Improved lifestyle and decreased diabetes risk over 13 years: long-term follow-up of the randomised Finnish Diabetes Prevention Study (DPS)
Abstract
Aims/hypothesis This study aimed to determine whether lifestyle intervention lasting for 4 years affected diabetes incidence, body weight, glycaemia or lifestyle over 13 years among individuals at high risk of type 2 diabetes.
Introduction
Lifestyle intervention has repeatedly and conclusively been shown to prevent or postpone the development of type 2 diabetes among high-risk individuals [1–5]. The Finnish Diabetes Prevention Study (DPS) was the first individually randomised, controlled clinical trial to show that a relative risk reduction of almost 60% can be achieved with intensive dietary and physical activity counselling [2]. Today several other trials among different populations and ethnic groups have confirmed this finding, with relative risk reduction ranging from 30% to 60% and absolute risk reduction of approximately 15–20% during active intervention [6].
We have previously shown that the effect of lifestyle intervention on diabetes incidence and lifestyle indicators was sustained for a median of 3 years after the end of active lifestyle intervention [7]. The finding was subsequently supported by long-term follow-up results from other major prevention trials from China and the USA [8, 9]. It is not known whether the sustained reduction in diabetes inci- dence results from permanent lifestyle changes or whether it is the legacy effect of improved glycaemia in the past.
The aim of this study was to investigate whether diabetes incidence was still reduced after a median of 13 years from the initiation of lifestyle intervention. In addition, we ex- plored the changes in lifestyle (diet and physical activity) and clinical variables (body weight, fasting and 2 h plasma glucose after an OGTT) during and after the active inter- vention period and analysed the association between life- style changes and diabetes risk.