Lifestyle Counseling in Primary Care Setting May Reduce Incidence of T2D in High-risk Patients

April 8, 2021
Sydney Jennings

Associate Editor of Patient Care Online

A recent study showed lifestyle counseling in primary care was effective in preventing type 2 diabetes in long-term follow-up.

Individuals at high risk for type 2 diabetes (T2D) who achieved moderate weight reduction through lifestyle counseling in primary care demonstrated long-term reduction in the incidence of drug-treated T2D, according to a recent study published online ahead of print in the journal Primary Care Diabetes.

Randomized controlled trials have shown that a lifestyle intervention including a healthy diet, exercise, and weight control in high-risk individuals is efficient for the prevention of T2D and management of cardiovascular risk factors.

However, “a limited number of implementation studies exist that have evaluated effects of lifestyle interventions for diabetes prevention in primary care settings with a long follow-up time,” wrote study authors led by Reeta Rintamäki, Department of Endocrinology and Clinical Nutrition, Kuopio University Hospital, Finland.

For this reason, Rintamäki and colleagues conducted a follow-up study of the Finnish National Diabetes Prevention Program (FIN-D2D), the first global large-scale diabetes prevention program in a primary health care setting, conducted between 2003 and 2008.

The aim of the current study was to analyze the long-term effects of 1-year weight change on the incidence of T2D, cardiovascular events, and all-cause mortality.

Altogether, 10 149 individuals at high-risk for T2D were identified with the Finnish Diabetes Risk Score (FINDRISC) in 400 primary health care centers. Participants who scored ≥15 points in the FINDRISC were invited to receive either individual or group-based lifestyle counseling comprising a healthy diet, exercise, and weight control.

Of the participants who were enrolled at baseline, 8353 had an oral glucose tolerance test. Complete follow-up data during the 1-year intervention were available for 2730 individuals (mean body mass index, >30 kg/m2). The long-term outcome events were collected from national health registers after the median follow-up of 7.4 years.

Results

Among individuals who participated in the 1-year lifestyle intervention and achieved a weight loss of 2.5%-4.9% and ≥5%, the incidence of drug-treated T2D was reduced by 37% (hazard ratio [HR]=0.63; confidence interval [CI] 0.49−0.81; p=0.0001) and 29% (HR=0.63; CI 0.49−0.81; p=0.0001), respectively, vs those with stable weight after multivariable adjustment.

In participants with weight gain of ≥2.5%, the incidence of drug-treated T2D was higher than in those with stable weight (HR=1.22, CI 0.99-1.51; p=0.059).

“The observed moderate weight loss was not associated with a reduction in cardiovascular events or all-cause mortality in a post-hoc analysis, but the number of the events was small resulting in low statistical power,” concluded authors in the Discussion.