Lifestyle Counseling for Type 2 Diabetes Risk Reduction in Dutch Primary Care Hypothetical Midlife Interventions in Women and Risk of Type 2 Diabetes Combined effect of alcohol consumption and lifestyle behaviors on risk of type 2 diabetes. A lifestyle intervention to reduce Type 2 diabetes risk in Dutch primary care: 2.5-year results of a randomized controlled trial. Incidence of Type 2 Diabetes in the Randomized Multiple Risk Factor Intervention Trial Importance of Weight Loss Maintenance and Risk Prediction in the Prevention of Type 2 Diabetes: Analysis of European Diabetes Prevention Study RCT The Finnish Diabetes Prevention Study. Adherence to healthy lifestyle factors and risk of death in men with diabetes mellitus: The Physicians' Health Study. Effectiveness of a Group-Based Culturally Tailored Lifestyle Intervention Program on Changes in Risk Factors for Type 2 Diabetes among Asian Indians in the United States Effects of lifestyle intervention in persons at risk for type 2 diabetes mellitus - results from a randomised, controlled trial Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: follow-up of the Finnish Diabetes Prevention Study Outcomes from a Multiple Risk Factor Diabetes Self-Management Trial for Latinas: ¡Viva Bien! Motivational interviewing and problem solving treatment to reduce type 2 diabetes and cardiovascular disease risk in real life: a randomized controlled trial Lifestyle changes can be achieved through counseling and follow-up in first-degree relatives of patients with type 2 diabetes. Effects of a tailored lifestyle self-management intervention in patients with type 2 diabetes. Healthy behaviours and 10-year incidence of diabetes: a population cohort study. Examining the Psychological Pathways to Behavior Change in a Group-Based Lifestyle Program to Prevent Type 2 Diabetes
OBJECTIVE To study the overall effect of the Active Prevention in High-Risk Individuals of Diabetes Type 2 in and Around Eindhoven ( APHRODITE ) lifestyle intervention on type 2 diabetes risk reduction in Dutch primary care after 0.5 and 1.5 years and to evaluate the variability between general practice s. RESEARCH DESIGN AND METHODS Individuals at high risk for type 2 diabetes ( Finnish Diabetes Risk Score ≥13 ) were r and omly assigned into an intervention group ( n = 479 ) or a usual-care group ( n = 446 ) . Comparisons were made between study groups and between general practice s regarding changes in clinical and lifestyle measures over 1.5 years . Participant , general practitioner , and nurse practitioner characteristics were compared between individuals who lost weight or maintained a stable weight and individuals who gained weight . RESULTS Both groups showed modest changes in glucose values , weight measures , physical activity , energy intake , and fiber intake . Differences between groups were significant only for total physical activity , saturated fat intake , and fiber intake . Differences between general practice s were significant for BMI and 2-h glucose but not for energy intake and physical activity . In the intervention group , the nurse practitioners ’ mean years of work experience was significantly longer in individuals who were successful at losing weight or maintaining a stable weight compared with unsuccessful individuals . Furthermore , successful individuals more often had a partner . CONCLUSIONS Risk factors for type 2 diabetes could be significantly reduced by lifestyle counseling in Dutch primary care . The small differences in changes over time between the two study groups suggest that additional intervention effects are modest . In particular , the level of experience of the nurse practitioner and the availability of partner support seem to facilitate intervention success Background : R and omized trials have examined short-term effects of lifestyle interventions for diabetes prevention only among high-risk individuals . Prospect i ve studies have examined the associations between lifestyle factors and diabetes in healthy population s but have not characterized the intervention . We estimated the long-term effects of hypothetical lifestyle interventions on diabetes in a prospect i ve study of healthy women , using the parametric g-formula . Methods : Using data from the Nurses ’ Health Study , we followed 76,402 women from 1984 to 2008 . We estimated the risk of type 2 diabetes under eight hypothetical interventions : quitting smoking , losing weight by 5 % every 2 years if overweight/obese , exercising at least 30 minutes a day , eating less than three servings a week of red meat , eating at least two servings a day of whole grain , drinking two or more cups of coffee a day , drinking five or more grams of alcohol a day , and drinking less than one serving of soda a week . Results : The 24-year risk of diabetes was 9.6 % under no intervention and 4.3 % when all interventions were imposed ( 55 % lower risk [ 95 % confidence interval = 47 to 63 % ] ) . The most effective interventions were weight loss ( 24 % lower risk ) , physical activity ( 19 % ) , and moderate alcohol use ( 19 % ) . Overweight/obese women would benefit the most , with 10.8 percentage point reduction in 24-year risk of diabetes . The validity of these estimates relies on the absence of unmeasured confounding , measurement error , and model misspecification . Conclusion : A combination of dietary and nondietary lifestyle modifications , begun in midlife or later in relatively healthy women , could have prevented at least half of the cases of type 2 diabetes in this cohort of U.S. women BACKGROUND It has been suggested that the inverse association between alcohol and type 2 diabetes could be explained by moderate drinkers ' healthier lifestyles . OBJECTIVE We studied whether moderate alcohol consumption is associated with a lower risk of type 2 diabetes in adults with combined low-risk lifestyle behaviors . DESIGN We prospect ively examined 35,625 adults of the Dutch European Prospect i ve Investigation into Cancer and Nutrition ( EPIC-NL ) cohort aged 20 - 70 y , who were free of diabetes , cardiovascular disease , and cancer at baseline ( 1993 - 1997 ) . In addition to moderate alcohol consumption ( women : 5.0 - 14.9 g/d ; men : 5.0 - 29.9 g/d ) , we defined low-risk categories of 4 lifestyle behaviors : optimal weight [ body mass index ( in kg/m(2 ) ) < 25 ] , physically active ( > or = 30 min of physical activity/d ) , current nonsmoker , and a healthy diet [ upper 2 quintiles of the Dietary Approaches to Stop Hypertension ( DASH ) diet ] . RESULTS During a median of 10.3 y , we identified 796 incident cases of type 2 diabetes . Compared with teetotalers , hazard ratios of moderate alcohol consumers for risk of type 2 diabetes in low-risk lifestyle strata after multivariable adjustments were 0.35 ( 95 % CI : 0.17 , 0.72 ) when of a normal weight , 0.65 ( 95 % CI : 0.46 , 0.91 ) when physically active , 0.54 ( 95 % CI : 0.41 , 0.71 ) when nonsmoking , and 0.57 ( 95 % CI : 0.39 , 0.84 ) when consuming a healthy diet . When > or =3 low-risk lifestyle behaviors were combined , the hazard ratio for incidence of type 2 diabetes in moderate alcohol consumers after multivariable adjustments was 0.56 ( 95 % CI : 0.32 , 1.00 ) . CONCLUSION In subjects already at lower risk of type 2 diabetes on the basis of multiple low-risk lifestyle behaviors , moderate alcohol consumption was associated with an approximately 40 % lower risk compared with abstention AIMS To determine the effectiveness of a 2.5-year lifestyle intervention for Type 2 diabetes prevention in Dutch general practice compared with usual care . METHODS A r and omized controlled trial of 925 individuals at high risk for Type 2 diabetes ( FINDRISC-score ≥ 13 ) in 14 general practice s in the Netherl and s. Intervention consisted of lifestyle counselling from the nurse practitioner and the general practitioner . Usual care consisted of oral and written information at the start of the study . Study groups were compared over 2.5 years regarding changes in clinical and lifestyle measures . RESULTS Both groups showed modest changes in body weight , glucose concentrations , physical activity and dietary intake [ weight : intervention group , -0.8 ( 5.1 ) kg , usual care group , -0.4 ( 4.7 ) kg , ( P=0.69 ) ; fasting plasma glucose : intervention group , -0.17 ( 0.4 ) mmol/l , usual care group , -0.10 ( 0.5 ) mmol/l , ( P=0.10 ) ] . Differences between groups were significant only for total physical activity and fibre intake . In the intervention group , self-efficacy was significantly higher in individuals successful at losing weight compared with unsuccessful individuals . No significant differences in participant weight loss were found between general practitioners and nurse practitioners with different levels of motivation or self-efficacy . CONCLUSIONS Diabetes risk factors could significantly be reduced by lifestyle counselling in Dutch primary care . However , intervention effects above the effects attributable to usual care were modest . Higher participant self-efficacy seemed to facilitate weight loss . Lack of motivation or self-efficacy of professionals did not negatively influence participant guidance Context Weight loss and exercise decrease the development of diabetes in people with impaired glucose tolerance , but the effectiveness of these interventions in people with normal glucose tolerance is unknown . Contribution Using data from a large r and omized , controlled trial of cardiovascular disease prevention in men , the investigators show that participants with normal glucose tolerance at baseline developed diabetes at similar rates whether they received the diet and exercise intervention or usual care . However , the intervention was associated with lower risk of diabetes among nonsmokers . Implication s While diet and exercise may reduce the development of diabetes in nonsmokers with normal glucose metabolism at baseline , this benefit was not apparent among smokers . The Editors Epidemiologic studies have identified several potentially modifiable risk factors for type 2 diabetes mellitus , including obesity , a diet in which a high proportion of calories comes from fat , and low levels of physical activity ( 1 - 7 ) . Authorities have advocated that trials should test promising hypotheses about the primary prevention of type 2 diabetes ( 1 ) . R and omized intervention studies have demonstrated that , among those who already have impaired glucose tolerance , interventions that promote weight loss and increased exercise can reduce the risk for incident diabetes ( 8 - 10 ) . However , interventions should occur before at-risk individuals develop impaired glucose tolerance . A 2-year r and omized trial of diet , exercise , or both in individuals with a parental history of diabetes showed a statistically imprecise lower risk for developing diabetes in the intervention group ( 11 ) . To test such a hypothesis in groups who do not necessarily have a parental history of diabetes would be expensive . Strategies proposed for the primary prevention of type 2 diabetes include  weight reduction , reduced dietary fat intake , and increased exercise  ( 2 , 4 , 7 ) . These interventions are similar to those developed for preventing coronary heart disease ; therefore , examination of type 2 diabetes incidence rates in coronary heart disease prevention trials can provide preliminary evidence on the potential of such interventions to reduce type 2 diabetes risk . The Multiple Risk Factor Intervention Trial ( MRFIT ) enrolled 12866 middle-aged men at high risk for coronary heart disease and delivered either special intervention or usual care  over 6 to 7 years . The research ers obtained fasting glucose values yearly , and participants self-reported their use of insulin or oral hypoglycemic agents . The glucose values and reports of diabetes medication use enable estimation of diabetes incidence during the trial . Previous reports from MRFIT have described risk factors for the development of diabetes in the usual care group ( 12 ) and the risk for death associated with incident diabetes in the combined special intervention and usual care groups ( 13 ) . In this paper , we compare the incidence of diabetes in the  intervention and control groups of the MRFIT , report on an unexpected subgroup finding related to baseline cigarette smoking status , and explore reasons for the different results among smokers and nonsmokers . Methods Procedures Detailed descriptions of the MRFIT have been published ( 14 - 17 ) . Briefly , between 1973 and 1976 , the MRFIT investigators screened 361662 men for eligibility at 22 U.S. clinical centers . Of this group , 12866 men age 35 to 57 years were r and omly assigned : 6428 men to the special intervention group and 6438 men to the usual care group . Screening occurred at 3 visits . At the first screening visit , investigators assessed the risk for coronary heart disease by using measurements of serum cholesterol level , diastolic blood pressure , and self-reported cigarette smoking ( 14 ) . Men who were in the upper 15 % ( changed to 10 % after one third of the screening was completed ) of risk were invited to attend a second screening visit . Because of the eligibility criteria used in the MRFIT , the usual relationships among these risk factors were modified . For example , nonsmokers had to have higher blood pressure and lipid levels on average than smokers to be eligible for the trial . At the second screening visit , a blood sample was taken after an overnight fast . A central laboratory at the Institute of Medical Sciences in San Francisco , California , analyzed the blood sample s by using a protocol previously described ( 18 ) and measured serum glucose in the fasting sample and in a sample taken 1 hour after a 75-g oral glucose load . The MRFIT also measured height and weight ( after the patient had disrobed ) . Individuals with body weight 150 % or more of desirable weight were excluded from the trial ( defined as 0.9 of the average for men of the same height in the 19601962 National Health Examination Survey [ 19 ] ) . We used body mass index ( BMI ) as the measure of relative weight in our report . Men without evidence of cardiovascular or other life-threatening diseases were invited to attend a third screening visit . At this visit , eligible men who consented to the trial were r and omly assigned . All participants had annual examinations for at least 6 years . A fasting blood sample was taken at each annual examination , from which serum glucose concentration and plasma lipid levels were measured . In addition , at the sixth annual visit , a blood sample taken 1 hour after a 75-g oral glucose load was obtained . At each annual examination , participants were asked whether a physician had told them that they had diabetes at any time in the previous 12 months . Each participant was also asked whether he was using insulin or oral hypoglycemic agents . In the MRFIT , 24-hour dietary recalls were obtained at baseline and during follow-up ( 20 , 21 ) . We cited data from baseline and year 6 in our report . Intervention Details of the intervention program of the MRFIT have been reported ( 16 , 22 ) . Briefly , the special intervention group received nutritional counseling that was aim ed at reducing saturated fat and dietary cholesterol consumption and increasing  polyunsaturated fat intake .  Smokers participated in a behavioral intervention program aim ed at cessation . In men at or more than 115 % of desirable weight , reductions in caloric intake and increases in moderate physical activity were recommended . Elevated blood pressure was treated pharmacologically according to a stepped-care protocol that started with 50 mg of chlorthalidone or hydrochlorothiazide if weight reduction and moderate salt restriction did not achieve the desired blood pressure goals . Definition of Diabetes The definition of incident diabetes followed the American Diabetes Association ( ADA ) guidelines ( 23 ) . With this definition , a participant was considered to have developed diabetes if at any annual visit the fasting glucose level was 7 mmol/L or greater ( 126 mg/dL ) or the participant reported taking insulin or oral hypoglycemic agents . Use of a single fasting glucose determination to design ate diabetic participants is consistent with the ADA criteria for epidemiologic studies . Exclusions The MRFIT attempted at baseline to exclude men with identified diabetes from the trial . The trial excluded individuals who were using hypoglycemic drugs , as well as those who were not being treated but who exhibited clinical symptoms of hyperglycemia ( 15 ) . Despite these exclusion criteria , the trial included 42 men who reported ( without confirmation ) taking insulin , 414 men with a baseline fasting glucose level of 7 mmol/L or greater ( 126 mg/dL ) , and 52 men with a glucose level of 16.65 mmol/L or greater ( 300 mg/dL ) 1 hour after a 75-g oral glucose load . We excluded these 508 men and an additional 531 men ( 291 in the usual care group and 240 in the special intervention group ) with fewer than 2 fasting glucose values throughout the trial from our analyses , leaving 11827 men ( 5893 in the usual care group and 5934 in the special intervention group ) who , by our criteria , were at risk for developing diabetes over the next 6 years ( Figure ) . Figure . Description of study exclusions . Statistical Analysis We used time-to-event methods appropriate for interval-censored data to compare incidence of diabetes in the special intervention and usual care groups ( 24 ) . We estimated the cumulative percentage of patients developing diabetes , assuming that participants at risk who did not attend an annual visit did not meet our criteria for diabetes . We used proportional hazards regression models to study the influence of baseline predictors on hazard ratio estimates and to investigate treatment by subgroup interactions . We also used these models to study the influence of risk factor changes on the incidence of diabetes and on special interventionusual care hazard ratios . We checked the proportional hazards assumption by including a covariate corresponding to the interaction of failure time and special intervention or usual care . In these models , we up date d risk factor levels ( for example , BMI , use of antihypertensive drugs  , and smoking status ) annually and considered them to be time-dependent covariates . With this approach , we considered the latest values of risk factors ( those immediately preceding diabetes ) and baseline levels as predictors . We also used longitudinal regression models for binary data ( 25 ) . With these models , participants could be classified as diabetic on several annual visits or at 1 annual visit and not the next . We used analysis of variance with covariates corresponding to baseline level of the factor being considered to compare risk factor levels at 6 years for  special intervention and usual care men , both overall and according to baseline cigarette smoking status . With these models , we also investigated the interaction between treatment and smoking status . Both time-to-event analyses and analyses of variance are stratified by clinical center . We performed all analyses by using SAS , version 9.1 ( SAS Institute , Inc. , Cary , North Carolina ) . Role of the Funding Background Prevalence of type 2 diabetes ( T2D ) is increasing worldwide . T2D prevention by lifestyle intervention is effective . Pragmatic scalable interventions are needed , with evidence to efficiently target and monitor such interventions . We report pooled analyses of data from three European trial cohorts : to analyse T2D incidence , sustained weight loss and utility of risk predictors . Methods We analysed data on 749 adults with impaired glucose tolerance ( 278 men and 471 women , mean age 56 years , mean BMI 31 kgm−2 ) recruited between 1993 and 2003 , and r and omised to intensive lifestyle intervention ( I ) or lifestyle advice control ( C ) . The intervention aim ed to increase physical activity , modify diet , and promote weight loss≥5 % . Using Cox-regression survival analysis , we assessed T2D incidence and the impact on T2D incidence of sustained weight loss , and of baseline cut-point values of FINDRISC score , fasting plasma glucose ( FPG ) , and HbA1c . Results Mean follow-up duration was 3.1 years . T2D was diagnosed in 139 participants ( I = 45/379 , C = 94/370 ) . Cumulative T2D incidence was 57 % lower in the intervention compared with the control group ( HR 0.42 ( 95 % CI 0.29 to 0.60 ) P<0.001 ) . Participants with ≥5 % weight loss at one year had 65 % lower T2D incidence ( HR 0.35 ( 95 % CI 0.22 to 0.56 ) P<0.001 ) ; maintaining ≥5 % weight loss for two and three years further reduced T2D incidence . Recommended cut-points to identify those at high risk for T2D would have identified different proportions of European Diabetes Prevention Study ( EDIPS ) participants with similar hazard-ratios for intervention effect . Conclusions Pooled analysis of EDIPS trial data reinforces evidence for T2D prevention by lifestyle intervention . Analysis showed the preventive effect of ≥5 % weight loss , especially if maintained long term , which has utility for intervention monitoring . Analysis of proposed cut-points demonstrates difficulties in balancing risk and benefit , to efficiently target interventions and suggests evidence is needed to define clinical policy . Trial registration s The Finnish Diabetes Prevention study , Helsinki , Finl and : Clinical Trials.gov ; NCT00518167 The SLIM diabetes prevention study , Maastricht , The Netherl and s : Clinical Trials.gov ; NCT00381186 The EDIPS-Newcastle diabetes prevention study , Newcastle upon Tyne , UK : International St and ard R and omised Controlled Trial Number ; IS RCT N15670600 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 BACKGROUND & AIMS The relationship between healthy lifestyle factors and mortality in people with type 2 diabetes is unclear . The purpose of this study was to examine whether healthy lifestyle factors are associated with mortality in people with type 2 diabetes . METHODS We prospect ively studied 1163 men with type 2 diabetes from the Physicians ' Health Study . Lifestyle factors consisted of currently not smoking , moderate drinking ( 1 - 2 drinks/day ) , vigorous exercise ( 1+/week ) , BMI < 25 kg/m2 , and being in the top 2 quintiles of the alternate healthy eating index-2010 ( AHEI-2010 ) . Multivariate Cox regression models were used to estimate hazard ratios ( 95 % confidence intervals ) of mortality . RESULTS At baseline , average age was 69 years and mean follow up was 9 years . About 22 % of study participants had ≤1 healthy lifestyle factor , 37 % had two , 29 % had three , and 12 % had four or more healthy lifestyle factors . An inverse relationship was found between the number of lifestyle factors and total mortality . Compared with participants who had ≤1 healthy lifestyle factor , the risk of death was 42 % ( 95 % CI ; 19%-58 % ) lower for those with two healthy lifestyle factors , 41 % ( 95 % CI ; 18%-58 % ) lower for those with three , and 44 % ( 95 % CI ; 12%-64 % ) lower for those with 4 or more healthy lifestyle factors . CONCLUSION Adherence to modifiable healthy lifestyle factors is associated with a lower risk of death among adult men with type 2 diabetes . Our study emphasizes the importance of educating individuals with diabetes to adhere to healthy lifestyle factors This study used an experimental , pretest-posttest control group repeated measures design to evaluate the effectiveness of a community-based culturally appropriate lifestyle intervention program to reduce the risk for type 2 diabetes ( T2DM ) among Gujarati Asian Indians ( AIs ) in an urban community in the US . Participants included 70 adult AIs in the greater Houston metropolitan area . The primary outcomes were reduction in weight and hemoglobin A1c ( HbA1c ) and improvement in physical activity . Participants were screened for risk factors and r and omly assigned to a 12-week group-based lifestyle intervention program ( n = 34 ) or a control group ( n = 36 ) that received st and ard print material on diabetes prevention . Participants also completed clinical measures and self-reported question naires about physical activity , social , and lifestyle habits at 0 , 3 , and 6 months . No significant baseline differences were noted between groups . While a significant decline in weight and increase in physical activity was observed in all participants , the intervention group lowered their HbA1c ( p < 0.0005 ) and waist circumference ( p = 0.04 ) significantly as compared to the control group . Findings demonstrated that participation in a culturally tailored , lifestyle intervention program in a community setting can effectively reduce weight , waist circumference , and HbA1c among Gujarati AIs living in the US Background Lifestyle change is probably the most important single action to prevent type 2 diabetes mellitus . The purpose of this study was to assess the effects of a low-intensity individual lifestyle intervention by a physician and compare this to the same physician intervention combined with an interdisciplinary , group-based approach in a real-life setting . Methods The " Finnish Diabetes Risk score " ( FINDRISC ) was used by GPs to identify individuals at high risk . A r and omised , controlled design and an 18 month follow-up was used to assess the effect of individual lifestyle counselling by a physician ( individual physician group , ( IG ) ) every six months , with emphasis on diet and exercise , and compare this to the same individual lifestyle counselling combined with a group-based interdisciplinary program ( individual and interdisciplinary group , ( IIG ) ) provided over 16 weeks . Primary outcomes were changes in lifestyle indicated by weight reduction ≥ 5 % , improvement in exercise capacity as assessed by VO2 max and diet improvements according to the Smart Diet Score ( SDS ) . Results 213 participants ( 104 in the IG and 109 in the IIG group , 50 % women ) , with a mean age of 46 and mean body mass index 37 , were included ( inclusion rate > 91 % ) of whom 182 returned at follow-up ( drop-out rate 15 % ) . There were no significant differences in changes in lifestyle behaviours between the two groups . At baseline 57 % ( IG ) and 53 % ( IIG ) of participants had poor aerobic capacity and after intervention 35 % and 33 % , respectively , improved their aerobic capacity at least one metabolic equivalent . Unhealthy diets according to SDS were common in both groups at baseline , 61 % ( IG ) and 60 % ( IIG ) , but uncommon at follow-up , 17 % and 10 % , respectively . At least 5 % weight loss was achieved by 35 % ( IG ) and 28 % ( IIG ) . In the combined IG and IIG group , at least one primary outcome was achieved by 93 % while all primary outcomes were achieved by 6 % . Most successful was the 78 % reduction in the proportion of participants with unhealthy diet ( almost 50 % absolute reduction ) . Conclusion It is possible to achieve important lifestyle changes in persons at risk for type 2 diabetes with modest clinical efforts . Group intervention yields no additional effects . The design of the study , with high inclusion and low dropout rates , should make the results applicable to ordinary clinical setting s . Trial registration Clinical Trials.gov : 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 Background Culturally appropriate interventions are needed to assist Latinas in making multiple healthful lifestyle changes . Purpose The purpose of this study was to test a cultural adaptation of a successful multiple health behavior change program , ¡ Viva Bien ! Methods R and om assignment of 280 Latinas with type 2 diabetes to usual care only or to usual care + ¡ Viva Bien !  , which included group meetings for building skills to promote the Mediterranean diet , physical activity , stress management , supportive re sources , and smoking cessation . Results ¡ Viva Bien ! participants compared to usual care significantly improved psychosocial and behavioral outcomes ( fat intake , stress management practice , physical activity , and social – environmental support ) at 6 months , and some improvements were maintained at 12 months . Biological improvements included hemoglobin A1c and heart disease risk factors . Conclusions The ¡ Viva Bien ! multiple lifestyle behavior program was effective in improving psychosocial , behavioral , and biological/ quality of life outcomes related to heart health for Latinas with type 2 diabetes ( Clinical Trials.gov no : NCT00233259 ) Background Intensive lifestyle interventions in well-controlled setting s are effective in lowering the risk of chronic diseases such as type 2 diabetes ( T2DM ) and cardiovascular diseases ( CVD ) , but there are still no effective lifestyle interventions for everyday practice . In the Hoorn Prevention Study we aim ed to assess the effectiveness of a primary care based lifestyle intervention to reduce the estimated risk of developing T2DM and for CVD mortality , and to motivate changes in lifestyle behaviors . Methods The Hoorn Prevention Study is a parallel group r and omized controlled trial , implemented in the region of West-Friesl and , the Netherl and s. 622 adults with ≥10 % estimated risk of T2DM and /or CVD mortality were r and omly assigned and monitored over a period of 12 months . The intervention group ( n=314 ) received a theory-based lifestyle intervention based on an innovative combination of motivational interviewing and problem solving treatment , provided by trained practice nurses in 12 general practice s. The control group ( n=308 ) received existing health brochures . Primary outcomes was the estimated diabetes risk according to the formula of the Atherosclerosis Risk In Communities ( ARIC ) Study , and the estimated risk for CVD mortality according to the Systematic COronary Risk Evaluation ( SCORE ) formula . Secondary outcomes included lifestyle behavior ( diet , physical activity and smoking ) . The research assistants , the principal investigator and the general practitioners were blinded to group assignment . Linear and logistic regression analysis was applied to examine the between-group differences in each outcome measure , adjusted for baseline values . Results 536 ( 86.2 % ) of the 622 participants ( age 43.5 years ) completed the 6-month follow-up , and 502 ( 81.2 % ) completed the 12-month follow-up . The mean baseline T2DM risk was 18.9 % ( SD 8.2 ) and the mean CVD mortality risk was 3.8 % ( SD 3.0 ) . The intervention group participated in a median of 2 sessions . Intention-to-treat analyses showed no significant differences in outcomes between the two groups at 6 or 12-months follow-up . Conclusions The lifestyle intervention was not more effective than health brochures in reducing risk scores for T2DM and CVD or improving lifestyle behavior in an at-risk population .Trial registration Current Controlled Trials : IS RCT OBJECTIVE To describe two lifestyle prevention strategies tested in first-degree relatives of patients with type 2 diabetes and to present the short-term effects of these strategies on nutrient intake , physical activity pattern , and body weight . DESIGN In this 16-week controlled intervention trial , subjects were assigned to one of three treatment conditions : diet group ( D ) ( n=25 ) , diet and exercise group ( DE ) ( n=30 ) , or control group ( C ) ( n=22 ) . Subjects/ setting Non-diabetic relatives of individuals with diabetes were recruited ( n=77 ; men and women ; age 25 to 55 years ) . INTERVENTION Intervention groups received group counseling on two occasions and follow-up through unannounced telephone interviews every 10 days . Counseling regarding diet and physical activity was based on the Nordic Nutrition Recommendations . In addition , increased intake of fatty fish and low glycemic index foods were recommended . Main outcome measures Changes in diet ( assessed by food frequency question naires ) , leisure time physical activity ( assessed through interviews ) , fatty acid composition of erythrocyte membrane , and body weight . Statistical analysis One-way analysis of variance and Mann-Whitney U test were used to compare changes among groups . RESULTS Compared with the control group , both intervention groups decreased intake of saturated fatty acids ( percent of energy ) , increased intake of dietary fiber , and reduced average glycemic index of the diet . The ratio of n-6:n-3 fatty acids of the erythrocyte membranes decreased , confirming increased intake of fatty fish . Body weight decreased 1.7 kg ( 2.1 % , P=.030 ) in group DE , and physical activity increased in the least-active subjects ( + 70 min/week , P<.01 within group ) . Applications/ Conclusions Healthy individuals with heredity for type 2 diabetes can achieve desired changes in lifestyle factors associated with increased risk for the disease OBJECTIVES The aim of the present study was to develop , implement and evaluate a brief intervention to improve adherence to the recommended lifestyle changes for patients with Type 2 diabetes , in particular to help patients to reduce the total amount of fat consumed and to increase lifestyle physical activity levels . DESIGN AND METHOD A brief , tailored lifestyle self-management intervention for patients with Type 2 diabetes was evaluated in a r and omized controlled trial . One hundred participants ( aged 40 - 70 yrs ) completed assessment s at three time points- baseline , three months and one year . Participants were allocated to either an intervention group who received the brief tailored intervention including follow-up telephone calls , or a usual care control group . RESULTS Results indicate that the intervention was successful in helping patients to reduce fat intake and , to a lesser extent , increase lifestyle physical activity levels . These self-reported changes in behaviour were reflected in the objective data with weight maintenance in the intervention group compared to the control group , together with a significant reduction ( 2 cm ) in waist circumference . CONCLUSIONS These results provide further evidence of the effectiveness of tailored interventions for lifestyle change OBJECTIVE To examine the association between meeting behavioural goals and diabetes incidence over 10 years in a large , representative Swedish population . METHODS Population -based prospect i ve cohort study of 32,120 individuals aged 35 to 55 years participating in a health promotion intervention in Västerbotten County , Sweden ( 1990 to 2013 ) . Participants underwent an oral glucose tolerance test , clinical measures , and completed diet and activity question naires . Poisson regression quantified the association between achieving six behavioural goals at baseline - body mass index ( BMI ) < 25 kg/m(2 ) , moderate physical activity , non-smoker , fat intake < 30 % of energy , fibre intake ≥15 g/4184 kJ and alcohol intake ≤20 g/day - and diabetes incidence over 10 years . RESULTS Median interquartile range ( IQR ) follow-up time was 9.9 ( 0.3 ) years ; 2211 individuals ( 7 % ) developed diabetes . Only 4.4 % of participants met all 6 goals ( n=1245 ) and compared to these individuals , participants meeting 0/1 goals had a 3.74 times higher diabetes incidence ( 95 % confidence interval (CI)=2.50 to 5.59 ) , adjusting for sex , age , calendar period , education , family history of diabetes , history of myocardial infa rct ion and long-term illness . If everyone achieved at least four behavioural goals , 14.1 % ( 95 % CI : 11.7 to 16.5 % ) of incident diabetes cases might be avoided . CONCLUSION Interventions promoting the achievement of behavioural goals in the general population could significantly reduce diabetes incidence OBJECTIVE To examine the psychological process of lifestyle change among adults at risk for type 2 diabetes . RESEARCH DESIGN AND METHODS A r and omized control trial in which 307 volunteers ( intervention , n = 208 ; wait control , n = 99 ) diagnosed with prediabetes completed a  six-session group-based intervention to promote healthier living . Participants ’ motivation to change , diet and exercise self-efficacy , mood , knowledge about diabetes , activity levels , healthy eating , waist circumference , and weight were assessed before and after the program . RESULTS Participation in the program was associated with significant increases in healthy eating and physical activity , reductions in waist and weight , and improvements in motivation , positive mood , self-efficacy , and knowledge . Examination of the pathways to lifestyle change showed that the educational aspect of the program increased activity levels because it increased diabetes knowledge and improved mood . Eating behavior was not mediated by any of the psychological variables . Improvements in diet and physical activity were , in turn , directly associated with changes in weight and waist circumference . CONCLUSIONS Although the program significantly improved motivation , self-efficacy , and mood , its impact on knowledge uniquely explained the increase in physical activity .  Group-based programs that are tailored to lifestyle behaviors may provide a cost-effective method of diabetes prevention , but more research is needed to explain why they improve healthy eating
The associations were largely consistent and significant among individuals from different socioeconomic background s and baseline characteristics .
Conclusions /interpretationAdoption of a healthy lifestyle is associated with substantial risk reduction in type 2 diabetes and long-term adverse outcomes among diabetic individuals .
Aims /hypothesisA healthy lifestyle has been widely recommended for the prevention and management of type 2 diabetes .
However , no systematic review has summarised the relationship between combined lifestyle factors ( including , but not limited to , smoking , alcohol drinking , physical activity , diet and being overweight or obese ) and  incident type 2 diabetes and risk of health outcomes among diabetic individuals .