METHODS This long-term follow-up ( median 10 years , interquartile range 9.0 - 10.5 ) of the three-arm Diabetes Prevention Program r and omized controlled clinical trial ( metformin , intensive lifestyle and placebo ) , performed on 2766 ( 88 % ) of the Diabetes Prevention Program participants ( who originally had impaired glucose tolerance ) , comprised a mean of 3.2 years of r and omized treatment , approximately 1-year transition ( during which all participants were offered intensive lifestyle intervention ) and 5 years follow-up ( Diabetes Prevention Program Outcomes Study ) . During the study , participants were followed in their original groups with their clinical care being provided by practitioners outside the research setting . The study determined lipoprotein profiles and blood pressure and medication use annually . RESULTS After 10 years ' follow-up from Diabetes Prevention Program baseline , major reductions were seen for systolic ( -2 to -3 ) and diastolic ( -6 to -6.5 mmHg ) blood pressure , and for LDL cholesterol ( -0.51 to -0.6 mmol/l ) and triglycerides ( -0.23 to -0.25 mmol/l ) in all groups , with no between-group differences . HDL cholesterol also rose significantly ( 0.14 to 0.15 mmol/l ) in all groups . Lipid ( P = 0.01 ) and blood pressure ( P = 0.09 ) medication use , however , were lower for the lifestyle group during the Diabetes Prevention Program Outcomes Study . CONCLUSION Overall , intensive lifestyle intervention achieved , with less medication , a comparable long-term effect on cardiovascular disease risk factors , to that seen in the metformin and placebo groups
Identified evidence suggests that cardiovascular disease ( CVD ) prevention services should consider regulation of blood glucose as a key target for intervention .
The primary objective of this study was to analyze the most up-to- date evidence regarding whether and how blood sugar regulation influences cardiovascular health promotion and disease prevention by carrying out an umbrella review .