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Determinants for the effectiveness of lifestyle intervention in the Finnish Diabetes Prevention Study

¹Diabetes Unit, Department of Health Promotion and Chronic Disease Prevention, National Public Health Institute, Helsinki, Finland
²Department of Public Health, University of Helsinki, Helsinki, Finland
³Laboratory for Population Research, Department of Health and Functional Capacity, National Public Health Institute, Turku, Finland
⁴Research Department, Social Insurance Institution, Turku, Finland
⁵Research Unit of Tampere University Hospital, Tampere, Finland
⁶The Diabetes Center, Finnish Diabetes Association, Tampere, Finland
⁷Department of Public Health Science and General Practice, University of Oulu, Oulu, Finland
⁸Unit of General Practice, Oulu University Hospital, Oulu, Finland
⁹Health Centre of Oulu, Oulu, Finland
¹⁰School of Public Health and Clinical Nutrition, Department of Clinical Nutrition, University of Kuopio, Kuopio, Finland

aana.lindstrom{at}ktl.fi

ABSTRACT

Objective: Intensive lifestyle intervention reduced significantly diabetes incidence among the participants of the Finnish Diabetes Prevention Study. We investigated whether and to what extent risk factors for type 2 diabetes and other baseline characteristics of the study participants modified the effectiveness of the lifestyle intervention.

Research Design and Methods: Overweight, middle-aged volunteers with impaired glucose tolerance were randomized to intensive lifestyle intervention (n=265) or control group (n=257) for a median of 4 years. Diabetes status was ascertained annually with repeated oral glucose tolerance testing. Incidence rates of diabetes and hazard ratios (HR) comparing the intervention group with the control group were calculated by sex and baseline tertiles of age, BMI, waist circumference, plasma glucose concentration at fasting and 2 hours after a glucose load, fasting serum insulin and insulin resistance index, and categories of composite baseline Finnish Diabetes Risk Score (FINDRISC). Interactions between the intervention assignment and baseline risk factors on diabetes risk were analyzed.

Results: The intervention was most effective among the oldest individuals (HRs 0.77, 0.49, and 0.36 by increasing age tertiles, respectively; p for interaction = 0.0130) and those with a high baseline FINDRISC (HRs 1.09, 0.84, 0.34, and 0.22 by increasing risk score category, respectively; p for interaction = 0.0400). The effect of the intervention on diabetes risk was not modified by other baseline characteristics or risk factors.

Conclusions: The FINDRISC may be useful in identifying high risk groups most likely to benefit from intensive lifestyle intervention to prevent type 2 diabetes.

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