The long-term effect of lifestyle interventions to prevent diabetes in the China Da Qing Diabetes Prevention Study: a 20-year follow-up study

医学 糖尿病 入射(几何) 心理干预 危险系数 2型糖尿病 累积发病率 物理疗法 糖耐量受损 老年学 内科学 置信区间 内分泌学 移植 物理 光学 精神科
作者
Guangwei Li,Ping Zhang,Jinping Wang,Edward W. Gregg,Wenying Yang,Qiuhong Gong,Hui Li,Hongliang Li,Jiang Yayun,Yali An,Ying Shuai,Bo Zhang,Jingling Zhang,Theodore J. Thompson,Robert B. Gerzoff,Gojka Roglić,Yinghua Hu,Peter H. Bennett
出处
期刊:The Lancet [Elsevier BV]
卷期号:371 (9626): 1783-1789 被引量:1548
标识
DOI:10.1016/s0140-6736(08)60766-7
摘要

Summary

Background

Intensive lifestyle interventions can reduce the incidence of type 2 diabetes in people with impaired glucose tolerance, but how long these benefits extend beyond the period of active intervention, and whether such interventions reduce the risk of cardiovascular disease (CVD) and mortality, is unclear. We aimed to assess whether intensive lifestyle interventions have a long-term effect on the risk of diabetes, diabetes-related macrovascular and microvascular complications, and mortality.

Methods

In 1986, 577 adults with impaired glucose tolerance from 33 clinics in China were randomly assigned to either the control group or to one of three lifestyle intervention groups (diet, exercise, or diet plus exercise). Active intervention took place over 6 years until 1992. In 2006, study participants were followed-up to assess the long-term effect of the interventions. The primary outcomes were diabetes incidence, CVD incidence and mortality, and all-cause mortality.

Findings

Compared with control participants, those in the combined lifestyle intervention groups had a 51% lower incidence of diabetes (hazard rate ratio [HRR] 0·49; 95% CI 0·33–0·73) during the active intervention period and a 43% lower incidence (0·57; 0·41–0·81) over the 20 year period, controlled for age and clustering by clinic. The average annual incidence of diabetes was 7% for intervention participants versus 11% in control participants, with 20-year cumulative incidence of 80% in the intervention groups and 93% in the control group. Participants in the intervention group spent an average of 3·6 fewer years with diabetes than those in the control group. There was no significant difference between the intervention and control groups in the rate of first CVD events (HRR 0·98; 95% CI 0·71–1·37), CVD mortality (0·83; 0·48–1·40), and all-cause mortality (0·96; 0·65–1·41), but our study had limited statistical power to detect differences for these outcomes.

Interpretation

Group-based lifestyle interventions over 6 years can prevent or delay diabetes for up to 14 years after the active intervention. However, whether lifestyle intervention also leads to reduced CVD and mortality remains unclear.

Funding

Centers for Disease Control and Prevention, WHO, the China-Japan Friendship Hospital, and Da Qing First Hospital.
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