Determinants for the Effectiveness of Lifestyle Intervention in the Finnish Diabetes Prevention Study

  1. Jaana Lindström, PHD12,
  2. Markku Peltonen, PHD1,
  3. Johan G. Eriksson, MD, PHD12,
  4. Sirkka Aunola, PHD3,
  5. Helena Hämäläinen, MD, PHD4,
  6. Pirjo Ilanne-Parikka, MD5,
  7. Sirkka Keinänen-Kiukaanniemi, MD, PHD6,
  8. Matti Uusitupa, MD, PHD7,
  9. Jaakko Tuomilehto, MD, MPH, PHD12 and
  10. for the Finnish Diabetes Prevention Study (DPS) Group*
  1. 1Diabetes Unit, Department of Health Promotion and Chronic Disease Prevention, National Public Health Institute, Helsinki, Finland
  2. 2Department of Public Health, University of Helsinki, Helsinki, Finland
  3. 3Laboratory for Population Research, Department of Health and Functional Capacity, National Public Health Institute, Turku, Finland
  4. 4Research Department, Social Insurance Institution, Turku, Finland
  5. 5Research Unit of Tampere University Hospital and the Diabetes Center, Finnish Diabetes Association, Tampere, Finland
  6. 6Institute of Health Sciences (General Practice), University of Oulu, Unit of General Practice, Oulu University Hospital and Health Centre of Oulu, Oulu, Finland
  7. 7School of Public Health and Clinical Nutrition, Department of Clinical Nutrition, University of Kuopio, Kuopio, Finland
  1. Corresponding author: Jaana Lindström, National Public Health Institute, Mannerheimintie 166, 00300 Helsinki, Finland. E-mail: jaana.lindstrom{at}ktl.fi

Abstract

OBJECTIVE—Intensive lifestyle intervention significantly reduced diabetes incidence among the participants in 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 randomly assigned to intensive lifestyle intervention (n = 265) or to a 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 (HRs) 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 h 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; Pinteraction = 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; Pinteraction = 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.

Footnotes

  • Published ahead of print at http://care.diabetesjournals.org on 5 February 2008. DOI: 10.2337/dc07-2162. Clinical trial reg. no. NCT00518167, clinicaltrials.gov.

  • *

    * A complete list of the members of the Finnish Diabetes Prevention Study Group can be found in the appendix.

  • The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C Section 1734 solely to indicate this fact.

    • Accepted January 21, 2008.
    • Received November 12, 2007.
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  1. Diabetes Care vol. 31 no. 5 857-862
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