Lifestyle
intervention (LI) can prevent type 2 diabetes, but response to LI varies depending
on risk subphenotypes. We tested if prediabetic individuals with low risk
benefit from conventional LI and individuals with high risk benefit from an
intensification of LI in a multi-center randomized controlled intervention over
12 months with 2 years follow up. 1105 prediabetic individuals
based on ADA glucose criteria were stratified into a high- and low-risk
phenotype, based on previously described thresholds of insulin secretion,
insulin sensitivity and liver fat content. Low-risk individuals were randomly
assigned to conventional LI according to the DPP protocol or control (1:1),
high-risk individuals to conventional or intensified LI with doubling of
required exercise (1:1). A total of 908 (82%) participants completed the study. In high-risk individuals,
the difference between conventional and intensified LI in post-challenge
glucose change was -0.29 mmol/l [CI:-0.54;-0.04], p=0.025. Liver fat (-1.34 percentage points [CI:-2.17;-0.50], p=0.002) and
cardiovascular risk (-1.82[CI:-3.13-0.50],p=0.007) underwent larger reductions
with intensified than with conventional LI. During a follow up of 3 years,
intensified compared to conventional LI had a higher probability to normalize
glucose tolerance (p=0.008). In conclusion, it is possible in high-risk
individuals with prediabetes to improve glycemic and cardiometabolic outcomes
by intensification of LI. Individualized, risk-phenotype-based LI may be beneficial
for the prevention of diabetes.
Prevention of Diabetes: Effects of a Lifestyle Intervention
