Lifestyle Intervention for Prevention of Type 2 Diabetes in Primary Health Care
One-year follow-up of the Finnish National Diabetes Prevention Program (FIN-D2D)
- Timo Saaristo, MD1,2,
- Leena Moilanen, MD3,
- Eeva Korpi-Hyövälti, MD4,
- Mauno Vanhala, MD5,
- Juha Saltevo, MD6,
- Leo Niskanen, MD3,
- Jari Jokelainen, MS7,
- Markku Peltonen, PHD8,
- Heikki Oksa, MD1,
- Jaakko Tuomilehto, MD9,
- Matti Uusitupa, MD10 and
- Sirkka Keinänen-Kiukaanniemi, MD7,11
- 1Pirkanmaa Hospital District, Tampere, Finland;
- 2Finnish Diabetes Association, Tampere, Finland;
- 3Department of Medicine, Kuopio University Hospital, Northern Savo Hospital District, Kuopio, Finland;
- 4Department on Internal Medicine, South Ostrobothnia Hospital District, Seinäjoki, Finland;
- 5Unit of Family Practice, Central Finland Hospital District, Jyväskylä, and Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland;
- 6Department of Internal Medicine, Central Finland Hospital District, Jyväskylä, Finland;
- 7University of Oulu, Institute of Health Sciences, Faculty of Medicine, Oulu, Finland;
- 8National Institute for Health and Welfare, Helsinki, Finland;
- 9Department of Public Health, University of Helsinki, Helsinki, Finland;
- 10Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland;
- 11North Ostrobothnia Hospital District, Oulu, Finland.
- Corresponding author: Leena Moilanen, .
OBJECTIVE To investigate 1-year outcomes of a national diabetes prevention program in Finland.
RESEARCH DESIGN AND METHODS Altogether 10,149 individuals at high risk for diabetes were identified with the Finnish Diabetes Risk Score (FINDRISC; scoring ≥15 points), by a history of impaired fasting glucose (IFG) or impaired glucose tolerance (IGT), cardiovascular disease, or gestational diabetes mellitus in 400 primary health care centers. One-year follow-up data were available for 2,798 participants who were nondiabetic at baseline (919 men and 1,879 women, aged 56.0 ± 9.9 and 54.0 ± 10.7 years [mean ± SD] with BMI 30.9 ± 4.6 and 31.6 ± 5.4 kg/m2).
RESULTS The incidence of diabetes was 2.0 and 1.2% in men and women with normal glucose tolerance at baseline, 13.5 and 7.4% in those with IFG, and 16.1 and 11.3% in those with IGT, respectively. Altogether 17.5% of the subjects lost ≥5% weight with no sex difference. The relative risk of diabetes was 0.31 (95% CI 0.16–0.59) in the group who lost ≥5% weight, 0.72 (0.46–1.13) in the group who lost 2.5–4.9% weight, and 1.10 (0.77–1.58) in the group who gained ≥2.5% compared with the group who maintained weight.
CONCLUSIONS The FIN-D2D was the first national effort to implement the prevention of diabetes in a primary health care setting. Methods for recruiting high-risk subjects were simple and easy to use. Moderate weight loss in this very high-risk group was especially effective in reducing risk of diabetes among those participating in the program.
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.
- Received March 2, 2010.
- Accepted July 13, 2010.
- © 2010 by the American Diabetes Association.
Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.