[Effect of lifestyle interventions on reduction of cardiovascular disease events and its mortality in pre-diabetic patients:long-term follow-up of Da Qing Diabetes Prevention Study]. Impact of intensive lifestyle and metformin therapy on cardiovascular disease risk factors in the diabetes prevention program. Postchallenge Glucose, A1C, and Fasting Glucose as Predictors of Type 2 Diabetes and Cardiovascular Disease Development and piloting of a community health worker-based intervention for the prevention of diabetes among New Zealand Maori in Te Wai o Rona: Diabetes Prevention Strategy. Ten-Year Mortality and Cardiovascular Morbidity in the Finnish Diabetes Prevention Study—Secondary Analysis of the Randomized Trial General effect on high-risk persons when general practitioners are trained in intensive treatment of type 2 diabetes Effect of Intervention in Subjects with High Risk of Diabetes Mellitus in Pakistan Early lifestyle intervention in patients with non-insulin-dependent diabetes mellitus and impaired glucose tolerance. Lowering the criterion for impaired fasting glucose: impact on disease prevalence and associated risk of diabetes and ischemic heart disease. The prevention or delay of type 2 diabetes. Physical Activity/Exercise and Type 2 Diabetes Effects of Ramipril and Rosiglitazone on Cardiovascular and Renal Outcomes in People With Impaired Glucose Tolerance or Impaired Fasting Glucose Prevention of type 2 diabetes in adults with impaired glucose tolerance: the European Diabetes Prevention RCT in Newcastle upon Tyne, UK No excess 12-year mortality in men with impaired glucose tolerance who participated in the Malmö Preventive Trial with diet and exercise Long-term effects of a randomised trial of a 6-year lifestyle intervention in impaired glucose tolerance on diabetes-related microvascular complications: the China Da Qing Diabetes Prevention Outcome Study Prevention of type 2 diabetes by lifestyle intervention: a Japanese trial in IGT males. Effects of insulin resistance and insulin secretion on the efficacy of interventions to retard development of type 2 diabetes mellitus: the DA Qing IGT and Diabetes Study. The long-term effect of lifestyle interventions to prevent diabetes in the China Da Qing Diabetes Prevention Study: a 20-year follow-up study Lifestyle Intervention and Adipokine Levels in Subjects at High Risk for Type 2 Diabetes Chinese herbal medicine Tianqi reduces progression from impaired glucose tolerance to diabetes: a double-blind, randomized, placebo-controlled, multicenter trial. Screening for diabetes using an oral glucose tolerance test within a western multi-ethnic population identifies modifiable cardiovascular risk: the ADDITION-Leicester study Study on lifestyle-intervention and impaired glucose tolerance Maastricht (SLIM): design and screening results. Effect of baseline HbA1c level on the development of diabetes by lifestyle intervention in primary healthcare settings: insights from subanalysis of the Japan Diabetes Prevention Program Physical activity and cause-specific mortality in men with Type 2 diabetes/impaired glucose tolerance: evidence from the Whitehall study. Clinical research of traditional Chinese medical intervention on impaired glucose tolerance. XENical in the prevention of diabetes in obese subjects (XENDOS) study: a randomized study of orlistat as an adjunct to lifestyle changes for the prevention of type 2 diabetes in obese patients. Randomised controlled trial evaluating lifestyle interventions in people with impaired glucose tolerance. Prevention of type 2 diabetes in a primary healthcare setting: Three-year results of lifestyle intervention in Japanese subjects with impaired glucose tolerance A successful diabetes prevention study in Eskimos: the Alaska Siberia project Predictors of Progression From Impaired Glucose Tolerance to NIDDM: An Analysis of Six Prospective Studies Prevention of diabetes in women with a history of gestational diabetes: effects of metformin and lifestyle interventions. Prevalence and correlates of diabetes mellitus and impaired glucose tolerance among adults in Luzon, Philippines. Preventing type 2 diabetes using combination therapy: design and methods of the CAnadian Normoglycaemia Outcomes Evaluation (CANOE) trial A lifestyle intervention in primary care prevents deterioration of insulin resistance in patients with impaired glucose tolerance: A randomised controlled trial Effect of a Low–Resource-Intensive Lifestyle Modification Program Incorporating Gymnasium-Based and Home-Based Resistance Training on Type 2 Diabetes Risk in Australian Adults Weight Loss in Severely Obese Subjects Prevents the Progression of Impaired Glucose Tolerance to Type II Diabetes: A longitudinal interventional study Rationale, Design, and Baseline Characteristics of Beijing Prediabetes Reversion Program: A Randomized Controlled Clinical Trial to Evaluate the Efficacy of Lifestyle Intervention and/or Pioglitazone in Reversion to Normal Glucose Tolerance in Prediabetes Shenzhu Tiaopi granule combined with lifestyle intervention therapy for impaired glucose tolerance: a randomized controlled trial. Fasting, non-fasting glucose and HDL dysfunction in risk of pre-diabetes, diabetes, and coronary disease in non-diabetic adults A randomized lifestyle intervention with 5-year follow-up in subjects with impaired glucose tolerance: Pronounced short-term impact but long-term adherence problems Comparison of the Effects of Pioglitazone and Metformin on Insulin Resistance and Hormonal Markers in Patients with Impaired Glucose Tolerance and Early Diabetes Effects of supervised exercise on gamma-glutamyl transferase levels in patients with isolated impaired fasting glucose and those with impaired fasting glucose plus impaired glucose tolerance. Long-term improvement in insulin sensitivity by changing lifestyles of people with impaired glucose tolerance: 4-year results from the Finnish Diabetes Prevention Study. Effects of Diet and Exercise in Preventing NIDDM in People With Impaired Glucose Tolerance: The Da Qing IGT and Diabetes Study Population-Based Incidence of Type 2 Diabetes in Northern Spain Effects of Exenatide and Lifestyle Modification on Body Weight and Glucose Tolerance in Obese Subjects With and Without Pre-Diabetes Impact of Positive Family History and Genetic Risk Variants on the Incidence of Diabetes Improvement in diet habits, independent of physical activity helps to reduce incident diabetes among prediabetic Asian Indian men. The Finnish Diabetes Prevention Study. Study on Lifestyle Intervention and Impaired Glucose Tolerance Maastricht (SLIM): preliminary results after one year A tailored lifestyle intervention to reduce the cardiovascular disease risk of individuals with Familial Hypercholesterolemia (FH): design of the PRO-FIT randomised controlled trial The Indian Diabetes Prevention Programme shows that lifestyle modification and metformin prevent type 2 diabetes in Asian Indian subjects with impaired glucose tolerance (IDPP-1) Determinants of progression from impaired fasting glucose and impaired glucose tolerance to diabetes in a high-risk screened population: 3 year follow-up in the ADDITION study, Denmark Evaluation of a diabetes patient education program consisting of a three-day hospitalization and a six-month follow-up by telephone counseling for mild type 2 diabetes and IGT Prediction of diabetes using ADA or WHO criteria in post-menopausal women: a 10-year follow-up study Predictors of lifestyle intervention outcome and dropout: the SLIM study Cardiovascular disease markers in type 2 diabetes: the effects of a moderate home-based exercise training programme DELIGHT (delay of impaired glucose tolerance by a healthy lifestyle trial) - a feasibility study on implementing a program of sustainable diabetes prevention in German companies. Cardiovascular disease risk reduction in rural China: a clustered randomized controlled trial in Zhejiang Short-term reproducibility of impaired fasting glycaemia, impaired glucose tolerance and diabetes The ADDITION study, DK. One-year follow-up of untreated obese white children and adolescents with impaired glucose tolerance: high conversion rate to normal glucose tolerance. Relative risk of conversion from normoglycaemia to impaired glucose tolerance or non-insulin dependent diabetes mellitus in polycystic ovarian syndrome. The rising prevalence of diabetes and impaired glucose tolerance: the Australian Diabetes, Obesity and Lifestyle Study. The Cost-Effectiveness of Lifestyle Modification or Metformin in Preventing Type 2 Diabetes in Adults with Impaired Glucose Tolerance Rationale, design and baseline data from the Pre-diabetes Risk Education and Physical Activity Recommendation and Encouragement (PREPARE) programme study: a randomized controlled trial. Rationale, design, and baseline characteristics for a large international trial of cardiovascular disease prevention in people with dysglycemia: the ORIGIN Trial (Outcome Reduction with an Initial Glargine Intervention). Incidence and predictors of type 2 diabetes among Koreans: A 12-year follow up of the Korean Genome and Epidemiology Study. Is treatment needed for mild impairment of glucose tolerance in pregnancy? A randomized controlled trial. A1C predicts type 2 diabetes and impaired glucose tolerance in a population at risk: the community diabetes prevention project Motivational interviewing and problem solving treatment to reduce type 2 diabetes and cardiovascular disease risk in real life: a randomized controlled trial Reduced Progression to Type 2 Diabetes From Impaired Glucose Tolerance After a 2-Day In-Hospital Diabetes Educational Program Plasma glucose levels as predictors of diabetes: the Mexico City diabetes study Influence of Lifestyle on Incident Cardiovascular Disease and Mortality in Patients With Diabetes Mellitus. Effects of exercise and nutrition on memory in Japanese Americans with impaired glucose tolerance. From policemen to policies: what is the future for 2-h glucose? The Kelly West Lecture, 2000. Abdominal Obesity and Physical Inactivity as Risk Factors for NIDDM and Impaired Glucose Tolerance in Indian, Creole, and Chinese Mauritians Exercise with calorie restriction improves insulin sensitivity and glycogen synthase activity in obese postmenopausal women with impaired glucose tolerance. Long-term clinical effect of Tangyiping Granules (糖异平颗粒) on patients with impaired glucose tolerance Insulin resistance and insulin secretory dysfunction are independent predictors of worsening of glucose tolerance during each stage of type 2 diabetes development. High incidence of Type 2 diabetes mellitus in South African Indians: a 10-year follow-up study. The spectrum of neuropathy in diabetes and impaired glucose tolerance Assessing progression to impaired glucose tolerance and type 2 diabetes mellitus. Role of systolic blood pressure and plasma triglycerides in diabetic peripheral arterial disease. The Edinburgh Artery Study. Pioglitazone does not enhance the effectiveness of lifestyle modification in preventing conversion of impaired glucose tolerance to diabetes in Asian Indians: results of the Indian Diabetes Prevention Programme-2 (IDPP-2) Effectiveness of a Pragmatic Education Program Designed to Promote Walking Activity in Individuals With Impaired Glucose Tolerance Effect of α-lipoic acid and exercise training on cardiovascular disease risk in obesity with impaired glucose tolerance Effects of Nordic walking on cardiovascular risk factors in overweight individuals with type 2 diabetes, impaired or normal glucose tolerance. Comparison of maternal-fetal outcomes in gestational diabetes and lesser degrees of glucose intolerance. High prevalence of undiagnosed diabetes mellitus in Southern Germany: Target populations for efficient screening. The KORA survey 2000 Feasibility of a randomized controlled intervention with physical activity in participants with impaired glucose tolerance recruited by FINDRISC: A pilot study Regression From Pre-Diabetes to Normal Glucose Regulation in the Diabetes Prevention Program Psychosocial factors are independent risk factors for the development of Type 2 diabetes in Japanese workers with impaired fasting glucose and/or impaired glucose tolerance1 Randomised controlled trial evaluating the effectiveness of behavioural interventions to modify cardiovascular risk factors in men and women with impaired glucose tolerance: outcomes at 6 months.
OBJECTIVE To investigate if a six-year intensive lifestyle intervention in people with pre-diabetes lead to reduction of cardiovascular events and cardiovascular disease ( CVD ) mortality in subsequent 23 years . METHODS Five hundreds and nineteen subjects with normal glucose tolerance ( NGT ) and 577 subjects with impaired glucose tolerance ( IGT ) in Da Qing city were recruited in the study in 1986 . The IGT subjects r and omly assigned to either the no-intervention group or one of three lifestyle intervention groups ( diet , exercise , or diet plus exercise ) to receive a 6-year lifestyle intervention . In 2009 , the participants were followed up to assess the primary outcomes of cardiovascular events and CVD mortality by a question naire and medical records . RESULTS Subjects in IGT no-intervention group had the highest incidences of cardiovascular events ( 44.44 % ) and CVD mortality ( 20.00 % ) , while those in NGT group had the lowest incidences of cardiovascular events ( 29.59 % ) and CVD mortality ( 7.52 % ) after 23-year follow-up . The incidences of cardiovascular events and CVD mortality in IGT intervention subjects were 37.84 % and 12.53 % , respectively . The multivariable analyses showed that , after controlling of age , gender , BMI smoking , blood pressure and cardiovascular event at baseline , the CVD mortality and incidence of cardiovascular events in IGT no-intervention group was 1.89 ( HR = 1.89 , 95%CI 1.11 - 3.22 , P = 0.02 ) and 1.38 ( HR = 1.38 , 95%CI 1.01 - 1.90 , P = 0.04 ) times of those in NGT group . However , the CVD mortality and incidence of cardiovascular events were not different in the IGT intervention group compared with those in the NGT group ( HR = 1.39 , 95%CI 0.89 - 2.18 , P = 0.15 and HR = 1.25 , 95%CI 0.98 - 1.59 , P = 0.07 , respectively ) . CONCLUSIONS Subjects with IGT were at high risk for cardiovascular events and mortality . A six-year lifestyle intervention in this population can reduce both the incidence of cardiovascular event and CVD mortality OBJECTIVE The Diabetes Prevention Program demonstrated the ability to delay or prevent type 2 diabetes in participants with impaired glucose tolerance ( IGT ) . Participants with IGT are at high risk for cardiovascular disease ( CVD ) , with a marked increase in the number and severity of CVD risk factors . We prospect ively assessed the impact of our interventions on hypertension , dyslipidemia , and CVD events . RESEARCH DESIGN AND METHODS The study group consisted of 3,234 individuals with IGT r and omly assigned to receive intensive lifestyle intervention , metformin , or placebo . Annual assessment of blood pressure , lipids , electrocardiogram , and CVD events was undertaken . RESULTS Hypertension was present in 30 % of participants at study entry and then increased in the placebo and metformin groups , although it significantly decreased with intensive lifestyle intervention . Triglyceride levels fell in all treatment groups , but fell significantly more with intensive lifestyle intervention . Total cholesterol and LDL cholesterol levels were similar among treatment groups . Intensive lifestyle intervention significantly increased the HDL cholesterol level and reduced the cumulative incidence of the proatherogenic LDL phenotype B. At 3 years of follow-up , the use for pharmacologic therapy to achieve established goals in the intensive lifestyle group was 27 - 28 % less for hypertension and 25 % less for hyperlipidemia compared with placebo and metformin groups . Over an average of 3 years , 89 CVD events from 64 participants were positively adjudicated study wide , with no differences among treatment groups . CONCLUSIONS Lifestyle intervention improves CVD risk factor status compared with placebo and metformin therapy . Although no differences in CVD events were noted after 3 years , achieved risk factor modifications suggest that longer intervention may reduce CVD event rates OBJECTIVE A1C has been proposed as a new indicator for high risk of type 2 diabetes . The long-term predictive power and comparability of elevated A1C with the currently used high-risk indicators remain unclear . We assessed A1C , impaired glucose tolerance ( IGT )  , and  impaired fasting glucose ( IFG )  as predictors of type 2 diabetes and cardiovascular disease ( CVD ) at 10 years . RESEARCH DESIGN AND METHODS This prospect i ve population -based study of 593 inhabitants from northern Finl and , born in 1935 , was conducted between 1996 and 2008 .  An oral glucose tolerance test ( OGTT ) was conducted at baseline and follow-up , and A1C was determined at baseline .  Those with a history of diabetes were excluded from the study . Elevated A1C was defined as 5.7–6.4 % . Incident type 2 diabetes was confirmed by two OGTTs . Cardiovascular outcome was measured as incident CVD or CVD mortality . Multivariate log-binomial regression models were used to predict diabetes , CVD , and CVD mortality at 10 years . Receiver operating characteristic curves compared predictive values of A1C , IGT , and IFG . RESULTS Incidence of diabetes during the follow-up was 17.1 % . Two of three of the cases of newly diagnosed diabetes were predicted by a raise in ≥1 of the markers . Elevated A1C , IGT , or IFG preceded diabetes in 32.8 , 40.6 , and 21.9 % , respectively . CVD was predicted by an intermediate and diabetic range of 2-h glucose but only by diabetic A1C levels in women . CONCLUSIONS A1C predicted 10-year risk of type 2 diabetes at a range of A1C 5.7–6.4 % but CVD only in women at A1C ≥6.5 % OBJECTIVE The progression from impaired glucose tolerance (IGT)/impaired fasting glucose ( IFG ) to type 2 diabetes can be prevented or delayed through intensive lifestyle changes . How to translate this to implementation across whole communities remains unclear . We now describe the results to a pilot of a personal trainer ( Maori Community Health Worker , MCHW ) approach among Maori in New Zeal and . DESIGN , SETTING AND SUBJECTS A r and omised cluster-controlled trial of intensive lifestyle change was commenced among 5,240 non-pregnant Maori family members without diabetes from 106 rural and 106 urban geographical clusters . Baseline assessment s included lifestyle question naires , anthropometric measurements and venesection . A pilot study ( Vanguard Study ) cohort of 160 participants were weighed before and during MCHW intervention , and compared with fifty-two participants weighed immediately before intervention and with 1,143 participants from the same geographical area . Interactions between participants and the MCHW were reported using personal digital assistants with a programmed detailed structured approach to each interview . RESULTS During the Vanguard Study , participants and MCHW found the messages , toolkit and delivery approach acceptable . Those with IGT/IFG diagnosed ( n 27 ) experienced significant weight loss after screening and during the Vanguard Study ( 5.2 ( sd 6.6 ) kg , paired t test P < 0.01 ) . Significant weight loss occurred during the Vanguard Study among all participants ( -1.3 ( sd 3.6 ) kg , P < 0.001 ) . CONCLUSIONS Comparable initial weight loss was shown among those with IGT/IFG and those from existing trials . Community-wide prevention programmes are feasible among Maori and are likely to result in significant reductions in the incidence of diabetes Background The Finnish Diabetes Prevention Study ( DPS ) was a r and omized controlled trial , which showed that it is possible to prevent type 2 diabetes by lifestyle changes . The aim of the present study was to examine whether the lifestyle intervention had an effect on the ten-year mortality and cardiovascular morbidity in the DPS participants originally r and omized either into an intervention or control group . Furthermore , we compared these results with a population -based cohort comprising individuals of varying glucose tolerance states . Methods and Findings Middle-aged , overweight people with IGT ( n = 522 ) were r and omized into intensive intervention ( including physical activity , weight reduction and dietary counseling ) , or control “ mini-intervention ” group . Median length of the intervention period was 4 years and the mean follow-up was 10.6 years . The population -based reference study cohort included 1881 individuals ( 1570 with normal glucose tolerance , 183 with IGT , 59 with screen-detected type 2 diabetes , 69 with previously known type 2 diabetes ) with the mean follow-up of 13.8 years .  Mortality and cardiovascular morbidity data were collected from the national Hospital Discharge Register and Causes of Death Register . Among the DPS participants who consented for register linkage ( n = 505 ) , total mortality ( 2.2 vs. 3.8 per 1000 person years , hazard ratio HR = 0.57 , 95 % CI 0.21–1.58 ) and cardiovascular morbidity ( 22.9 vs. 22.0 per 1000 person years , HR = 1.04 , 95 % CI 0.72–1.51 ) did not differ significantly between the intervention and control groups . Compared with the population -based cohort with impaired glucose tolerance , adjusted HRs were 0.21 ( 95 % CI 0.09–0.52 ) and 0.39 ( 95 % CI 0.20–0.79 ) for total mortality , and 0.89 ( 95 % CI 0.62–1.27 ) and 0.87 ( 0.60–1.27 ) for cardiovascular morbidity in the intervention and control groups of the DPS , respectively . The risk of death in DPS combined cohort was markedly lower than in FINRISK IGT cohort ( adjusted HR 0.30 , 95 % CI 0.17–0.54 ) , but there was no significant difference in the risk of CVD ( adjusted HR 0.88 , 95 % CI 0.64–1.21 ) . Conclusions Lifestyle intervention among persons with IGT did not decrease cardiovascular morbidity  during the first 10 years of follow-up . However , the statistical power may not be sufficient to detect small differences between the intervention and control groups . Low total mortality among participants of the DPS compared with individuals with IGT in the general population could be ascribed to a lower cardiovascular risk profile at baseline and regular follow-up . Trial Registration Clinical Trials.gov Objective . Within the frame of a r and omized clinical trial to examine whether training of general practitioners ( the intervention group ) in intensive lifestyle modification and pharmacological treatment of patients with type 2 diabetes has a spillover effect on individuals with impaired fasting glycaemia ( IFG ) or impaired glucose tolerance ( IGT ) . Design . A high-risk screening study for type 2 diabetes with an intervention programme , where general practice s were r and omized to provide st and ard treatment versus intensive lifestyle modification and pharmacological treatment to newly diagnosed diabetic patients . Setting . General practice s in Denmark . Subjects . Of 1821 individuals identified with IFG or IGT , results from oral glucose tolerance tests after one and three years were available in 1510 individuals . Main outcome measures . Progression rates from IFG and IGT to diabetes and effect of intervention were estimated in a regression model using interval censoring . Results . A total of 442 persons developed diabetes .  There was no significant overall effect of intervention on progression rates . For risk factors , no difference in rate of change was found between r and omization groups , but a difference was found between general practice s within the same r and omization groups . Conclusion . General practitioners identify a high number of incident diabetes cases in individuals with IFG or IGT found by high-risk screening . Intervention at the general practitioner 's level in intensive treatment type 2 diabetes does not have a significant spillover effect reducing the risk of diabetes from pre-diabetic conditions . This could indicate that intervention strategies should be specifically targeted at individuals with IFG or IGT , either by training general practitioners or directly at the individual level Aims . To observe the rate of conversion from impaired glucose tolerance ( IGT ) to diabetes following lifestyle modification ( LSM ) or a combination of lifestyle and metformin compared to a control population with 18-month followup . Methods . Forty screening camps were organized , which 5000 people attended . Around 2300 persons filled the question naire and 1825 subjects were identified as high risk . Of 1739 subjects who took the oral glucose tolerance test , 317 subjects were identified as IGT . The 317 IGT subjects were r and omized into three groups : control group was given st and ard medical advice , LSM group was given intensive lifestyle modification advice , while LSM + drug group was given intensive lifestyle advice and metformin 500 mg twice daily . Results . At the end , 273 subjects completed the study , giving a compliance rate of 86 % . Total of 47 incident cases of diabetes were diagnosed ( overall incidence was 4 cases per 1000 person-months with the incidence of 8.6 cases in control group , 2.5 cases in the LSM , and 2.3 cases in the LSM + drug groups ) . Conclusions . Study showed that lifestyle intervention had a major impact in preventing diabetes among IGT subjects in this region . Adding drug did not show any improved results . We recommend lifestyle advice and followup should be incorporated in primary health care Non-insulin-dependent diabetes mellitus ( NIDDM ) is preceded by impaired glucose tolerance ( IGT ) lasting for years before manifesting as overt hyperglycaemia . Both genetic and environmental factors contribute to the development of IGT and NIDDM . Obesity , physical inactivity and high-fat diet have been found to predict IGT and NIDDM . Therefore , a diet and exercise intervention from diagnosis of NIDDM could improve the treatment outcome and prognosis of patients with NIDDM . Furthermore , because subjects with IGT are at increased risk for diabetes and atherosclerotic vascular disease , it is reasonable to assume that in terms of reducing the incidence and longterm consequences of NIDDM an intervention at this phase is more effective than in overt diabetes . Although the nonpharmacological approach is generally accepted as the first-line treatment of NIDDM its efficacy has often been question ed . Therefore , it is important to carry out long-term controlled studies to find out to what extent lifestyle modification could improve the metabolic control and level of major cardiovascular risk factors known to be associated with poor outcome in NIDDM . This kind of study also gave relevant experience in planning studies aim ing at primary prevention of NIDDM . One-year dietary and exercise intervention on newly diagnosed NIDDM patients in Kuopio , Finl and result ed in a better metabolic control and a moderate reduction in cardiovascular risk factors as compared to the conventional treatment group . After the second year of follow-up only 12.5 % in the intervention group were receiving  oral antidiabetic drugs  vs. 34.8 % in the conventional treatment group . Weight reduction and a reduced use of saturated fats appeared to be the main determinants of successful treatment results . Good aerobic capacity was associated with an increase in HDL cholesterol . A multicentre primary prevention study on IGT patients is continuing in Finl and applying the same principles of intervention as used in the study on newly diagnosed NIDDM patients . Pilot results show that glucose tolerance can be improved by lifestyle changes OBJECTIVE To determine the effect of lowering the fasting plasma glucose ( FPG ) criterion for impaired fasting glucose ( IFG ) on the prevalence of IFG , the risks of diabetes , and cardiovascular disease ( CVD ) associated with IFG . RESEARCH DESIGN AND METHODS Three studies were used : 1 ) . the 1998 National Health Survey ( NHS98 ) , a r and omly selected cross-sectional sample of 4723 subjects ; 2 ) . the Singapore Impaired Glucose Tolerance ( IGT ) Follow-up Study , a cohort study comprising 295 IGT and 292 normal glucose tolerance subjects ( frequency matched for age , sex , and ethnic group ) followed up from 1992 to 2000 ; and 3 ) . the Singapore CVD Cohort Study , comprising 5920 subjects from three cross-sectional studies in whom the first ischemic heart disease ( IHD ) event was identified through linkage to registry data bases . Risk of diabetes ( Singapore IGT Follow-up study ) was estimated using logistic regression adjusted for age , sex , and ethnicity . Risk of IHD ( Singapore CVD cohort ) was estimated using stratified ( by study , from which data were derived ) Cox 's proportional hazards models adjusted for age , sex , and ethnicity . RESULTS Lowering the criterion for diagnosing IFG to 5.6 mmol/l increased the prevalence of IFG from 9.5 to 32.3 % in the NHS98 . The lower cutoff identified more subjects at risk of diabetes and IHD , but the relative risk was lower than that for IGT . CONCLUSIONS Greater efforts to identify those with IGT , or a group at similar risk of diabetes and CVD , may be a more efficient public health measure than lowering the FPG criterion for diagnosing IFG D iabetes is one of the most costly and burdensome chronic diseases of our time and is a condition that is increasing in epidemic proportions in the U.S. and throughout the world ( 1 ) . The complications result ing from the disease are a significant cause of morbidity and mortality and are associated with the damage or failure of various organs such as the eyes , kidneys , and nerves . Individuals with type 2 diabetes are also at a significantly higher risk for coronary heart disease , peripheral vascular disease , and stroke , and they have a greater likelihood of having hypertension , dyslipidemia , and obesity ( 2–6 ) . There is also growing evidence that at glucose levels above normal but below the diabetes threshold diagnostic now referred to as pre-diabetes , there is a substantially increased risk of cardiovascular disease ( CVD ) and death ( 5,7–10 ) . In these individuals , CVD risk factors are also more prevalent ( 5–7,9,11–14 ) , which further increases the risk but is not sufficient to totally explain it . In contrast to the clear benefit of glucose lowering to prevent or retard the progression of microvascular complications associated with diabetes ( 15– 18,21 ) , it is less clear whether the high rate of CVD in people with impaired glucose homeostasis , i.e. , those with impaired fasting glucose ( IFG ) , impaired glucose tolerance ( IGT ) , or diabetes , is caused by elevated blood glucose levels or will respond to treatments that lower blood glucose . Epidemiological studies have shown a clear relationship ( 19,20 ) , whereas intervention trials in people with diabetes suggest , but have not demonstrated , a clear benefit of glycemic control ( 15,16,21,22 ) . Additionally , there are no studies that have investigated a benefit of glucose lowering on macrovascular disease in subjects with only pre-diabetes ( IFG or IGT ) but not diabetes . Although the treatment of diabetes has become increasingly sophisticated , with over a dozen pharmacological agents available to lower blood glucose , a multitude of ancillary supplies and equipment available , and a clear recognition by health care professionals and patients that diabetes is a serious disease , the normalization of blood glucose for any appreciable period of time is seldom achieved ( 23 ) . In addition , in well-controlled socalled “ intensively ” treated patients , serious complications still occur ( 15–18,21 ) , and the economic and personal burden of diabetes remains . Furthermore , microvascular disease is already present in many individuals with undiagnosed or newly diagnosed type 2 diabetes ( 11,24– 28 ) . Given these facts , it is not surprising that studies have been initiated in the last decade to determine the feasibility and benefit of various strategies to prevent or delay the onset of  type 2 diabetes .  Two early reports ( 29,30 ) suggested that changes in lifestyle can prevent diabetes , but weaknesses in study design limited their general relevance . Recently , however , four well- design ed r and omized controlled trials have been reported ( 31–35 ) . In the Finnish study ( 31 ) , 522 middleaged ( mean age 55 years ) obese ( mean BMI 31 kg/m ) subjects with IGT were r and omized to receive either brief diet and exercise counseling ( control group ) or intensive individualized instruction on weight reduction , food intake , and guidance on increasing physical activity ( intervention group ) . After an average follow-up of 3.2 years , there was a 58 % relative reduction in the incidence of diabetes in the intervention group compared with the control subjects . A strong correlation was also seen between the ability to stop the progression to diabetes and the degree to which subjects were able to achieve one or more of the following : lose weight ( goal of 5.0 % weight reduction ) , reduce fat intake ( goal of 30 % of calories ) , reduce saturated fat intake ( goal of 10 % of calories ) , increase fiber intake ( goal of 15 g/1,000 kcal ) , and exercise ( goal of 150 min/week ) . No untoward effects of the lifestyle interventions were observed . In the Diabetes Prevention Program ( DPP ) ( 32–34 ) , the 3,234 enrolled subjects were slightly younger ( mean age 51 years ) and more obese ( mean BMI 34 kg/m ) but had nearly identical glucose intolerance compared with subjects in the Finnish study . About 45 % of the participants were from minority groups ( e.g , AfricanAmerican , Hispanic ) , and 20 % were 60 years of age . Subjects were r and omized to one of three intervention groups , which included the intensive nutrition and exercise counseling ( “ lifestyle ” ) group or either of two masked medication treatment groups : the biguanide metformin group or the placebo group . The latter interventions were combined with st and ard diet and exercise recommendations . After an average follow-up of 2.8 years ( range 1.8–4.6 years ) , a 58 % relative reduction in the progression to diabetes was observed in the lifestyle group ( absolute incidence 4.8 % ) , and a 31 % relative reduction in the progression of diabetes was observed in the metformin group ( absolute incidence 7.8 % ) compared with control subjects ( absolute incidence 11.0 % ) . ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● For decades , exercise has been considered a cornerstone of diabetes management , along with diet and medication . However , high- quality evidence on the importance of exercise and fitness in diabetes was lacking until recent years . The present document summarizes the most clinical ly relevant recent advances related to people with type 2 diabetes and the recommendations that follow from these . Our recently published technical review on physical activity/exercise and type 2 diabetes ( 1 ) includes greater detail on individual studies , on prevention of diabetes , and on the physiology of exercise . The present statement focuses on type 2 diabetes . Issues primarily germane to type 1 diabetes will be covered in a subsequent technical review and ADA Statement . The levels of evidence used are defined by the ADA in ref . 2 . Two r and omized trials each found that lifestyle interventions including ∼150 min/week of physical activity and  diet-induced weight loss of 5–7 % reduced the risk of progression from impaired glucose tolerance ( IGT ) to type 2 diabetes by 58 % ( 3,4 ) . A cluster-r and omized trial found that diet alone , exercise alone , and combined diet and exercise were equally effective in reducting the progression from IGT to diabetes ( 5 ) . Therefore , there is firm and consistent evidence that programs of increased physical activity  and modest weight loss reduce the incidence of type 2 diabetes in individuals with IGT . Boule et al. ( 6 ) undertook a systematic review and meta- analysis on the effects of structured exercise interventions in clinical trials of ≥8 weeks duration on HbA1c ( A1C ) and body mass in people with type 2 diabetes . Postintervention A1C was significantly lower in exercise than control groups ( 7.65 vs. 8.31 % , weighted mean difference −0.66 % ; P < 0.001 ) . In contrast , postintervention body weight did not differ between the exercise and control groups . Meta-regression confirmed that the beneficial effect of exercise on A1C OBJECTIVE —Impaired glucose tolerance ( IGT ) and /or impaired fasting glucose ( IFG ) are risk factors for diabetes , cardiovascular disease ( CVD ) , and kidney disease . We determined the effects of ramipril and rosiglitazone on combined and individual CVD and renal outcomes in people with IGT and /or IFG in the Diabetes REduction Assessment With ramipril and rosiglitazone Medication ( DREAM ) trial . RESEARCH DESIGN AND METHODS —A total of 5,269 people aged ≥30 years , with IGT and /or IFG without known CVD or renal insufficiency , were r and omized to 15 mg/day ramipril versus placebo and 8 mg/day rosiglitazone versus placebo . A composite cardiorenal outcome and its CVD and renal components were assessed during the 3-year follow-up . RESULTS —Compared with placebo , neither ramipril ( 15.7 % [ 412 of 2,623 ] vs. 16.0 % [ 424 of 2,646 ] ; hazard ratio [ HR ] 0.98 [ 95 % CI 0.84–1.13 ] ; P = 0.75 ) nor rosiglitazone ( 15.0 % [ 394 of 2,635 ] vs. 16.8 % [ 442 of 2,634 ] ; 0.87 [ 0.75–1.01 ] ; P = 0.07 ) reduced the risk of the cardiorenal composite outcome . Ramipril had no impact on the CVD and renal components .  Rosiglitazone  increased heart failure ( 0.53 vs. 0.08 % ; HR 7.04 [ 95 % CI 1.60–31.0 ] ; P = 0.01 ) but reduced the risk of the renal component ( 0.80 [ 0.68–0.93 ] ; P = 0.005 ) ; prevention of diabetes was independently associated with prevention of the renal component ( P < 0.001 ) . CONCLUSIONS —Ramipril did not alter the cardiorenal outcome or its components . Rosiglitazone , which reduced diabetes , also reduced the development of renal disease but not the cardiorenal outcome and increased the risk of heart failure Abstract Background Diabetes prevalence is increasing . The Finnish Diabetes Prevention Study ( DPS ) showed a 58 % reduction in Type 2 Diabetes ( T2D ) incidence in adults with impaired glucose tolerance ( IGT ) . The European Diabetes Prevention Study ( EDIPS ) extends the DPS to different European population s , using the same study design . In the Newcastle arm of this study ( EDIPS-Newcastle ) , we tested the hypothesis that T2D can be prevented by lifestyle intervention and explored secondary outcomes in relation to diabetes incidence . Methods We recruited 102 participants ( 42 men and 60 women , mean age 57 years , mean BMI 34 kgm-2 ) with IGT to EDIPS-Newcastle and r and omised to Intervention and usual care Control groups .  The intervention included individual motivational interviewing aim ed at : weight reduction , increase in physical activity , fibre and carbohydrate intake and reduction of fat intake ( secondary outcomes ) . The primary outcome was diagnosis of T2D . Results Mean duration of follow-up was 3.1 years . T2D was diagnosed in 16 participants ( I = 5 , C = 11 ) . Absolute incidence of T2D was 32.7 per 1000 person-years in the Intervention-group and 67.1 per 1000 person-years in the Control-group . The overall incidence of diabetes was reduced by 55 % in the Intervention-group , compared with the Control-group : RR 0.45 ( 95%CI 0.2 to 1.2).Explanatory survival analysis of secondary outcomes showed that those who sustained beneficial changes for two or more years reduced their risk of developing T2D . Conclusion Our results are consistent with other diabetes prevention trials . This study was design ed as part of a larger study and although the sample size limits statistical significance , the results contribute to the evidence that T2D can be prevented by lifestyle changes in adults with IGT . In explanatory analysis small sustained beneficial changes in weight , physical activity or dietary factors were associated with reduction in T2D incidence . Trial Registration International St and ard R and omised Controlled Trial Number registry ( IS RCT N)Registry number : IS RCT N 15670600 http://www.controlled-trials.com/is rct n/ search .html?srch=15670600%26sort=3%26dir = Summary Impaired glucose tolerance ( IGT ) is associated with increased mortality due to ischaemic heart disease ( IHD ) , but as it is not known whether this excess mortality can be reduced by preventing or delaying the development of non-insulin-dependent diabetes mellitus ( NIDDM ) , a long-term NIDDM prevention trial of dietary counselling and physical exercise was launched at Malmö , Sweden , the 12-year follow-up of which is reported here . At 12-year follow-up of 6956 men who underwent health screening at 48 years of age , an IGT intervention group ( n = 288 ) who participated in a long-term NIDDM prevention programme were compared with an IGT non-r and omised routine treatment group ( n = 135 ) , a diabetic group ( n = 144 ) , and the remainder , the normal glucose tolerance ( NGT ) group ( n = 6389 ) . The variables studied included the levels of blood glucose , plasma insulin , blood pressure , blood lipids , lung function and maximum oxygen uptake .  Subjects with IGT were characterised by overweight , poor vital capacity , hypertension , hypertriglyceridaemia and hyperinsulinaemia . The mortality rate in the IGT intervention group was similar to that in the NGT group ( 6.5 vs 6.2 per 1000 person years at risk ) and lower than that in the IGT routine treatment group ( 6.5 vs 14.0 , p = 0.009 ) . In the two IGT groups taken together , intervention but not body mass index , systolic blood pressure , smoking , cholesterol or the 2-h glucose level predicted mortality . Systolic blood pressure was a predictor of IHD mortality among IGT subjects ; and in the cohort as a whole , body mass index , systolic blood pressure , hypercholesterolaemica , diabetes and smoking were predictors of IHD mortality . The findings suggest that a long-term intervention programme , with an emphasis on lifestyle changes , including dietary counselling and physical exercise , will reduce mortality in subjects with IGT who are at an increased risk of both developing NIDDM and of premature death due to IHD and other causes . [ Diabetologia ( 1998 ) 41 : 1010–1016 Aims /hypothesisWe determined the effects of 6 years of lifestyle intervention in persons with impaired glucose tolerance ( IGT ) on the development of retinopathy , nephropathy and neuropathy over a 20 year period . Methods In 1986 , 577 adults with IGT from 33 clinics in Da Qing , China were r and omly assigned by clinic to a control group or one of three lifestyle intervention groups ( diet , exercise , and diet plus exercise ) . Active intervention was carried out from 1986 to 1992 . In 2006 we conducted a 20 year follow-up study of the original participants to compare the incidence of microvascular complications in the combined intervention group vs the control group . Results Follow-up information was obtained on 542 ( 94 % ) of the 577 original participants . The cumulative incidence of severe retinopathy was 9.2 % in the combined intervention group and 16.2 % in the control group ( p = 0.03 , log-rank test ) . After adjusting for clinic and age , the incidence of severe retinopathy was 47 % lower in the intervention group than the control group ( hazard rate ratio 0.53 , 95 % CI 0.29–0.99 , p = 0.048 ) . No significant differences were found in the incidence of severe nephropathy ( hazard rate ratio 1.05 , 95 % CI 0.16–7.05 , intervention vs control , p = 0.96 ) or in the prevalence of neuropathy ( 8.6 % vs 9.1 % , p = 0.89 ) among the 20 year survivors . Conclusions /interpretationLifestyle intervention for 6 years in IGT was associated with a 47 % reduction in the incidence of severe , vision-threatening retinopathy over a 20 year interval , primarily due to the reduced incidence of diabetes in the intervention group . However , similar benefits were not seen for nephropathy or neuropathy Prevention of type 2 diabetes by intensive lifestyle intervention design ed to achieve and maintain ideal body weight was assessed in subjects with impaired glucose tolerance ( IGT ) . Male subjects with IGT recruited from health-screening examinees were r and omly assigned in a 4:1 ratio to a st and ard intervention group ( control group ) and intensive intervention group ( intervention group ) . The final numbers of subjects were 356 and 102 , respectively . The subjects in the control group and in the intervention group were advised to maintain body mass index ( BMI ) of < 24.0 kg/m2 and of < 22.0 kg/m2 , respectively , by diet and exercise . In the intervention group , detailed instructions on lifestyle were repeated every 3 - 4 months during hospital visits . Diabetes was judged to have developed when two or more consecutive fasting plasma glucose ( FPG ) values exceeded 140 mg/dl . A 100 g oral glucose tolerance test was performed every 6 months to detect improvement of glucose tolerance . The subjects were seen in an ordinary outpatient clinic . The cumulative 4-year incidence of diabetes was 9.3 % in the control group , versus 3.0 % in the intervention group , and the reduction in risk of diabetes was 67.4 % ( P < 0.001 ) . Body weight decreased by 0.39 kg in the control group and by 2.18 kg in the intervention group ( P < 0.001 ) . The control group was subclassified according to increase and decrease in body weight . The incidence of diabetes was positively correlated with the changes in body weight , and the improvement in glucose tolerance was negatively correlated . Subjects with higher FPG at baseline developed diabetes at a higher rate than those with lower FPG . Higher 2h plasma glucose values and higher BMI values at baseline were also associated with a higher incidence of diabetes , but the differences were not significant . Subjects with a low insulinogenic index ( DeltaIRI/DeltaPG 30 min after an oral glucose load ) developed diabetes at a significantly higher rate than those with a normal insulinogenic index . Comparison of the BMI data and incidence of diabetes in five diabetes prevention studies by lifestyle intervention revealed a linear correlation between the incidence of diabetes and the BMI values , with the exception of the DaQing Study . However , the slope of the reduction in incidence of diabetes in the intensive intervention groups was steeper than expected simply on the basis of the reduction of BMI , suggesting that the effect of lifestyle intervention can not be solely ascribed to the body weight reduction . We conclude that lifestyle intervention aim ed at achieving ideal body weight in men with IGT  is effective and can be conducted in an outpatient clinic setting OBJECTIVE To investigate the effects of insulin resistance ( IR ) and insulin secretion ( IS ) on the development of diabetes mellitus in individuals with impaired glucose tolerance ( IGT ) who underwent lifestyle interventions .  METHODS 284 out of 577 individuals with IGT identified by population -based screening in Da Qing , China , who were r and omized to undergo diet change and /or increased physical activity  had baseline fasting and 2 h post-load insulin determinations . They were followed for 6 years for the development of diabetes . IR and IS were assessed using calculated indices based on fasting plasma insulin and glucose . The interactions of IR , IS , obesity and plasma glucose and the effects of the lifestyle interventions were evaluated using Cox Proportional Hazards analysis . RESULTS Both IR and IS were significantly associated with the development of diabetes . Lifestyle interventions were more effective in those with lower IT and higher IS at baseline . Diet plus exercise interventions result ed in significantly lower incidence of diabetes , even after controlling for IR , IS , BMI and 2hrPG . CONCLUSION Both IR and beta-cell function were predictors of diabetes in Chinese with IGT . Lifestyle intervention reduced the incidence of DM and these interventions were more effective in those with less IR 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 aim ed 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 r and omly 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 OBJECTIVE —We investigated whether circulating adipokine concentrations can be altered by lifestyle intervention according to general recommendations in subjects at risk for diabetes as well as the potential of leptin , adiponectin , and resistin as biomarkers for lifestyle-induced improvements in glucose metabolism and insulin resistance . RESEARCH DESIGN AND METHODS —In the Study on Lifestyle intervention and Impaired glucose tolerance Maastricht , 147 men and women with impaired glucose tolerance ( IGT ) were r and omized to either a combined diet- and -exercise intervention or a control program . At baseline and after 1 year , an oral glucose tolerance test , an exercise test , and anthropometric measurements were performed . After 1 year , complete data of 103 subjects ( 50 intervention and 53 control subjects ) were obtained . RESULTS —Lifestyle intervention reduced plasma leptin concentrations ( −14.2 % ) in IGT subjects but did not alter plasma adiponectin ( −0.3 % ) or resistin ( −6.5 % ) concentrations despite marked improvements in glucose tolerance and insulin resistance . CONCLUSIONS —Changes in leptin concentration were related to improvements in insulin sensitivity independent of changes in body composition CONTEXT Living in a prediabetes state significantly increases a patient 's risk for both diabetes and cardiovascular disease .  Tianqi capsule , containing 10 Chinese herbal medicines , is used in China for the treatment of type 2 diabetes mellitus ( T2DM ) . OBJECTIVE The purpose of this study was to assess whether Tianqi prevented T2DM in subjects with impaired glucose tolerance ( IGT ) over the course of a 12-month treatment . METHODS Individuals with IGT were r and omly allocated in a double-blind manner to receive Tianqi ( n = 210 ) or a placebo ( n = 210 ) for 12 months . Oral glucose tolerance tests were conducted every 3 months to assess the development of diabetes or restoration to normal glucose tolerance . All subjects received the same lifestyle education . The primary endpoint was the conversion of IGT to T2DM . Body weight and body mass index were observed . Adverse effects were monitored . RESULTS Of the 420 enrolled subjects with IGT , 389 completed the trial ( 198 in the Tianqi group and 191 in the placebo group ) . At the end of the 12-month trial , 36 subjects in the Tianqi group ( 18.18 % ) and 56 in the placebo group ( 29.32 % ) had developed diabetes ( P = .01 ) . There was a significant difference in the number of subjects who had normal glucose tolerance at the end of the study between the Tianqi and placebo groups ( n = 125 , 63.13 % , and n = 89 , 46.60 % , respectively ; P = .001 ) . Cox 's proportional hazards model analysis showed that Tianqi reduced the risk of diabetes by 32.1 % compared with the placebo . No severe adverse events occurred in the trial . There were no statistical differences in body weight and body mass index changes between the Tianqi group and the placebo group during the 12-month trial . CONCLUSIONS Treatment with a Tianqi capsule for 12 months significantly decreased the incidence of T2DM in subjects with IGT , and this herbal drug was safe to use Aims /hypothesisThe aim of this study was to determine the frequency of undiagnosed glucose abnormalities and the burden of cardiovascular disease ( CVD ) risk among south Asians and white Europeans attending a systematic screening programme for type 2 diabetes ( ADDITION-Leicester ) and to estimate the achievable risk reduction in individuals identified with glucose disorders . Methods R and om sample s of individuals ( n = 66,320 ) from 20 general practice s were invited for a 75 g OGTT and CVD risk assessment .  Ten-year CVD risk among screen-detected people with diabetes or impaired glucose regulation ( IGR )  ( impaired fasting glycaemia and /or impaired glucose tolerance [ IGT ] ) was computed using the Framingham-based ETHRISK engine and achievable risk reduction was predicted using relative reductions for treatments extracted from published trials . Results A total of 6,041 participants ( 48 % male , 22 % south Asian ) aged 40–75 years inclusive were included .  Undiagnosed glucose disorders occurred more frequently in south Asians than white Europeans ; age and sex adjusted odds ratios were 1.74 ( 95 % CI 1.42–2.13 ) and 2.30 ( 95 % CI 1.68–3.16 ) for IGT and diabetes respectively . Prevalence of any undetected glucose disorder was 17.5 % in the whole cohort . Adjusted 10-year risk was similar in screen-detected people with IGR and diabetes ( 18.3 % vs 21.6 % ) , and was higher in south Asians across the glucose spectrum . Absolute CVD risk reductions of up to 13 % in those with screen-detected type 2 diabetes and 6 % in IGR are achievable using existing cardioprotective therapies . Conclusions /interpretation Population screening with an OGTT identifies a significant burden of modifiable CVD risk , especially within south Asian groups . Strategies enticing this population to consider screening programmes are urgently needed as significant risk reduction is possible once a glucose abnormality is identified . Trial registration : Clinical Trials.gov NCT00318032 Funding : The project is funded for support and treatment costs by NHS Department of Health Support for Science and project grants The study on lifestyle-intervention and impaired glucose tolerance Maastricht ( SLIM ) is a 3 years r and omised clinical trial design ed to evaluate the effect of a combined diet and physical activity intervention program on glucose tolerance in a Dutch population at increased risk for developing type 2 diabetes . Here the design of the lifestyle-intervention study is described and results are presented from the preliminary population screening , conducted between March 1999 and June 2000 . In total , 2,820 subjects with an increased risk of having disturbances in glucose homeostasis ( i.e. age > 40 years and BMI > 25 kg/m(2 ) or a family history of diabetes ) underwent a first oral glucose tolerance test ( OGTT ) . Abnormal glucose homeostasis was detected in 826 subjects ( 30.4 % ) : 226 type 2 diabetes ( type 2DM , 8.3 % ) , 215 impaired fasting glucose ( IFG , 7.9 % ) and 385 impaired glucose tolerance ( IGT , 14.2 % ) . Both increasing age and BMI were strongly related to the prevalence of IGT and diabetes . After a second OGTT , 114 subjects with glucose intolerance and in otherwise good health were eligible for participation in the intervention study ( SLIM ) . The high prevalence of disturbances in glucose homeostasis observed in the preliminary screening underscore the importance of early ( lifestyle ) interventions in those at risk for developing diabetes . SLIM will address this topic in the Dutch population Objectives To determine the effects of a lifestyle intervention on the development of type 2 diabetes mellitus ( T2DM ) among participants with impaired glucose tolerance ( IGT ) , in particular in the subgroup with baseline glycated hemoglobin ( HbA1c ) levels ≥5.7 % , in primary healthcare setting s. Design R and omized controlled trial . Setting 32 healthcare centers in Japan . Participants Participants with IGT , aged 30–60 years , were r and omly assigned to either an intensive lifestyle intervention group ( ILG ) or a usual care group ( UCG ) . Interventions During the initial 6 months , participants in the ILG received four group sessions on healthy lifestyles by public health providers . An individual session was further conducted biannually during the 3 years . Participants in the UCG received usual care such as one group session on healthy lifestyles . Outcome measures The primary endpoint was the development of T2DM based on an oral glucose tolerance test . Results The mean follow-up period was 2.3 years . The annual incidence of T2DM were 2.7 and 5.1/100 person-years of follow-up in the ILG ( n=145 ) and UCG ( n=149 ) , respectively . The cumulative incidence of T2DM was significantly lower in the ILG than in the UCG among participants with HbA1c levels ≥5.7 % ( log-rank=3.52 , p=0.06 ; Breslow=4.05 , p=0.04 ; Tarone-Ware=3.79 , p=0.05 ) , while this was not found among participants with HbA1c levels < 5.7 % . Conclusions Intensive lifestyle intervention in primary healthcare setting is effective in preventing the development of T2DM in IGT participants with HbA1c levels ≥5.7 % , relative to those with HbA1c levels < 5.7 % . Trial registration number UMIN000003136 AIMS Given that studies of individuals with Type 2 diabetes or impaired glucose tolerance indicate that physical activity has a normalizing effect on several indices of coronary heart disease ( CHD ) risk-including body weight , blood pressure , blood lipids , and cardiorespiratory fitness-it is plausible that activity may reduce CHD incidence in this group in the long term . The aim of the present analysis was to explore this hypothesis using data from a prospect i ve observational study . METHODS We examined the relation of two indices of physical activity-walking pace and leisure activity-to total mortality , CHD , and other cardiovascular diseases in a 25-year follow-up of 6408 male British Civil Servants who underwent an oral glucose tolerance test at study entry . RESULTS In 352 men who were identified as having Type 2 diabetes or impaired glucose tolerance ( diabetes/IGT ) at baseline , 215 had died at follow-up and , in 6056 normoglycaemics , 2550 deaths had occurred . The two indices of physical activity were inversely related to all-cause , CHD , and other cardiovascular disease mortality in both normoglycaemics and in men with diabetes/IGT . Although these associations were attenuated somewhat after statistical adjustment for a range of covariates , the majority held , suggesting an independent effect for physical activity . The gradient of the activity-mortality association was steeper in individuals with diabetes/IGT in comparison with the normoglycaemics , with the linear trend across activity levels for CHD risk differing markedly in the analyses of both walking pace ( P-value for interaction test = 0.05 ) and leisure activity ( P-value = 0.02 ) . CONCLUSIONS The findings of the present analysis of men with Type 2 diabetes/IGT provide support for those from a small number of other studies of persons with Type 2 diabetes suggesting that this group may benefit from physical activity in terms of CHD risk reduction To identify a safe and effective Impaired Glucose Tolerance ( IGT ) intervention program using Traditional Chinese Medicine ( TCM ) supported by St and ard Health Care Advice ( SHCA ) for the evidence -based TCM intervention in IGT and evidence -based prevention of type 2 diabetes . A total of 510 IGT patients were r and omly assigned into either control or TCM intervention  group ( 255 patients for each group ) . The control group received st and ard health care according to SHCA . The intervention group also received TCM intervention in addition to st and ard health care . The study was conducted over a three-year follow-up . At the end of three years follow-up , accumulative incidence and average annual incidence rate of diabetes in the control group was 43.86 % and 14.62 % respectively . Accumulative incidence and average annual incidence rate of diabetes in the TCM intervention group was 22.17 % and 7.39 % respectively . Compared with the control treatment , TCM intervention can reduce the relative risk of IGT patients progressing to type 2 diabetes by 49.45 % and absolute risk by 21.69 % . In the TCM intervention group , oral glucose tolerance test ( OGTT ) , 2 h glucose , glycated hemoglobin , insulin resistance and body mass index were all significantly improved when compared to the control group . No significant side effect was observed during the follow-up in the TCM group . The SHCA-supported TCM intervention can reduce the conversion rate of IGT to diabetes and improve insulin resistance ; therefore , it is a safe and effective IGT intervention strategy OBJECTIVE It is well established that the risk of developing type 2 diabetes is closely linked to the presence and duration of overweight and obesity . A reduction in the incidence of type 2 diabetes with lifestyle changes has previously been demonstrated . We hypothesized that adding a weight-reducing agent to lifestyle changes may lead to an even greater decrease in body weight , and thus the incidence of type 2 diabetes , in obese patients . RESEARCH DESIGN AND METHODS In a 4-year , double-blind , prospect i ve study , we r and omized 3,305 patients to lifestyle changes plus either orlistat 120 mg or placebo , three times daily . Participants had a BMI > /=30 kg/m2 and normal ( 79 % ) or impaired ( 21 % ) glucose tolerance ( IGT ) . Primary endpoints were time to onset of type 2 diabetes and change in body weight . Analyses were by intention to treat . RESULTS Of orlistat-treated patients , 52 % completed treatment compared with 34 % of placebo recipients ( P < 0.0001 ) . After 4 years ' treatment , the cumulative incidence of diabetes was 9.0 % with placebo and 6.2 % with orlistat , corresponding to a risk reduction of 37.3 % ( P = 0.0032 ) . Exploratory analyses indicated that the preventive effect was explained by the difference in subjects with IGT . Mean weight loss after 4 years was significantly greater with orlistat ( 5.8 vs. 3.0 kg with placebo ; P < 0.001 ) and similar between orlistat recipients with impaired ( 5.7 kg ) or normal glucose tolerance ( NGT ) ( 5.8 kg ) at baseline . A second analysis in which the baseline weights of subjects who dropped out of the study was carried forward also demonstrated greater weight loss in the orlistat group ( 3.6 vs. 1.4 kg ; P < 0.001 ) . CONCLUSIONS Compared with lifestyle changes alone , orlistat plus lifestyle changes result ed in a greater reduction in the incidence of type 2 diabetes over 4 years and produced greater weight loss in a clinical ly representative obese population . Difference in diabetes incidence was detectable only in the IGT subgroup ; weight loss was similar in subjects with IGT or NGT [ correction ] AIM To evaluate the effectiveness of lifestyle interventions in people with impaired glucose tolerance ( IGT ) . METHODS Participants with IGT ( n=78 ) , diagnosed on two consecutive oral glucose tolerance tests ( OGTTs ) , were r and omly assigned to a 2-year lifestyle intervention or to a control group . Main outcome measures were changes from baseline in : nutrient intake ; physical activity ; anthropometry , glucose tolerance and insulin sensitivity . Measurements were repeated at 6 , 12 and 24 months follow-up . RESULTS After 24 months follow-up , there was a significant fall in total fat consumption ( difference in change between groups ( Delta intervention-Delta control)= -17.9 , 95 % confidence interval ( CI ) -33.6 to -2.1g/day ) as a result of the intervention . Body mass was significantly lower in the intervention group compared with controls after 6 months ( -1.6 , 95 % CI -2.9 to -0.4 kg ) and 24 months ( -3.3 , 95 % CI -5.7 to -0.89 kg ) . Whole body insulin sensitivity , assessed by the short insulin tolerance test ( ITT ) , improved after 12 months in the intervention group ( 0.52 , 95 % CI 0.15 - 0.89%/min ) . CONCLUSIONS These findings complement the findings of the Finnish Diabetes Prevention Study and the American Diabetes Prevention Study , both of which tested intensive interventions , by showing that pragmatic lifestyle interventions result in improvements in obesity and whole body insulin sensitivity in individuals with IGT , without change in other cardiovascular risk factors Background A r and omized control trial was performed to test whether a lifestyle intervention program , carried out in a primary healthcare setting using existing re sources , can reduce the incidence of type 2 diabetes in Japanese with impaired glucose tolerance ( IGT ) . The results of 3 years ' intervention are summarized . Methods Through health checkups in communities and workplaces , 304 middle-aged IGT subjects with a mean body mass index ( BMI ) of 24.5 kg/m2 were recruited and r and omized to the intervention group or control group . The lifestyle intervention was carried out for 3 years by public health nurses using the curriculum and educational material s provided by the study group . Results After 1 year , the intervention had significantly improved body weight ( -1.5 ± 0.7 vs. -0.7 ± 2.5 kg in the control ; p = 0.023 ) and daily non-exercise leisure time energy expenditure ( 25 ± 113 vs. -3 ± 98 kcal ; p = 0.045 ) . Insulin sensitivity assessed by the Matsuda index was improved by the intervention during the 3 years . The 3-year cumulative incidence tended to be lower in the intervention group ( 14.8 % vs.8.2 % , log-rank test : p = 0.097 ) . In a sub- analysis for the subjects with a BMI > 22.5 kg/m2 , a significant reduction in the cumulative incidence was found ( p = 0.027 ) . Conclusions The present lifestyle intervention program using existing healthcare re sources is beneficial in preventing diabetes in Japanese with IGT . This has important implication s for primary healthcare-based diabetes prevention . Trial registration Abstract Objectives . To test the efficacy of a simple intervention method to reduce risk factors for type 2 diabetes ( DM ) and cardiovascular disease ( CVD ) in Alaskan Eskimos . Study Design . The study consisted of 1 ) a comprehensive screening for risk factors of 454 individuals in 4 villages , 2 ) a 4-year intervention and 3 ) a repetition of the screening in year 5 to test the efficacy of the intervention . Methods . Personal counseling ( 1hr/year ) stressed the consumption of more traditional foods high in ɷ-3 fatty acids and less of certain specific store-bought foods high in palmitic acid , which was identified as being associated with glucose intolerance . Results . The intervention result ed in significant reductions in plasma concentrations of total cholesterol ( p = 0.0001 ) , LDL cholesterol ( p = 0.0001 ) , fasting glucose ( p = 0.0001 ) , diastolic blood pressure ( p = 0.0007 ) and improved glucose tolerance ( p = 0.0006 ) . This occurred without loss of body weight . Sixty percent of the participants had improved glucose tolerance ; only one of the 44 originally identified with impaired glucose tolerance ( IGT ) developed DM during the study . Conclusions . Dramatic improvements of risk factors for DM and CVD were achieved in the intervention by primarily stressing the need for changes in the consumption of specific fats . The results suggest that fat consumption is an important risk factor for DM . ( Int J Circumpolar Health 2005 ; 64(4):409–424 Risk factors associated with the progression from impaired glucose tolerance ( IGT ) to NIDDM were examined in data from six prospect i ve studies . IGT and NIDDM were defined in all studies by World Health Organization ( WHO ) criteria , and baseline risk factors were measured at the time of first recognition of IGT . The studies varied in size from 177 to 693 participants with IGT , and included men and women followed from 2 to 27 years after the recognition of IGT . Across the six studies , the incidence rate of NIDDM was 57.2/1,000 person-years and ranged from 35.8/1,000 to 87.3/1,000 person-years . Although baseline measures of fasting and 2-h postchallenge glucose levels were both positively associated with NIDDM incidence , incidence rates were sharply higher for those in the top quartile of fasting plasma glucose levels , but increased linearly with increasing 2-h postchallenge glucose quartiles . Incidence rates were higher among the Hispanic , Mexican-American , Pima , and Nauruan population s than among Caucasians . The effect of baseline age on NIDDM incidence rates differed among the studies ; the rates did not increase or rose only slightly with increasing baseline age in three of the studies and formed an inverted U in three studies . In all studies , estimates of obesity ( including BMI , waist-to-hip ratio , and waist circumference ) were positively associated with NIDDM incidence . BMI was associated with NIDDM incidence independently of fasting and 2-h post challenge glucose levels in the combined analysis of all six studies and in three cohorts separately , but not in the three studies with the highest NIDDM incidence rates . Sex and family history of diabetes were generally not related to NIDDM progression . This analysis indicates that persons with IGT are at high risk and that further refinement of risk can be made by other simple measurements . The ability to identify persons at high risk of NIDDM should facilitate clinical trials in diabetes prevention CONTEXT A past history of gestational diabetes mellitus ( GDM ) confers a very high risk of postpartum development of diabetes , particularly type 2 diabetes . OBJECTIVE The Diabetes Prevention Program ( DPP ) sought to identify individuals with impaired glucose tolerance ( IGT ) and intervene in an effort to prevent or delay their progression to diabetes . This analysis examined the differences between women enrolled in DPP with and without a reported history of GDM . DESIGN The DPP was a r and omized , controlled clinical trial . SETTING The study was a multicenter , National Institutes of Health-sponsored trial carried out at 27 centers including academic and Indian Health Services sites . PATIENTS A total of 2190 women were r and omized into the DPP and provided information for past history of GDM . This analysis addressed the differences between those 350 women providing a past history of GDM and those 1416 women with a previous live birth but no history of GDM . INTERVENTIONS Subjects were r and omized to either st and ard lifestyle and placebo or metformin therapy or to an intensive lifestyle intervention . MAIN OUTCOMES The primary outcome was the time to development of diabetes ascertained by semiannual fasting plasma glucose and annual oral glucose tolerance testing . Assessment s of insulin secretion and insulin sensitivity were also performed . RESULTS Whereas entering the study with similar glucose levels , women with a history of GDM r and omized to placebo had a crude incidence rate of diabetes 71 % higher than that of women without such a history . Among women reporting a history of GDM , both intensive lifestyle and metformin therapy reduced the incidence of diabetes by approximately 50 % compared with the placebo group , whereas this reduction was 49 and 14 % , respectively in parous women without GDM . These data suggest that metformin may be more effective in women with a GDM history as compared with those without . CONCLUSIONS Progression to diabetes is more common in women with a history of GDM compared with those without GDM history despite equivalent degrees of IGT at baseline . Both intensive lifestyle and metformin are highly effective in delaying or preventing diabetes in women with IGT and a history of GDM Recognizing the problem posed by diabetes mellitus , the National Diabetes Commission was created by Republic Act 8191 in 1996 . The Commission identified the need for a Second National Diabetes Survey to have an up date d estimate of the magnitude of the disease in the country and to have the needed information for developing a diabetes prevention and control program . This paper reports the prevalence of  diabetes mellitus and impaired glucose tolerance ( IGT ) in adults and the factors associated with the prevalence of these conditions . A cross-sectional population -based study assessed the occurrence of diabetes and impaired glucose tolerance among a r and om sample of 7044 adults , aged 20 - 65 years who were residents of urban and rural areas in Luzon .  Blood glucose level  was measured by OGTT using the current WHO criteria . The crude diabetes prevalence of 5.1 % represented a 54 % increase over the figure ( 3.3 % ) for a similar population in Luzon in 1982 . An increase was also noted in the magnitude of IGT which almost doubled from 4.1 % in 1982 to 8.1 % in the present survey . Only one in three diabetics reported that they had diabetes . The frequency of diabetes and IGT in urban and rural areas were about the same , although a substantial increase from the earlier survey was noted in rural areas . Women registered a higher prevalence for both conditions than men . Aside from age and gender , the other correlates of diabetes mellitus were hypertension , family history of diabetes , WHR , BMI , and physical inactivity . IGT had similar correlates as diabetes except physical inactivity . The present findings which are consistent with those of other studies underscore the role of lifestyle behaviors in diabetes and should be the target of intervention to prevent further increase in disease frequency Several studies have demonstrated that type 2 diabetes mellitus ( DM ) can be prevented/delayed in subjects with impaired glucose tolerance ( IGT ) by using pharmacologic agents and /or lifestyle interventions . However , a number of challenges remain , including the translation of lifestyle programmes to the general population and the need to achieve greater risk reductions by using pharmacologic approaches . IGT , like DM , is characterized by insulin resistance , β‐cell dysfunction and increased hepatic glucose production . We believe that the use of combination diabetes therapy would be a particularly effective diabetes prevention strategy . In this context , we initiated the Canadian Normoglycemia Outcomes Evaluation ( CANOE ) study , a moderately sized , r and omized , double‐blind , controlled trial . The primary objective of CANOE is to determine whether treatment with metformin plus rosiglitazone , in addition to a healthy living lifestyle programme , will prevent the development of DM . The secondary objective of CANOE is to determine whether this treatment approach will improve cardiovascular risk factors associated with IGT . A total of 200 patients will be recruited in Toronto and London , Ontario , and followed for an average of 4 years ( range 3–5 years ) . Active treatment with metformin ( 500 mg ) plus rosiglitazone ( 2 mg ) , administered as one capsule twice daily , will be compared to matched placebo .  Subjects will be eligible for r and omization if they have IGT and are between the ages of 30–75 years . The primary outcome will be the development of new‐onset DM , diagnosed by either two fasting plasma glucose values of ≥7 mmol/l or one positive oral glucose tolerance test with a 2‐h plasma glucose value of > 11.0 mmol/l during the active drug phase of the trial . With a sample size of 100 participants per group , we will be able to detect a relative risk reduction of 45 % , with a two‐sided log‐rank test with a significance level of 0.05 and 80 % power , assuming that the median time to progression is 8 years in the control group and that participants will be recruited over 2 years and followed for an average of 4 years . In conclusion , the CANOE study will determine whether combination pharmacological therapy combined with a lifestyle intervention programme can significantly modify the development of diabetes in high‐risk Canadians Aims : We hypothesised that the expected increase in insulin resistance over three years ’ time in individuals with impaired glucose tolerance ( IGT ) and /or impaired fasting glucose could be attenuated by an intervention with focus on physical activity in ordinary primary care . Methods : We conducted a r and omised controlled trial with 96 participants over three years . Examination of the participants included anthropometric measures , blood pressure , body weight and height , blood sample s , an oral glucose tolerance test , and question naires about diet and lifestyle . The study subjects were r and omised to either an intense intervention with information , group sessions , referral to physical activity and a step-counter ( n = 31 ) , a less intense intervention without the group sessions ( n = 35 ) , or care as usual group ( CAUG ) ( n = 30 ) . Differences between the groups were analysed with general linear models adjusted for age , gender , baseline values and time in the intervention . Results : Individual insulin resistance increased in the CAUG . Due to having a similar effect , we combined the two intervention groups into a combined intervention group ( CIG ; n = 66 ) in the analyses . In individuals with IGT , the increase in the homeostatic model assessment -insulin resistance differed significantly between those in the CAUG and the CIG ( Δ = 0.8 ; CI : 0.1–1.6 ; p = 0.034 ) . Likewise , diastolic blood pressure decreased more in the CIG than in the CAUG ( Δ = 5.1 ; CI : 0.1–10.0 ; p = 0.047 ) . A total of 17 individuals developed Type 2 diabetes , 23 % were in the CIG and 33 % in the CAUG ; so there was a 32 % reduced risk in the intervention group . Conclusions : A lifestyle intervention focused on physical activity is feasible in ordinary primary care and prevents deterioration in insulin sensitivity in individuals with IGT over a three-year period OBJECTIVE —The purpose of this study was to assess the effectiveness of a low – re source -intensive lifestyle modification program incorporating resistance training and to compare a gymnasium-based with a home-based resistance training program on diabetes diagnosis status and risk . RESEARCH DESIGN AND METHODS —A quasi-experimental two-group study was undertaken with 122 participants with diabetes risk factors ; 36.9 % had impaired glucose tolerance ( IGT ) or impaired fasting glucose ( IFG ) at baseline . The intervention included a 6-week group self-management education program , a gymnasium-based or home-based 12-week resistance training program , and a 34-week maintenance program . Fasting plasma glucose ( FPG ) and 2-h plasma glucose , blood lipids , blood pressure , body composition , physical activity , and diet were assessed at baseline and week 52 . RESULTS —Mean 2-h plasma glucose and FPG fell by 0.34 mmol/l ( 95 % CI −0.60 to −0.08 ) and 0.15 mmol/l ( −0.23 to −0.07 ) , respectively . The proportion of participants with IFG or IGT decreased from 36.9 to 23.0 % ( P = 0.006 ) . Mean weight loss was 4.07 kg ( −4.99 to −3.15 ) . The only significant difference between resistance training groups was a greater reduction in systolic blood pressure for the gymnasium-based group ( P = 0.008 ) . CONCLUSIONS —This intervention significantly improved diabetes diagnostic status and reduced diabetes risk to a degree comparable to that of other low – re source -intensive lifestyle modification programs and more intensive interventions applied to individuals with IGT . The effects of home-based and gymnasium-based resistance training did not differ significantly OBJECTIVE To determine if weight loss may prevent conversion of impaired glucose tolerance ( IGT ) to diabetes , because weight loss reduces insulin resistance . The prevalence of IGT in the U. S. population is estimated at 11.2 % , more than twice that of diabetes . Furthermore , because an oral glucose tolerance test is needed for its detection , most of these patients are undiagnosed . Screening for IGT would be meaningful if progression to diabetes could be delayed or prevented . RESEARCH DESIGN AND METHODS For an average of 5.8 years ( range 2–10 years ) , 136 individuals with IGT and clinical ly severe obesity ( > 45 kg excess body weight ) were followed . The experimental group included 109 patients with IGT who underwent bariatric surgery for weight loss . The control group was made up of 27 subjects with IGT who did not have bariatric surgery . The criteria of the World Health Organization was used to detect IGT and diabetes in this population . The main outcome measure of this nonr and omized control trial is the incidence density , or number of events ( development of diabetes ) divided by the time of exposure to risk . RESULTS Of the 27 subjects in the control group , 6 developed diabetes during an average of 4.8 ± 2.5 years of postdiagnosis follow-up , yielding a rate of conversion to diabetes of 4.72 cases per 100 person-years . The 109 individuals of the experimental group were followed for an average of 6.2 ± 2.5 years postbariatric surgery . Based on the 95 % confidence interval of the comparison group , we would expect to find that between 22 and 36 subjects in the experimental group developed diabetes over the follow-up period . Only 1 of the 109 experimental-group patients developed diabetes , result ing in a conversion rate of the experimental group of only 0.15 cases per 100 person-years , which is significantly lower ( P < 0.0001 ) than the control group . CONCLUSIONS Weight loss in patients with clinical ly severe obesity prevents the progression of IGT to diabetes by > 30-fold Background . Patients with prediabetes are at high risk for diabetes and cardiovascular disease ( CVD ) . No study has explored whether intervention could revert prediabetes to normal glycemic status as the primary outcome . Beijing Prediabetes Reversion Program ( BPRP ) would evaluate whether intensive lifestyle modification and /or pioglitazone could revert prediabetic state to normoglycemia and improve the risk factors of CVD as well . Methods . BPRP is a r and omized , multicenter , 2 × 2 factorial design study . Participants diagnosed as prediabetes were r and omized into four groups ( conventional/intensive lifestyle intervention and 30 mg pioglitazone/placebo ) with a three-year follow-up . The primary endpoint was conversion into normal glucose tolerance . The trial would recruit 2000 participants ( 500 in each arm ) . Results . Between March 2007 and March 2011 , 1945 participants were r and omized . At baseline , the individuals were 53 ± 10 years old , with median BMI 26.0 ( 23.9 , 28.2 ) kg/m2 and HbA1c 5.8 ( 5.6 , 6.1)% . 85 % of the participants had IGT and 15 % had IFG . Parameters relevant to glucose , lipids , blood pressure , lifestyle , and other metabolic markers were similar between conventional and intensive lifestyle intervention group at baseline . Conclusion . BPRP was the first study to determine if lifestyle modification and /or pioglitazone could revert prediabetic state to normoglycemia in Chinese population . Major baseline parameters were balanced between two lifestyle intervention groups . This trial is registered with www.chictr.org.cn : ChiCTR-PRC-06000005 OBJECTIVE The purpose of the study was to evaluate the clinical effects of the Shenzhu Tiaopi granule ( SZTP ) combined with a lifestyle intervention in patients with impaired glucose tolerance ( IGT ) , who also had a spleen deficiency and damp overabundance syndrome ( SDDOS ) . METHODS After a one-month washout period , a total of 514 patients were r and omly assigned to the control ( lifestyle intervention ) and experimental ( SZTP plus lifestyle intervention ) groups , with 257 patients in each group . Patients in the control group received the lifestyle intervention ( diet and exercise ) for 12 months , while the patients in the experimental group were treated with SZTP plus the lifestyle intervention for 12 months . The Traditional Chinese Medicinal ( TCM ) symptom scores were observed in each group before and after treatment ; the conversion rates from IGT to diabetes mellitus ( DM ) were also measured . RESULTS Following 12 months of treatment , the conversion rate from IGT to DM in the experimental group was significantly lower than in the control group ( 8.52 % vs. 15.28 % , P<0.05 ) . A significantly higher number of patients with IGT reverted to normal blood glucose levels in the experimental group than in the control group ( 42.15 % vs. 32.87 % , P<0.05 ) . In addition , after following the treatment for 12 months , the TCM symptoms of patients in the experimental group were markedly alleviated , as compared to the control group ( P<0.01 ) . CONCLUSION The combination of SZTP and lifestyle intervention showed a reduction in the conversion from IGT to DM , and an increase in the conversion from IGT to normal blood glucose levels We determined in non-diabetic persons the risk of fasting and non-fasting glucose levels for pre-diabetes , diabetes , and coronary heart disease ( CHD ) , including the roles of serum C-reactive protein ( CRP ) and HDL cholesterol , and delineated risk profiles of the pre-diabetic states . Over 7¼ years , 2,619 middle-aged Turkish adults free of diabetes and CHD were studied prospect ively . Using different serum glucose categories including impaired fasting glucose ( IFG , 6.1–6.97 mmol/L ) and impaired glucose tolerance ( IGT ) , outcomes were analyzed by Cox regression . IFG was identified at baseline in 112 and IGT in 33 participants . Metabolic syndrome components distinguished individuals with IFG from those with normoglycemia . Participants with IGT tended to differ from adults in normal postpr and ial glucose categories in regard to high levels of triglycerides , apoA-I , and CRP . Diabetes risk , adjusted for sex , age , waist circumference , CRP , and HDL cholesterol , commenced at a fasting 5.6–6.1 mmol/L threshold , was fourfold at levels 6.1–6.97 mmol/L. Optimal glucose values regarding CHD risk were 5.0–6.1 mmol/L. Fasting and postpr and ial glucose values were not related to CHD risk in men ; IGT alone predicted risk in women ( HR 3.74 [ 1.16;12.0 ] ) , independent of age , systolic blood pressure , non-HDL cholesterol , waist circumference , smoking status , and CRP . HDL cholesterol was unrelated to the development of IFG , IGT , and diabetes , while CRP elevation independently predicted the development of diabetes . IGT independently predicts CHD risk , especially in women . HDL dysfunction associated with low- grade inflammation is a co-determinant of pre-diabetic states and their progression to diabetes Aims : To compare data on cardiovascular risk factor changes in lipids , insulin , proinsulin , fibrinolysis , leptin and C-reactive protein , and on diabetes incidence , in relation to changes in lifestyle . Methods : The study was a r and omized lifestyle intervention trial conducted in northern Sweden between 1995 and 2000 , in 168 individuals with impaired glucose tolerance ( IGT ) and body mass index above 27 at start . The intensive intervention group ( n = 83 ) was subjected to a 1-month residential lifestyle programme . The usual care group ( n = 85 ) participated in a health examination ending with a single counselling session . Follow-up was conducted at 1 , 3 and 5 years . Results : At 1-year follow-up , an extensive cardio-metabolic risk factor reduction was demonstrated in the intensive intervention group , along with a 70 % decrease of progress to type 2 diabetes . At 5-year follow-up , most of these beneficial effects had disappeared . Reported physical activity and fibre intake as well as high-density lipoprotein cholesterol were still increased , and fasting insulin and proinsulin were lower . Conclusions : The intervention affected several important cardio-metabolic risk variables beneficially , and reduced the risk for type 2 diabetes , but the effects persisted only as long as the new lifestyle was maintained . Increased physical activity seemed to be the behaviour that was most easy to preserve Impaired glucose tolerance ( IGT ) is associated with cardiovascular risk factors , but the effects of pioglitazone and metformin on IGT are not well described . We tested the hypothesis that each drug would exhibit antiatherogenic and anti-inflammatory effects in subjects with IGT and early diabetes . The study design was a prospect i ve , r and omized , open label , cross-over study . Blood tests , including a 75-g oral glucose tolerance test ( OGTT ) , were performed at baseline and after each treatment . Pioglitazone 15 mg/day or metformin 500–750 mg/day was given for 3 months . Biochemical markers to assess insulin resistance as well as lipid , inflammatory , neurohumoral , and hemostatic factors were included . Twenty-five subjects ( 17 male , 8 female ; age [ mean±SD ] : 61±9 years ; 84 % hypertensive ) completed the protocol . Of 25 subjects , 14 were diagnosed as IGT and 11 as diabetes with 75-g OGTT . Pioglitazone significantly reduced fasting glucose ( p<0.05 ) , and homeotasis model assessment of insulin resistance ( HOMA-IR ) ( p<0.05 ) and metformin ( p<0.01 ) reduced cholesterol . Both drugs significantly reduced aldosterone ( both p<0.05 ) and von Willebr and factor ( vWF ) ( both p<0.05 ) . Plasma adiponectin was increased only by pioglitazone ( p<0.001 ) . Neither drug affected BP levels . In conclusion , pioglitazone was superior to metformin for the improvement of insulin resistance and adiponectin , and both drugs were equally effective in reducing vWF and aldosterone in subjects with IGT and early diabetes . Early intervention with pioglitazone or metformin therapy may reduce the incidence of future cardiovascular disease in subjects with impaired glucose tolerance or early diabetes AIM To study the effects of a supervised exercise program on serum gamma-glutamyl transferase ( GGT ) , glycemic control and cardiovascular risk factors in pre-diabetic patients with isolated impaired fasting glucose ( IFG ) and those with IFG plus impaired glucose tolerance ( IGT ) . METHODS Out of 60 pre-diabetic patients ( 30 with isolated IFG and 30 with IFG + IGT ) 24 were r and omly assigned to the  supervised exercise program  ( 1 h twice a week ) and 36 only obtained counselling on the risk of diabetes and its prevention . Patients have been followed over a 12-month period . RESULTS The main findings were that patients with IFG + IGT had increased GGT levels at baseline ( 49.2±27.4 U/L ) compared to subjects with isolated IFG ( 28.1±21.9 U/L ) ( p<0.01 ) , and that GGT levels improved only after the supervised exercise intervention within the IFG + IGT subjects ( - 17.7±19.6 U/L ) . Similarly , baseline triglyceride levels were also higher in IFG + IGT patients ( p<0.001 ) and there was a decrease through exercise intervention in these patients only ( p<0.05 ) . CONCLUSION GGT is an unspecific marker of oxidative stress and both high plasma glucose and triglycerides levels may produce oxidative stress . Thus , patients with IFG + IGT seem to have higher levels of oxidative stress than those with isolated IFG . Based on the known association between GGT levels and cardiovascular risk factors , IFG + IGT patients may be at higher risk for the development of cardiovascular diseases . The specific effect of regular exercise  on GGT in pre-diabetic patients may contribute to the underst and ing of the preventive effects related to exercise Lifestyle interventions reduce the incidence of type 2 diabetes among individuals with impaired glucose tolerance ( IGT ) . However , it is unknown whether this is due to improved insulin sensitivity or insulin secretion . We investigated at baseline insulin sensitivity and insulin secretion applying frequently sample d intravenous glucose tolerance test ( FSIGT ) in 87 of 101 obese middle-aged subjects with IGT r and omized into an intervention or a control group in the Finnish Diabetes Prevention Study . FSIGT was repeated after 4 years in 52 people . There were no significant differences in any of the baseline anthropometric or metabolic characteristics between the groups . The 4-year weight and waist circumference decreases were greater in the intervention than in the control group ( P = 0.043 and P = 0.025 , respectively ) . At 4-year examination , insulin sensitivity ( Si ) tended to be higher in the intervention group ( the difference between the mean values 36 % ; P = 0.067 , and P = 0.136 after adjustment for age , sex , BMI , and baseline Si value ) . There was strong correlation between the 4-year changes in Si and weight ( r = -0.628 and r = -0.710 , for intervention and control groups ; P < 0.001 for both ) . In the entire group , Si improved by 64 % in the highest tertile of weight loss but deteriorated by 24 % in those who gained weight ( lowest tertile ) . Acute insulin response declined significantly in the control group . In conclusion , Si markedly improved by weight reduction during the 4-year follow-up of individuals with IGT . Insulin secretion remained constant for years in individuals with IGT who were able to lose weight OBJECTIVE Individuals with impaired glucose tolerance ( IGT ) have a high risk of developing NIDDM . The purpose of this study was to determine whether diet and exercise interventions in those with IGT may delay the development of NIDDM , i.e. , reduce the incidence of NIDDM , and thereby reduce the overall incidence of diabetic complications , such as cardiovascular , renal , and retinal disease , and the excess mortality attributable to these complications . RESEARCH DESIGN AND METHODS In 1986 , 110,660 men and women from 33 health care clinics in the city of Da Qing , China , were screened for IGT and NIDDM . Of these individuals , 577 were classified ( using World Health Organization criteria ) as having IGT . Subjects were r and omized by clinic into a clinical trial , either to a control group or to one of three active treatment groups : diet only , exercise only , or diet plus exercise . Follow-up evaluation examinations were conducted at 2-year intervals over a 6-year period to identify subjects who developed NIDDM . Cox 's proportional hazard analysis was used to determine if the incidence of NIDDM varied by treatment assignment . RESULTS The cumulative incidence of diabetes at 6 years was 67.7 % ( 95 % CI , 59.8–75.2 ) in the control group compared with 43.8 % ( 95 % CI , 35.5–52.3 ) in the diet group , 41.1 % ( 95 % CI , 33.4–49.4 ) in the exercise group , and 46.0 % ( 95 % CI , 37.3–54.7 ) in the diet-plus-exercise group ( P < 0.05 ) . When analyzed by clinic , each of the active intervention groups differed significantly from the control clinics ( P < 0.05 ) . The relative decrease in rate of development of diabetes in the active treatment groups was similar when subjects were stratified as lean or overweight ( BMI < or ≥ 25 kg/m2 ) . In a proportional hazards analysis adjusted for differences in baseline BMI and fasting glucose , the diet , exercise , and diet-plus-exercise interventions were associated with 31 % ( P < 0.03 ) , 46 % ( P < 0.0005 ) , and 42 % ( P < 0.005 ) reductions in risk of developing diabetes , respectively . CONCLUSIONS Diet and /or exercise interventions led to a significant decrease in the incidence of diabetes over a 6-year period among those with IGT OBJECTIVE —The aim of this study was to define the incidence of  type 2 diabetes  in a low-risk Caucasian population in northern Spain and its association with various risk factors . RESEARCH DESIGN AND METHODS —The Asturias Study is a prospect i ve , population -based survey of diabetes and cardiovascular risk factors . The baseline examination was carried out during 1998–1999 when 1,034 individuals , aged 30–75 years , were r and omly selected to determine the prevalence of type 2 diabetes and pre-diabetes in the Principality of Asturias ( northern Spain ) . In 2004–2005 , these same subjects were invited for a follow-up examination ; 700 participated . This study includes only those individuals who did not have diabetes at baseline . We used the World Health Organization 1999 criteria to classify glucose metabolism at both baseline and follow-up . RESULTS —The incidence of diabetes adjusted for the age and sex structure of Asturias was 10.8 cases/1,000 person-years ( 95 % CI 8.1–14.8 ) . The incidence rates were 5 cases/1,000 person-years in individuals with normoglycemia , 21 cases/1,000 person-years in individuals with isolated impaired glucose tolerance ( IGT ) , 34.7 cases/1,000 person-years in individuals with isolated impaired fasting glucose ( IFG ) , and 95.2 cases/1,000 person-years in individuals with combined IFG-IGT . Stepwise multiple logistic regression analysis showed that , together with fasting plasma glucose ( FPG ) and 2-h plasma glucose , which were the strongest predictors of diabetes , triglycerides and BMI were also independently associated with progression to diabetes . CONCLUSIONS —In this 6-year prospect i ve population -based study , we found an incidence of type 2 diabetes of 10.8 cases/1,000 person-years . Both FPG and 2-h plasma glucose were strongly predictive of diabetes , and their effect was additive OBJECTIVE To assess the effects of exenatide on body weight and glucose tolerance in nondiabetic obese subjects with normal or impaired glucose tolerance ( IGT ) or impaired fasting glucose ( IFG ) . RESEARCH DESIGN AND METHODS Obese subjects ( n = 152 ; age 46 ± 12 years , female 82 % , weight 108.6 ± 23.0 kg , BMI 39.6 ± 7.0 kg/m2 , IGT or IFG 25 % ) were r and omized to receive exenatide ( n = 73 ) or placebo ( n = 79 ) , along with lifestyle intervention , for 24 weeks . RESULTS Exenatide-treated subjects lost 5.1 ± 0.5 kg from baseline versus 1.6 ± 0.5 kg with placebo ( exenatide − placebo , P < 0.001 ) . Placebo-subtracted difference in percent weight reduction was −3.3 ± 0.5 % ( P < 0.001 ) . Both groups reduced their daily calorie intake  ( exenatide , −449 cal ; placebo , −387 cal ) . IGT or IFG normalized at end point in 77 and 56 % of exenatide and placebo subjects , respectively . CONCLUSIONS Exenatide plus lifestyle modification decreased caloric intake and result ed in weight loss in nondiabetic obesity with improved glucose tolerance in subjects with IGT and IFG OBJECTIVE We aim ed to investigate the influence of positive family history ( FH+ ) of diabetes and 19 known genetic risk loci on the effectiveness of lifestyle changes and their predictive value on the incidence of type 2 diabetes  in the Finnish Diabetes Prevention Study ( DPS ) . RESEARCH DESIGN AND METHODS A total of 522 subjects with impaired glucose tolerance ( IGT ) were r and omized into the control ( n = 257 ) and intervention ( n = 265 ) groups . The mean follow-up was 6.2 years ( median 7 years ) , and the lifestyle intervention , aim ed at  weight reduction , healthy diet , and increased physical activity  , lasted for 4 years ( range 1–6 years ) . An oral glucose tolerance test ( OGTT ) and assessment of basic clinical variables were performed annually . RESULTS The effect of intervention on the incidence of diabetes was almost similar in subjects with FH+ compared with subjects with a negative family history ( FH− ) of diabetes during the entire follow-up . In the Cox model , including FH , genetic risk SNPs , and r and omization group , and adjusted for the effects of age , sex , BMI , and study center , only lifestyle intervention had a significant effect ( hazard ratio 0.55 , 95 % CI 0.41–0.75 , P < 0.001 ) on the incidence of diabetes . Further analyses showed that in addition to the baseline glucose and insulin values , 1-year changes in 2-h glucose and 2-h insulin achieved by lifestyle intervention had a significant effect on the incidence of diabetes . CONCLUSIONS These results emphasize the effectiveness of  lifestyle intervention  in reducing the risk of diabetes in high-risk individuals independently of genetic or familial risk of type 2 diabetes AIMS To assess the beneficial effects of the components of lifestyle intervention in reducing incidence of diabetes in Asian Indian men with impaired glucose tolerance ( IGT ) in India . METHODS This analysis was based on a 2 year prospect i ve , r and omized controlled primary prevention trial in a cohort of Asian Indian men with IGT ( n=537 ) ( Clinical Trial No : NCT00819455 ) . Intervention and control groups were given st and ard care advice at baseline . Additionally , the intervention group received frequent , mobile phone based text message reminders on healthy lifestyle principles .  Dietary intake and physical activity habits were recorded by vali date d question naires . The lifestyle goals were : reductions in consumption of carbohydrates , oil , portion size and body mass index of at least 1 unit ( 1 kg/m(2 ) ) from baseline and maintenance of good physical activity . The association between diabetes and lifestyle goals achieved was assessed using multiple logistic regression analyses . Changes in insulin sensitivity ( Matsuda 's insulin sensitivity index ) and oral disposition index during the follow-up were assessed . RESULTS At the end of the study , 123 ( 23.8 % ) participants developed diabetes  . The mean lifestyle score was higher in the intervention group compared with control ( 2.59 ± 1.13 vs. 2.28 ± 1.17 ; P=0.002 ) . Among the 5 lifestyle variables , significant improvements in the 3 dietary goal were seen with intervention . Concomitant improvement in insulin sensitivity and oral disposition index was noted . Higher lifestyle score was associated with lower risk of developing diabetes ( odds ratio : 0.54 [ 95 % CI : 0.44 - 0.70 ] ; P<0.0001 ) . CONCLUSIONS Beneficial effects of intervention were associated with increased compliance to lifestyle goals . The plausible mechanism is through improvement in insulin sensitivity and beta cell preservation The aim of the Finnish Diabetes Prevention Study is to assess the efficacy of an intensive diet-exercise programme in preventing or delaying  type 2 diabetes in individuals with impaired glucose tolerance ( IGT ) and to evaluate the effect of the programme on the risk factors of atherosclerotic vascular diseases and the incidence of cardiovascular events . In this ongoing study , a total of 523 overweight subjects with IGT based on two oral glucose tolerance tests were r and omized to either an intervention group or a control group . The main measure in the intervention group is individual dietary advice aim ed at reducing weight and intake of saturated fat and increasing intake of dietary fibre . The intervention subjects are individually guided to increase their level of physical activity .  The control group receives general information about the benefits of weight reduction , physical activity and healthy diet in the prevention of diabetes . A pilot study began in 1993 , and recruitment ended in 1998 . By the end of April 1999 there were 65 new cases of diabetes , 34 drop-outs and one death . The weight reduction was greater ( -4.6 kg ) at 1 year in the intervention group ( n = 152 ) than in the control group ( n = 143 , -0.9 kg , P < 0.0001 ) , and this difference was sustained in the second year of follow-up . At 1 year 43.4 % and at 2 years 41.8 % of the intervention subjects had achieved a weight reduction of at least 5 kg , while the corresponding figures for the control subjects were 14.0 and 12.0 % ( P < 0.001 between the groups ) . At 1 year the intervention group showed significantly greater reductions in 2 h glucose , fasting and 2 h insulin , systolic and diastolic blood pressure , and serum triglycerides . Most of the beneficial changes in cardiovascular risk factors were sustained for 2 years . These interim results of the ongoing Finnish Diabetes Prevention Study demonstrate the efficacy and feasibility of the lifestyle intervention programme AIMS : Important risk factors for the progression from impaired glucose tolerance to type II diabetes mellitus are obesity , diet and physical inactivity . The aim of this study is to evaluate the effect of a lifestyle-intervention programme on glucose tolerance in Dutch subjects with impaired glucose tolerance ( IGT ) . METHODS : A total of 102 subjects were studied , r and omised into two groups . Subjects in the intervention group received regular dietary advice , and were stimulated to lose weight and to increase their physical activity . The control group received only brief information about the beneficial effects of a healthy diet and increased physical activity . Before and after the first year , glucose tolerance was measured and several other measurements were done . RESULTS : Body weight loss after 1 y was higher in the intervention group . The 2-h blood glucose concentration decreased 0.8±0.3 mmol/l in the intervention group and increased 0.2±0.3 mmol/l in the control group ( P<0.05 ) . Body weight loss and increased physical fitness were the most important determinants of improved glucose tolerance and insulin sensitivity . CONCLUSION : A lifestyle-intervention programme according to general recommendations is effective and induces beneficial changes in lifestyle , which improve glucose tolerance in subjects with IGT . Body weight loss and increased physical fitness were the most important determinants of improved glucose tolerance and insulin sensitivity Background Because of a high cardiovascular disease ( CVD ) risk in people with Familial Hypercholesterolemia ( FH ) , early prevention of cardiovascular disease is important for health gain and cost reduction . This project focuses on the development and evaluation of an innovative intervention aim ing to reduce CVD risk by promoting a healthy lifestyle among people with FH . Methods This project is design ed as a r and omised controlled trial in which individuals with FH will be assigned r and omly to a control or intervention group . In the intervention group ( n = 200 ) , participants will receive a personalized intervention which is a combination of web-based tailored lifestyle advice and personal counselling by a lifestyle coach .  The control group ( n = 200 ) will receive care as usual . Primary outcomes are biological indicators of CVD risk : systolic blood pressure , glucose , BMI , waist circumference and lipids ( triglycerides , total , LDL and HDL cholesterol ) . Secondary outcomes are : healthy lifestyle behaviour ( with regard to smoking , physical activity , dietary pattern and compliance to statin therapy ) and psychological correlates and determinants of healthy lifestyle behaviour ( knowledge , attitude , risk perception , social influence , self-efficacy , cues to action , intention and autonomy ) . Measurement will take place at baseline , and at 3 and 12 months after r and omisation . Additionally , a throughout process-evaluation will be conducted to assess and monitor intervention implementation during the trial . Discussion Results of the PRO-FIT project will provide information about the effects and implementation of a healthy lifestyle intervention for individuals with FH . Our experiences with this intervention will be indicative about the suitability , feasibility and benefits of this approach for future interventions in other high-risk groups , such as Familial Combined Hypercholesterolemia ( FCH ) and diabetes . Trial registration Aims /hypothesisLifestyle modification helps in the primary prevention of diabetes in multiethnic American , Finnish and Chinese population s. In a prospect i ve community-based study , we tested whether the progression to diabetes could be influenced by interventions in native Asian Indians with IGT who were younger , leaner and more insulin resistant than the above population s. Methods We r and omised 531 ( 421 men 110 women ) subjects with IGT ( mean age 45.9±5.7 years , BMI 25.8±3.5 kg/m2 ) into four groups . Group 1 was the control , Group 2 was given advice on lifestyle modification ( LSM ) , Group 3 was treated with metformin ( MET ) and Group 4 was given LSM plus MET . The primary outcome measure was type 2 diabetes as diagnosed using World Health Organization criteria . Results The median follow-up period was 30 months , and the 3-year cumulative incidences of diabetes were 55.0 % , 39.3 % , 40.5 % and 39.5 % in Groups 1–4 , respectively . The relative risk reduction was 28.5 % with LSM ( 95 % CI 20.5–37.3 , p=0.018 ) , 26.4 % with MET ( 95 % CI 19.1–35.1 , p=0.029 ) and 28.2 % with LSM + MET ( 95 % CI 20.3–37.0 , p=0.022 ) , as compared with the control group . The number needed to treat to prevent one incident case of diabetes was 6.4 for LSM , 6.9 for MET and 6.5 for LSM + MET . Conclusions /interpretationProgression of IGT to diabetes is high in native Asian Indians .  Both LSM and MET significantly reduced the incidence of diabetes  in Asian Indians with IGT ; there was no added benefit from combining them Aims /hypothesisWe sought to identify determinants of progression from impaired fasting glucose ( IFG ) and impaired glucose tolerance ( IGT ) to diabetes in high-risk screened individuals . Methods In general practice s in Denmark , stepwise screening for type 2 diabetes mellitus in persons aged 40 to 69 years included a risk question naire , r and om blood glucose , HbA1c , fasting blood glucose and an OGTT . The 1,821 individuals with IGT or isolated IFG ( WHO 1999 ) were re-invited after 1 and 3 years . Follow-up data on  glucose measurements were available in 1,510 individuals and additional clinical data in 1,002 collected at the 3-year visits . Regression models using interval censoring were used . Results Progression rates from IFG and IGT to diabetes over 3.5 years were 11.8 and 17.0 per 100 person-years , respectively and were particularly high in the first year . Baseline determinants of progression were : IFG : glucose measures , BMI [ per kg/m2 , rate ratio ( RR ) 1.04 ( 95 % CI , 1.01–1.08 ) ] and triacylglycerol [ per twofold increase , RR 2.19 ( 1.49–3.22 ) ] ; and IGT : glucose measures and known hypertension [ RR 1.46 ( 1.11–1.93 ) ] . Weight reduction and decreased triacylglycerol were inversely associated with development of diabetes in IFG individuals [ per 1 kg/year , RR 0.81 ( 0.66–0.98 ) and per 1 mmol l−1 year−1 , RR 0.08 ( 0.01–0.51 ) , respectively ] , whereas in IGT participants  only weight reduction was inversely associated [ per 1 kg/year , RR 0.80 ( 0.67–0.96 ) ] . Conclusions /interpretationHigher levels of glucose measures , larger BMI , known hypertension and hypertriacylglycerolaemia are significant determinants of progression in high-risk screened individuals . Weight loss of 1 kg/year or reduction of hypertriacylglycerolaemia markedly reduced the risk of diabetes The purpose of this study was to evaluate the efficacy and feasibility of a newly developed diabetes patient education program consisting of a three-day hospitalization and a six-month follow-up by telephone counseling for patients with mild type 2 diabetes or impaired glucose tolerance ( IGT ) by a r and omized controlled trial ( RCT ) method . Fifty-two patients with mild type 2 diabetes or IGT ( HbAlc<8 ) were r and omly assigned to either an intervention group or a control group . The current care was continued for the control group and the new education program was provided in addition to the current care for the intervention group . Changes in weight , blood glucose in a 75g-oral glucose tolerance test ( 75g-OGTT ) , and HbAlc were measured in June 1997 as baseline data and again in Dec. 1997 . Scores for knowledge of diabetes , dietary habits , physical activity , health practice index , diabetes quality of life ( DQOL ) , and self-efficacy were also obtained . After six months , the intervention group showed a statistically significant weight loss and blood glucose reduction in the 75g-OGTT test , but the control group did not . A significant improvement in lifestyle was observed in the intervention group , especially in terms of dietary habits and physical activity . The knowledge test scores increased in both groups . There were no significant differences in HbAlc , DQOL , or self-efficacy between the two groups . The results of this study show that the combination of a three-day hospitalization and a six-month follow-up by telephone counseling is effective in metabolic control and improvement of lifestyle for patients with mild type 2 diabetes or IGT . The reasons for the effectiveness were considered to be that l)changes in lifestyle were based on autonomous decision-making ; 2)regular , consistent counseling was provided by the nurse in charge of each patient ; 3)extended follow-up is more effective than initial education in preventing a rebound of weight or metabolic control Aims /hypothesis . To study the risk of women with impaired fasting glucose ( IFG ) as against impaired glucose tolerance ( IGT ) developing diabetes.¶ Methods . Oral glucose tolerance tests ( 75 g ) were done in 265 women selected at r and om at baseline ( age 55–57 years ) and at a 10-year follow-up . Of the women 42 had IFG/NGT ( fasting glucose 6.1–6.9 mmol/l , 2-h glucose < 7.8 mmol/l ) , 66 IGT/NFG ( 2-h glucose 7.8–11.0 mmol/l , fasting glucose < 6.1 mmol/l ) , 30 IGT/IFG and 127 NFG/NGT.¶  Results . The 10-year progression to diabetes was similar in IGT/NFG ( 12.1 % ) and IFG/NGT groups ( 11.9 % , p = 0.97 ) . In IGT/IFG , 20.0 % had developed diabetes , which was not significantly higher than in IFG/NGT and IGT/NFG ( p = 0.53 ) . In NFG/NGT at baseline , only 3.9 % had developed diabetes , which was lower than in the other groups ( p = 0.023).¶ Conclusion /interpretation . Fasting and 2-h glucose concentrations are equally good in predicting diabetes development over a 10-year period in Caucasian postmenopausal women . Because IGT is more common than IFG , measuring only fasting glucose concentrations would , however , result in missing a prediabetic stage in a large group of people at risk for diabetes and cardiovascular diseases . [ Diabetologia ( 2000 ) 43 : 1224–1228 Background / Objectives : To evaluate the effect of a 4.1-year ( range 3–6 years ) lifestyle intervention according to general public health recommendations on glucose tolerance and dropout in a Dutch population with impaired glucose tolerance (IGT).Subjects/ Methods : In the Study on Lifestyle intervention and Impaired glucose tolerance Maastricht , 147 Caucasian IGT subjects were r and omized to an intervention group ( INT : n=74 ; 38 male , 36 female ) and control group ( CON : n=73 ; 37 male , 36 female ) . Annually , subjects underwent measurements of body weight , anthropometry , glucose tolerance ( oral glucose tolerance test ) , insulin resistance ( homeostasis model assessment -insulin resistance ) , maximal aerobic capacity ( VO2 max ) , blood lipids and blood pressure . INT received individual advice regarding a healthy diet and physical activity . Results : INT decreased their saturated fat intake , increased their carbohydrate intake ( P<0.05 ) and VO2 max ( P=0.04 ) compared with CON . Body weight did not change significantly ( P=0.20 ) between the groups . After an initial decrease , 2-h glucose levels overall increased in INT ( + 0.11 mmol/l ) , but significantly less than CON ( + 1.18 mmol/l ; P=0.04 ) . Diabetes incidence was lower in INT versus CON ( 30 versus 56 % , P=0.04 ) . Change in body weight was associated with change in 2-h glucose levels ( β=0.399 mmol/l per kg , P=0.02 ) . Dropouts had a lower aerobic fitness and socioeconomic status , and a higher body mass index ( BMI ) and 2-h glucose compared with non-dropouts . Conclusions : Prolonged feasible changes in diet and physical activity prevent deterioration of glucose tolerance and reduce diabetes risk . Low socioeconomic status , low aerobic fitness and high BMI and 2-h glucose are indicative of dropout to the program Patients with T2DM have an increased risk of CVD . Prevention of CVD represents the major goal of all treatment of T2DM , and early intervention in those patients at particularly high risk is important . We measured the insulin sensitivity and plasma biomarkers of CVD to determine whether a home-based exercise training program improves biomarker levels and insulin sensitivity . Patients with T2DM ( n=12 ) , IGT ( n=4 ) and healthy control subjects ( n=9 ) were studied before and after eight weeks of exercise training by rowing ergometry at 65—70 % of peak oxygen uptake . Conclusions : 1 ) patients with T2DM have elevated plasma concentrations of CVD biomarkers compared to the matched control and IGT groups ; 2 ) a moderate to vigorous intensity home-based training program did not reduce plasma concentrations of these CVD markers ; 3 ) insulin sensitivity improved as a result of exercise training in the control group , but not in the T2DM group BACKGROUND Ca . 50 % of Germans develop prediabetes in their lifetime . Though diabetes type 2 has been proven preventable , no screening for prediabetes has been implemented . DELIGHT was design ed to assess if screening for individuals at risk and long-st and ing diabetes prevention is feasible in the setting of companies within the scope of the German legal health system . MATERIAL S AND METHODS In 5 companies employees with a waist circumference of ≥ 94 ( men ) and ≥ 80 cm ( women ) were offered a check-up . Those with fasting plasma glucose ≥ 100 mg/dl ( IFG ) or ≥ 140 mg/dl 2 h after oral glucose load ( IGT ) were followed for 3 years with an optional moderate lifestyle program during the first year and quarterly assistance for another 2 years . RESULTS In 241 of 300 participants the self-measured waist circumference was confirmed as elevated . 3 % had type 2 diabetes , while 37 % had IFG ( isolated in 96 % ) or IGT , of whom 91.4 % ( men ) and 76.1 % ( women ) had a metabolic syndrome . Within 3 years in those who had lost ≥ 1 kg , weight was reduced by 3.9 kg , risk factors were improved , and no case of diabetes had developed , while among those with weight loss of < 1 kg or weight gain , 10 % of men and 5 % of women had developed diabetes type 2 . Screening for prediabetes did not increase the number or costs of drug prescriptions . CONCLUSIONS Companies provide a suitable setting for screening for prediabetes . Long-term diabetes prevention is successfully feasible within the narrow financial frame of a legal insurance system without rise of costs Background Cardiovascular disease ( CVD ) is a major cause of death in China . Despite government efforts , the majority of hypertensive and diabetic patients in China do not receive proper treatment . Reducing CVD events requires long-term care that is proactive , patient-centred , community-based , and sustainable . We have design ed a package of interventions for patients at high risk of CVD to be implemented by family doctors based in township hospitals ( providers of primary care ) in rural Zhejiang , China . This trial aims to determine whether the systematic CVD risk reduction package results in reduced CVD events among patients at risk of CVD compared with usual care , and whether the package is cost-effective and suitable for routine implementation and scale-up . Methods / Design This is a prospect i ve , open-label , cluster r and omized controlled trial ( RCT ) with blinded data analysis . The trial will r and omize 67 township hospitals with 31,708 participants in three counties in Zhejiang Province . Participants will be identified from existing health records and will comprise adults aged 50 to 74 years , with a calculated 10-year CVD risk of 20 % or higher , or diabetes . In the intervention arm , participants will receive a package of interventions including : 1 ) healthy lifestyle counseling ( smoking cessation , and salt , oil , and alcohol reduction ) ; 2 ) prescription of a combination of drugs ( antihypertensives , aspirin , and statin ) ; and 3 ) adherence support for drug compliance and healthy lifestyle change . In the control arm , participants will receive usual care for hypertension and diabetes management at individual clinicians ’ discretion . The primary outcome is the incidence of severe CVD events over 24 months of follow-up . All CVD events will be defined according to the World Health Organization ( WHO ) monitoring of trends and determinants in cardiovascular disease ( MONICA ) definitions , diagnosed at the county hospital or higher level , and reported by the Zhejiang surveillance system . Secondary outcomes include : mean systolic and diastolic blood pressure , blood glucose , serum total cholesterol ( TC ) , and adherence to appointments , and drugs and lifestyle changes . Discussion This trial focuses on risk reduction of CVD rather than specific diseases . It is not design ed to compare therapeutic and healthy lifestyle interventions , but rather their combined effects in primary care setting s. Through the trial , we intend to underst and the effectiveness of the comprehensive CVD reduction package in routine practice . We also intend to underst and the barriers and facilitators to implementing the package , and thus to advise on policy and practice change . Trial registration Current Controlled Trials : IS RCT We evaluated variations in glucose measurements and the reproducibility of glucose tolerance classification in a high-risk screening setting in general practice . Screening for diabetes was performed in persons aged 40 - 69 years . Based on capillary fasting ( FBG ) and 2-h blood glucose ( 2 hBG ) individuals with impaired fasting glycaemia ( IFG ) , impaired glucose tolerance ( IGT ) and diabetes had a second test done after 14 days .  Intra-individual coefficients of variation ( CV ) were estimated in each glucose tolerance class using the approximation CV(2)(x)=var(ln(x ) ) . Bl and -Altman plots with limits of agreement were made . In the total population , the CV(intra ) was 7.9 % and 13.8 % for FBG and 2 hBG , respectively . Limits of agreement ranged from -1.15 to 1.67 mmol/l for FBG and from - 2.62 to 3.27 mmol/l for 2 hBG . One individual with IFG and 22.5 % with IGT had diabetes at the second test , 76.1 % with diabetes had this diagnosis confirmed , and about 30 % with IFG and IGT had normal glucose tolerance at the second test . The expected values of repeated capillary blood glucose measurements were about+/-1 and + /-3 mmol/l for FBG and 2 hBG , respectively . Yet , 70 % of high-risk prediabetic individuals were persistently classified with abnormal glucose regulation ; diabetes was confirmed in 76 % of the cases AIMS Impaired glucose tolerance ( IGT ) is regarded at risk factor for later diabetes . The aim of this study was to identify predictive factors for outcome of IGT in obese children and adolescents . METHODS We prospect ively examined 79 obese white children and adolescents ( mean age 13.1 + /- 2.1 years , 51 % female , 76 % pubertal ) with IGT .  Anthropometrics , 2-h glucose in oral glucose tolerance test ( OGTT ) , fasting glucose , insulin , insulin resistance index homeostasis model assessment ( HOMA ) , glycated haemoglobin ( HbA(1c ) ) , lipids , blood pressure , waist circumference and pubertal stage were determined at baseline and 1 year later . RESULTS At follow-up , 32 % of the children continued to have IGT , 66 % converted to normal glucose metabolism , one child had impaired fasting glucose and one child developed Type 2 diabetes mellitus ( T2DM ) . Children with improvement of IGT had significantly lower weight , waist circumference , triglycerides , 2-h glucose during OGTT and HbA(1c ) at baseline compared with children who continued to have IGT . In the children whose glucose tolerance became normal , weight fell , and serum insulin concentrations , HOMA , lipids and blood pressure improved . They were also more likely to enter the late or post-pubertal stage than children who continued to have IGT . CONCLUSIONS Predictive factors for the frequent normalization of IGT in obese children and adolescents were lower weight , HbA(1c ) and 2-h glucose levels in OGTT at baseline , as well as a reduction of weight and entering late puberty stages during follow-up . Cardiovascular risk factors and HOMA improved along with the improvement of IGT , supporting an association between IGT , insulin resistance and features of the metabolic syndrome BACKGROUND Cross-sectional studies have shown a high frequency of impaired glucose tolerance ( IGT ) and non-insulin dependent diabetes mellitus ( NIDDM ) in women with polycystic ovarian syndrome ( PCOS ) . However , little is known about the change in glucose tolerance that occurs over a period of several years in women with PCOS . METHODS Sixty-seven women with PCOS received a 75 g glucose tolerance test and measurement of lipids at baseline and at follow-up after an average time of 6.2 years . All women followed prospect ively had normal glucose tolerance ( n = 54 ) or IGT ( n = 13 ) at the start of the study . RESULTS Change in glycaemic control from baseline was frequent , with 5/54 ( 9 % ) of normoglycaemic women at baseline developing IGT and a further 4/54 ( 8 % ) moving directly from normoglycaemic to NIDDM . For women with IGT at baseline , 7/13 ( 54 % ) had NIDDM at follow-up . Body mass index ( BMI ) at baseline was an independent significant predictor of adverse change in glycaemic control . CONCLUSIONS Women with PCOS , particularly those with a high BMI , should be review ed regularly with respect to IGT or NIDDM , as the frequency of impaired glycaemic control is high , and that the rate of conversion from normal glucose tolerance to IGT or NIDDM , or from IGT to NIDDM is substantial OBJECTIVE To determine the population -based prevalence of diabetes and other categories of glucose intolerance ( impaired glucose tolerance [ IGT ] and impaired fasting glucose [ IFG ] ) in Australia and to compare the prevalence with previous Australian data . RESEARCH DESIGN AND METHODS A national sample involving 11,247 participants aged > or = 25 years living in 42 r and omly selected areas from the six states and the Northern Territory were examined in a cross-sectional survey using the 75-g oral glucose tolerance test to assess fasting and 2-h plasma glucose concentrations .  The World Health Organization diagnostic criteria were used to determine the prevalence of abnormal glucose tolerance . RESULTS The prevalence of diabetes in Australia was 8.0 % in men and 6.8 % in women , and an additional 17.4 % of men and 15.4 % of women had IGT or IFG . Even in the youngest age group ( 25 - 34 years ) , 5.7 % of subjects had abnormal glucose tolerance . The overall diabetes prevalence in Australia was 7.4 % , and an additional 16.4 % had IGT or IFG . Diabetes prevalence has more than doubled since 1981 , and this is only partially explained by changes in age profile and obesity . CONCLUSIONS Australia has a rapidly rising prevalence of diabetes and other categories of abnormal glucose tolerance . The prevalence of abnormal glucose tolerance in Australia is one of the highest yet reported from a developed nation with a predominantly Europid background Context The Diabetes Prevention Program ( DPP ) showed that lifestyle changes or metformin effectively decreased the development of  type 2 diabetes in adults with impaired glucose tolerance . The economics of these interventions is important to policymakers . Contribution This cost-effectiveness model estimates that the DPP life-style intervention would cost society about $ 8800 and metformin would cost about $ 29900 per quality -adjusted life-year saved . While lifestyle intervention had a favorable cost-effectiveness profile at any adult age , metformin was not cost-effective after age 65 years . Implication s The cost-effectiveness of lifestyle intervention to prevent type 2 diabetes  in high-risk individuals is within the range that American society typically finds acceptable for health care interventions . The Editors During the past half century , the number of persons with diagnosed diabetes in the United States has increased 4- to 6-fold ( 1 ) . Recent large clinical trials from Asia , Europe , and North America have demonstrated that behavioral and medication interventions can delay or prevent the development of type 2 diabetes in persons with impaired glucose tolerance , which is defined by a plasma glucose level between 7.77 mmol/L ( 140 mg/dL ) and 11.04 mmol/L ( 199 mg/dL ) 2 hours after a 75-g oral glucose load ( 2 - 6 ) . The Diabetes Prevention Program ( DPP ) r and omly assigned 3234 nondiabetic persons 25 years of age or older with impaired glucose tolerance and fasting glucose levels between 5.27 mmol/L ( 95 mg/dL ) and 6.94 mmol/L ( 125 mg/dL ) to placebo ; a lifestyle-modification program with the goals of at least a 7 % weight loss and 150 minutes of physical activity per week ; or metformin , 850 mg twice daily ( 4 ) . The mean age of participants was 51 years , and the mean body mass index was 34.0 kg/m2 ; 68 % were women and 45 % were members of minority groups ( 4 ) . The average follow-up was 2.8 years . Compared with the placebo intervention , the lifestyle intervention reduced the incidence of type 2 diabetes by 58 % and the metformin intervention reduced the incidence of type 2 diabetes by 31 % ( 4 ) . We have previously described the costs of the DPP interventions and their cost-effectiveness within the 3-year trial period ( 7 , 8) . In this analysis , we project the costs , health outcomes , and cost-effectiveness of the DPP lifestyle and metformin interventions over a lifetime relative to the placebo intervention . Methods Clinical Trial The lifestyle intervention involved a healthy , low-calorie , low-fat diet and moderate physical activity , such as brisk walking . The lifestyle intervention was implemented with a 16-lesson core curriculum covering diet , exercise , and behavior modification that was taught by case managers on a one-on-one basis , followed by individual sessions ( usually monthly ) and group sessions with case managers ( 9 ) . At the end of the study , 38 % of participants in the lifestyle intervention group had lost at least 7 % of their initial body weight .  The metformin and placebo interventions were initiated at a dosage of 850 mg once a day . At 1 month , the dosage of metformin or placebo was increased to 850 mg twice daily . Case managers reinforced adherence during individual quarterly sessions ( 10 ) . At the end of the study , 72 % of participants in the metformin intervention group and 77 % of participants in the placebo intervention group took at least 80 % of the prescribed dose . All participants received st and ard lifestyle recommendations through written information and an annual 20- to 30-minute individual session that emphasized the importance of a healthy lifestyle ( 10 ) . Simulation Model We assessed the progression from impaired glucose tolerance to onset of diabetes to clinical ly diagnosed diabetes to diabetes with complications and death by using a lifetime simulation model originally developed by the Centers for Disease Control and Prevention and Research Triangle Institute International . The model has a Markov structure and includes annual transition probabilities between disease states ( 11 ) . In addition to disease progression , the model tracks costs and quality -adjusted life-years ( QALYs ) . The model has been described elsewhere ( 11 ) . For our analyses , we modified the model to include data from the DPP on progression , costs , and quality of life associated with impaired glucose tolerance , data from the United Kingdom Prospect i ve Diabetes Study ( UKPDS ) on diabetes progression and complications , and new data on cost and quality of life associated with diabetes . A technical report describing the model is available . Supplement . Technical Report Disease Progression , Complications , and Comorbid Conditions Impaired Glucose Tolerance to Onset of Type 2 Diabetes We analyzed data from the DPP to assess the annual hazard of diabetes onset in the lifestyle , metformin , and placebo intervention groups . For patients receiving the placebo intervention , the annual hazard of diabetes onset was 10.8 per 100 person-years . At 3 years of follow-up , the risk reductions for the lifestyle and metformin interventions were 55.8 % and 29.9 % , respectively . In the base-case analysis , we assumed that the lifestyle and metformin interventions would be applied until diabetes onset and that the health and quality -of-life benefits associated with the interventions persisted until diabetes onset . Complications and Comorbid Conditions Associated with Impaired Glucose Tolerance We analyzed data from the DPP and other published sources to assess the prevalence of complications and comorbid conditions in participants with impaired glucose tolerance . At baseline , 6.0 % of DPP participants had microalbuminuria and 0.4 % had nephropathy .  The DPP did not measure peripheral neuropathy , but previous studies found that the prevalence of neuropathy in persons with impaired glucose tolerance was 74 % of that in persons with newly diagnosed type 2 diabetes ( 12 ) and 12.3 % of persons with newly diagnosed type 2 diabetes have neuropathy ( 13 ) . Therefore , we assumed that at baseline , 8.5 % of DPP participants had clinical neuropathy . At baseline , 28 % of DPP participants had hypertension , 45 % had dyslipidemia , 7 % were smokers , 1.1 % had a history of cerebrovascular disease , and 2.0 % had a history of myocardial infa rct ion . No other complications were present . We assumed that during impaired glucose tolerance , microvascular or neuropathic complications would not progress . We assumed that hypertension and dyslipidemia developed at the rates observed in the DPP . On the basis of 2 large studies ( 14 , 15 ) , we assumed that the incidences of coronary heart disease and cerebrovascular disease in patients with impaired glucose tolerance were 58 % and 56 % , respectively , of those observed in patients with type 2 diabetes . We further assumed that nondiabetes-related mortality for persons with impaired glucose tolerance was the same as for persons with diabetes ( 16 ) . Onset of Type 2 Diabetes to Clinical Diagnosis of Type 2 Diabetes In the DPP , participants were tested for diabetes every 6 months ; diabetes was diagnosed at onset . In routine clinical practice , type 2 diabetes is estimated to develop 8 to 12 years before its clinical diagnosis ( 17 , 18 ) . In our base-case analysis , we therefore assumed that a 10-year delay occurred between the onset and clinical diagnosis of diabetes . Participants in the DPP  had a mean hemoglobin A1c level of 6.4 % at the onset of diabetes . Participants in the UKPDS had a mean hemoglobin A1c of 7.1 % after a dietary run-in period but before r and omization ( 13 ) . Both DPP placebo participants and UKPDS participants received st and ard lifestyle recommendations . Accordingly , we assumed that during the 10-year interval between onset and clinical diagnosis of diabetes , patients were treated for type 2 diabetes and that hemoglobin A1c level increased at 0.07 % per year from 6.4 % to 7.1 % . Complications and Comorbid Conditions Associated with Undiagnosed Diabetes We further assumed that between onset and clinical diagnosis of diabetes , microvascular and neuropathic complications progressed slowly , such that by clinical diagnosis of type 2 diabetes , their prevalence reached the level observed in the UKPDS cohort at r and omization ( 13 , 19 , 20 ) . We assumed that blood pressure and lipid levels progressed as they did in DPP participants and that cardiovascular complications occurred as they would in type 2 diabetes according to risk factors and hemglobin A1c level ( 21 , 22 ) . Clinical Diagnosis of Type 2 Diabetes to Diabetes with Complications and Death We assumed that after clinical diagnosis , all persons with type 2 diabetes received intensive glycemic management as described in the UKPDS ( 13 ) . We modeled changes in hemoglobin A1c and diabetes treatments to reflect those observed in the UKPDS intensive therapy group . We based risk for retinopathy progression on UKPDS 38 ( 23 ) , risk for nephropathy progression on UKPDS 64 ( 20 ) , and risk for neuropathy progression on UKPDS 33 ( 13 ) . We based risk for cerebrovascular disease on UKPDS 60 ( 22 ) and risk for coronary heart disease on UKPDS 56 ( 21 ) . Costs Costs of Impaired Glucose Tolerance To estimate the total direct medical costs of impaired glucose tolerance , we considered the costs of the DPP interventions ( the cost of identifying participants , implementing and maintaining the interventions , and monitoring and treating the side effects of the interventions ) and the costs of the medical care outside the DPP ( 7 ) . In analyses from the perspective of society , we included both direct medical costs and direct nonmedical costs . We did not include indirect costs because they are captured in the assessment of QALYs ( 24 ) . Table 1 shows the total direct medical costs by treatment group , sex , and year in the DPP ( 7 ) . Costs were higher in the lifestyle and metformin interventions than in the placebo intervention and higher in women than in men . Costs decreased over time in all 3 intervention groups but after year 1 tended to decrease more in the lifestyle than OBJECTIVE The PREPARE programme study is a r and omized controlled trial which aims to determine whether structured education can be used to increase physical activity and improve glucose tolerance in individuals with impaired glucose tolerance ( IGT ) . This paper outlines the rationale , design and baseline data from the PREPARE programme study . METHODS Individuals with IGT were recruited from ongoing diabetes screening programmes . Outcomes included an oral glucose tolerance test , physical activity ( piezoelectric pedometer ) and psychological determinants . RESULTS 103 individuals ( male n = 65 ; female n = 38 ) were recruited , 28 % of whom were from a South Asian ethnic background . At baseline the participants ' mean age and BMI were 64 + /- 9 years and 29.4 + /- 4.5 kg/m2 respectively . Steps per day were associated with 2-h glucose ( p = -0.22 , p = 0.03 ) , fasting glucose ( p = 0.22 , p = 0.04 ) , HDL-cholesterol ( p = 0.23 , p = 0.02 ) , triglycerides ( p = -0.22 , p = 0.03 ) and body fat percentage ( p = -0.26 , p = 0.01 ) . Mean self-efficacy scores were significantly ( p < 0.01 ) higher for walking than for any other form of exercise . Participants reported high levels of concern about their IGT status but were confident that exercise would help treat/control IGT . CONCLUSION This study demonstrates the importance of developing effective physical activity and self-management programmes for individuals with IGT . PRACTICE IMPLICATION S This study provides a detailed framework for the promotion of physical activity in a population identified with an increased risk of developing type 2 diabetes which , if successful , could feasibly be implemented in a primary health care or community setting AIMS Impaired fasting glucose ( IFG ) , impaired glucose tolerance ( IGT ) , and diabetes arise due to insufficient insulin secretion and are risk factors for cardiovascular ( CV ) events . Thus , targeting normal fasting glucose levels with insulin may reduce CV events . Previous studies suggest that omega-3 fatty acid supplements may reduce CV death ; however , their effect in high-risk dysglycemic individuals is not known . METHODS People aged > or = 50 years with evidence of CV disease and with IFG , IGT , newly detected or established diabetes ( on 0 or 1 oral agent ) , and a local glycated hemoglobin < 150 % of the upper limit of normal for that assay were recruited and allocated to ( a ) either 1 daily injection of insulin glargine with the dose titrated to achieve a fasting plasma glucose < or = 5.3 mmol/L ( 95 mg/dL ) , or st and ard glycemic care ; and ( b ) either omega-3-acid ethyl esters 90 ( 1 g consisting of EPA 465 mg and DHA 375 mg ) or identical placebo , according to a 2 x 2 factorial design . The 2 different primary outcomes for the insulin and omega-3 fatty acid arms are CV events and CV death , respectively . RESULTS A total of 12,612 ( mean age 64 , 35 % women ) people in 40 countries were r and omized during a 2-year period ending December 2005 . Eighty-two percent had established  diabetes  , 6 % had new diabetes  , and 12 % had IGT or IFG ;  the mean fasting plasma glucose was 7.3 mmol/L ( 131 mg/dL ) . CONCLUSIONS The ORIGIN trial will determine whether or not either or both of these interventions can reduce CV events AIM Because the incidence of type 2 diabetes in Korea has not been clearly defined , we examined the incidence of this condition and its association with impaired fasting glucose ( IFG ) , impaired glucose tolerance ( IGT ) , and other risk factors in a 12-year follow-up Korean community-based prospect i ve cohort study . METHODS We recruited 7542 subjects aged 40 - 69years without diabetes at baseline examination from the Korean Genome and Epidemiology Study and followed these subjects for 12years biennially . Diabetes was defined according to the 2010 American Diabetes Association criteria . The incidence of type 2 diabetes and the predictors of progression to diabetes were analyzed according to baseline glucose tolerance . RESULTS The overall incidence of type 2 diabetes was 22.1 per 1000person-years . Subjects with combined IFG-IGT at baseline had the highest incidence of diabetes , which was more than two-fold that of individuals with isolated IFG or isolated IGT ( 114.4 vs. 51.3 vs. 53.1 per 1000person-years ) . A multivariate Cox proportional hazards model analysis showed that combined IFG-IGT , which were strong predictors of diabetes , as well as age , urban residence , family history of diabetes , smoking status , abdominal obesity , hypertension , high triglycerides and low HDL cholesterols were also independently associated with progression to diabetes . CONCLUSIONS The incidence of type 2 diabetes is relatively high in our Korean community-based sample . Combined IFG-IGT are strong predictors of type 2 diabetes . Measurement of 2-hour plasma glucose in addition to fasting plasma glucose is necessary for the detection of individuals at high risk for development of diabetes The study was design ed to identify those pregnant women who are diagnosed as having gestational diabetes by National Diabetes Data Group ( NDDG ) criteria , but normal glucose tolerance ( NGT ) or impaired glucose tolerance ( IGT ) by the World Health Organization ( WHO ) criteria , and to test whether treatment changed the perinatal outcome in those with NGT and IGT . The 216 women with an abnormal 100 g oral glucose tolerance test ( OGTT ) using NDDG criteria were subjected to a 75 g OGTT . Using the WHO criteria , 111 women ( 51 % ) had NGT , 98 ( 45 % ) had IGT and 7 ( 3 % ) had frank diabetes mellitus . Those with NGT and IGT were r and omized into control and treatment groups . The perinatal outcome in these two groups was comparable whether the NGT and IGT groups were analysed together or separately except , that in those who were treated for IGT , smaller babies were born one week earlier than in the control group ( 3407 g vs 3110 g , P less than 0.01 ) . This suggests that the WHO criteria can safely replace the 100 g OGTT with substantial savings in manpower , money and patients ' time Aims In a population at risk for type 2 diabetes ( T2DM ) , we assessed early physical and metabolic markers that predict progression from normal to impaired glucose tolerance ( IGT ) and T2DM . Methods A total of 388 individuals ( 22 % male , age 46 + 11 years ) at risk for T2DM were r and omized to St and ard ( n = 182 ) or Intervention ( n = 206 ) care and evaluated at baseline and 5 annual follow-up visits , including blood pressure , BMI , A1C , lipids , urine albumin/creatinine ratio , VO2max , fasting glucose , insulin and C-peptide . The St and ard group received results of annual lab tests and quarterly newsletters , while the Intervention group received quarterly newsletters and detailed discussion s of lab results , routine self-directed activities , semi-annual group meetings and monthly telephone calls for ongoing support . Results Overall , 359 ( 93 % ) returned for at least one follow-up visit and 272 ( 70 % ) completed the final 5-year assessment . Return rates , changes in measures and incidence of IGT/T2DM were similar between groups . Low cardiorespiratory fitness ( VO2max ) was the most prevalent baseline abnormality . A1C and BMI were significant predictors of IGT/T2DM after controlling for other factors . The risk of IGT/T2DM within 5 years was 17.16 ( 95 % CL : 6.169 , 47.736 ) times greater for those with baseline A1C>=5.8 % as compared to those < 5.8 % ( p < 0.0001 ) . Conclusion Baseline A1C>=5.8 % was a significant predictor of IGT/T2DM within 5 years in a population at high risk for T2DM . A1C is routinely performed among patients with diabetes , however these data and other evidence suggest that it may also be a useful tool for risk assessment and screening Background Intensive lifestyle interventions in well-controlled setting s are effective in lowering the risk of chronic diseases such as type 2 diabetes ( T2DM ) and cardiovascular diseases ( CVD ) , but there are still no effective lifestyle interventions for everyday practice . In the Hoorn Prevention Study we aim ed to assess the effectiveness of a primary care based lifestyle intervention to reduce the estimated risk of developing T2DM and for CVD mortality , and to motivate changes in lifestyle behaviors . Methods The Hoorn Prevention Study is a parallel group r and omized controlled trial , implemented in the region of West-Friesl and , the Netherl and s. 622 adults with ≥10 % estimated risk of T2DM and /or CVD mortality were r and omly assigned and monitored over a period of 12 months . The intervention group ( n=314 ) received a theory-based lifestyle intervention based on an innovative combination of motivational interviewing and problem solving treatment , provided by trained practice nurses in 12 general practice s. The control group ( n=308 ) received existing health brochures . Primary outcomes was the estimated diabetes risk according to the formula of the Atherosclerosis Risk In Communities ( ARIC ) Study , and the estimated risk for CVD mortality according to the Systematic COronary Risk Evaluation ( SCORE ) formula . Secondary outcomes included lifestyle behavior ( diet , physical activity and smoking ) . The research assistants , the principal investigator and the general practitioners were blinded to group assignment . Linear and logistic regression analysis was applied to examine the between-group differences in each outcome measure , adjusted for baseline values . Results 536 ( 86.2 % ) of the 622 participants ( age 43.5 years ) completed the 6-month follow-up , and 502 ( 81.2 % ) completed the 12-month follow-up . The mean baseline T2DM risk was 18.9 % ( SD 8.2 ) and the mean CVD mortality risk was 3.8 % ( SD 3.0 ) . The intervention group participated in a median of 2 sessions . Intention-to-treat analyses showed no significant differences in outcomes between the two groups at 6 or 12-months follow-up . Conclusions The lifestyle intervention was not more effective than health brochures in reducing risk scores for T2DM and CVD or improving lifestyle behavior in an at-risk population .Trial registration Current Controlled Trials : IS RCT OBJECTIVE —We assessed the effects of a 2-day in-hospital diabetes educational program in preventing or delaying progression of impaired glucose tolerance ( IGT ) to type 2 diabetes , including analysis of changes in serum lipids , body weight , and blood pressure after the program . RESEARCH DESIGN AND METHODS —A total of 426 subjects ( 51 ± 9 years , BMI 24.6 ± 3.9 kg/m2 ) with newly diagnosed IGT were r and omly assigned to three groups , 143 as the short-term hospitalization with diabetes education and support ( STH ) group , 141 as the nonhospitalization but diabetes education and support ( DES ) group , and 142 as the neither hospitalization nor education ( control ) group . RESULTS —The average follow-up was 3.1 years . The incidence of diabetes was 8.0 , 10.7 , and 13.2 cases per 100 person-years for STH , DES , and control groups , respectively . The incidence of diabetes was 42 % lower ( 95 % CI 33–51 % ) in the STH group and 27 % lower ( 15–37 % ) in the DES group than in the control group . The incidence of diabetes was 21 % lower ( 10–31 % ) in the STH group than in the DES group . CONCLUSIONS —The 2-day in-hospital program with diabetes education and support every 3 months was more effective in preventing or delaying the progression from IGT to diabetes than only diabetes education and support every 3 months Aims /hypothesisThe value of diagnostic categories of glucose intolerance for predicting  type 2 diabetes  is much debated . We therefore sought to estimate relative and population -attributable risk of different definitions based on fasting ( impaired fasting glucose [ IFG ] ) or 2 h plasma glucose concentrations ( impaired glucose tolerance [ IGT ] ) and to describe the associated clinical phenotypes . Methods We prospect ively observed a population -based cohort of 1,963 non-diabetic participants ( mean age 47 years ) , in whom an OGTT was performed at baseline and 7 years later . Results IGT was fivefold more prevalent ( 13.5 % ) than IFG . In both categories , participants were older , heavier , hyperinsulinaemic , hyperproinsulinaemic and dyslipidaemic compared with participants with normal glucose tolerance . Relative risk of incident diabetes was similar for IFG and IGT categories ( 3.73 [ 95 % CI : 2.18–6.39 ] and 4.01 [ 95 % CI : 3.12–5.14 ] , respectively ) , but the population -attributable risk was fivefold higher for IGT ( 29 % [ 95 % CI : 26–32 ] ) than for IFG ( 6 % [ 95 % CI : 5–7 ] ) . Isolated IFG carried no increase in risk . Lowering the threshold to 5.6 mmol/l raised the population -attributable risk of IFG to 23 % ( 95 % CI : 20–25 ) ; its contribution to diabetes progression , however , was largely due to co-existent IGT . In multivariate analysis adjusting for sex , age , familial diabetes and BMI , fasting and 2 h glucose were independent predictors . Conclusions /interpretationFasting and 2 h glucose values are independent predictors of incident diabetes . Isolated IFG is not a high-risk condition ; lowering the diagnostic threshold increases the population -attributable risk of IFG fourfold , but performing an OGTT captures additional diabetes progressors compared with the number identified by IFG BACKGROUND Evidence is limited regarding the impact of healthy lifestyle practice s on the risk of subsequent cardiovascular events among patients with diabetes . OBJECTIVES The purpose of this study was to examine the associations of an overall healthy lifestyle , defined by eating a high- quality diet ( top two-fifths of Alternative Healthy Eating Index ) , nonsmoking , engaging in moderate- to vigorous-intensity physical activity ( ≥150 min/week ) , and drinking alcohol in moderation ( 5 to 15 g/day for women and 5 to 30 g/day for men ) , with the risk of developing cardiovascular disease ( CVD ) and CVD mortality among adults with type 2 diabetes ( T2D ) . METHODS This prospect i ve analysis included 11,527 participants with T2D diagnosed during follow-up ( 8,970 women from the Nurses ' Health Study and 2,557 men from the Health Professionals Follow-Up Study ) , who were free of CVD and cancer at the time of diabetes diagnosis .  Diet and lifestyle factors before and after T2D diagnosis were repeatedly assessed every 2 to 4 years . RESULTS There were 2,311 incident CVD cases and 858 CVD deaths during an average of 13.3 years of follow-up . After multivariate adjustment of covariates , the low-risk lifestyle factors after diabetes diagnosis were each associated with a lower risk of CVD incidence and CVD mortality . The multivariate-adjusted hazard ratios for participants with 3 or more low-risk lifestyle factors compared with 0 were 0.48 ( 95 % confidence interval [ CI ] : 0.40 to 0.59 ) for total CVD incidence , 0.53 ( 95 % CI : 0.42 to 0.66 ) for incidence of coronary heart disease , 0.33 ( 95 % CI : 0.21 to 0.51 ) for stroke incidence , and 0.32 ( 95 % CI : 0.22 to 0.47 ) for CVD mortality ( all p trend < 0.001 ) . The population -attributable risk for poor adherence to the overall healthy lifestyle ( <3 low-risk factors ) was 40.9 % ( 95 % CI : 28.5 % to 52.0 % ) for CVD mortality . In addition , greater improvements in healthy lifestyle factors from pre-diabetes to post-diabetes diagnosis were also significantly associated with a lower risk of CVD incidence and CVD mortality . For each number increment in low-risk lifestyle factors there was a 14 % lower risk of incident total CVD , a 12 % lower risk of coronary heart disease , a 21 % lower risk of stroke , and a 27 % lower risk of CVD mortality ( all p < 0.001 ) . Similar results were observed when analyses were stratified by diabetes duration , sex/cohort , body mass index at diabetes diagnosis , smoking status , and lifestyle factors before diabetes diagnosis . CONCLUSIONS Greater adherence to an overall healthy lifestyle is associated with a substantially lower risk of CVD incidence and CVD mortality  among adults with T2D . These findings further support the tremendous benefits of adopting a healthy lifestyle in reducing the subsequent burden of cardiovascular complications in patients with T2D Type 2 diabetes , impaired glucose tolerance ( IGT ) , and associated hyperinsulinemia increase the risk for impaired verbal memory ( 1–3 ) . In rodents , insulin resistance adversely affects brain structures that support memory ( 4 ) . In humans , pharmacologic management of diabetes improves cognitive functioning ( 5,6 ) . Weight loss and exercise decrease the incidence of diabetes ( 7,8 ) . This study examined whether endurance exercise and dietary fat restriction would improve cognition in Japanese American adults who have a high risk for IGT and type 2 diabetes ( 9 ) . Adults with IGT were recruited from the Japanese American Community Diabetes Study . Screening and diagnostic procedures have been described previously ( 10 ) . Participants ( 15 active and 13 control ) completed  cognitive testing  at baseline and at 6 and 12 months . Treatment was r and omly assigned , and groups were equivalent with respect to baseline age ( [ mean ± SD ] active 58.0 ± 9.7 and control 60.6 ± 9.0 years ) , BMI ( active 24.7 ± 3.2 and control 26.7 ± 4.3 kg/m2 ) , V o2max ( active 29.5 ± 7.1 and control 27.4 ± 5.6 ml · kg−1 · min−1 ) , and 2-h oral glucose tolerance test ( OGTT ) glucose levels ( active 9.4 ± 1.1 and control 9.4 ± 0.9 mmol/l ) . Active participants followed an American Heart Association step 2 eucaloric diet ( total calories < 30 % fat , < 7 % saturated fat , 55 % carbohydrate , and 15 % protein ) . An exercise physiologist supervised walking or jogging on a treadmill three times weekly for 1 h. OBJECTIVE To describe the characteristics and vital prognosis of men with diabetes diagnosed by one fasting plasma glucose ( FPG ) concentration > or = 7.0 mmol/l , with diabetes diagnosed by one isolated postchallenge hyperglycemia ( IPH ) ( FPG < 7.0 mmol/l and a 2-h plasma glucose concentration > or = 11.1 mmol/l ) , or with impaired glucose tolerance ( IGT ) . RESEARCH DESIGN AND METHODS This study involved a cohort of 6,881 Caucasian nondiabetic men from the Paris Prospect i ve Study , aged 44 - 55 years , who were followed for cause of death for 20 years . RESULTS Diabetes was diagnosed in 4.3 % of the men ( 1.0 % diabetes diagnosed by IPH ) , and IGT was diagnosed in 9 % of the men . At baseline , the men with diabetes diagnosed by IPH had a lower cardiovascular risk profile than those with diabetes diagnosed by FPG , as did the men with IGT and a normal fasting glucose level ( < 6.1 mmol/l , IGT and normal fasting glucose ) , compared with men with impaired fasting glucose ( 6.1 - 6.9 mmol/l , IGT and impaired fasting glucose [ IFG ] ) . At 20 years of follow-up , all-cause and cancer death rates were higher in men with diabetes diagnosed by IPH than in men with diabetes diagnosed by FPG ( 55 vs. 44 % , P < 0.1 and 31 vs. 17 % , P < 0.01 , respectively ) but were not significantly different for coronary causes ( 6 vs. 11 % ) . Men with IGT and normal fasting glucose also had significantly higher cancer death rates than men with IGT and IFG . CONCLUSIONS The most likely explanation for the high cancer and low coronary death rates is that men with diabetes diagnosed by IPH consumed alcohol ; the men in this study drank 49 g of pure alcohol on average per day , equivalent to 0.6 l of wine . If these results are confirmed by other prospect i ve studies , screening subjects for isolated postchallenge hyperglycemia may not be worthwhile Objective We wanted to determine whether obesity , abdominal fat distribution , and physical inactivity act similarly and independently as risk factors for noninsulin- dependent diabetes mellitus ( NIDDM ) and impaired glucose tolerance ( IGT ) in Hindu and Muslim Asian Indians , African-origin Creoles , and Chinese Mauritians . Research Design and Methods We examined a population -based r and om cluster sample of 5080 adult subjects from the Indian Ocean isl and of Mauritius .  Glucose tolerance was assessed with a 75-g oral glucose tolerance test and World Health Organization criteria . Results Univariate data and multiple logistic regression models indicated that age , family history of diabetes , body mass index ( BMI ) , waisthip ratio ( WHR ) , and physical inactivity conveyed similar risk for NIDDM ( and IGT ) in each ethnic group . After adjusting for all other factors , Hindu ethnicity conferred additional risk for NIDDM ( but not IGT ) in men , but in women there were no clear ethnic differences . Although BMI and WHR were independently significant risk factors , WHR conveyed relatively stronger risk for NIDDM than BMI in women , whereas the converse was true in men . For ethnic groups combined , the independent odds ratios for IGT associated with moderate and low physical activity scores ( relative to high ) were 1.56 and 1.71 ( P < 0.05 ) , respectively , in men and 1.32 and 1.69 ( P < 0.05 ) in women . In subjects with asymptomatic NIDDM diagnosed during the survey , the independent odds ratios were 1.96 and 2.00 ( P < 0.05 ) in men and 1.73 and 2.70 ( P < 0.05 ) in women . Conclusions These data indicate that BMI , abdominally distributed fat , and physical inactivity are important independent risk factors for both IGT and NIDDM in diverse ethnic groups . Attributable risk fractions for Mauritius suggest that population wide modification of levels of these risk factors could potentially result in substantially lower occurrence of NIDDM ( and IGT ) . Such interventions should be attempted in high-risk population Our objective was to compare the effects of in vivo insulin on skeletal muscle glycogen synthase ( GS ) activity in normal ( NGT ) vs. impaired glucose-tolerant ( IGT ) obese postmenopausal women and to determine whether an increase in insulin activation of GS is associated with an improvement in insulin sensitivity ( M ) following calorie restriction ( CR ) and /or aerobic exercise plus calorie restriction ( AEX + CR )  in women with NGT and IGT . We did a longitudinal , clinical intervention study of CR compared with AEX + CR .  Overweight and obese women , 49 - 76 yr old , completed 6 mo of  CR ( n = 46 ) or AEX + CR ( n = 50 ) with Vo(2 max ) , body composition , and glucose tolerance testing . Hyperinsulinemic euglycemic ( 80 mU·m(-2)·min(-1 ) ) clamps ( n = 73 ) and skeletal muscle biopsies ( before and during clamp ) ( n = 58 ) were performed before and after the interventions ( n = 50 ) . After 120 min of hyperinsulinemia during the clamp , GS fractional activity and insulin 's effect to increase GS fractional activity ( insulin - basal ) were significantly lower in IGT vs. NGT ( P < 0.01 ) at baseline . GS total activity increased during the clamp in NGT ( P < 0.05 ) , but not IGT , at baseline . CR and AEX + CR result ed in a significant 8 % weight loss with reductions in total fat mass , visceral fat , subcutaneous fat , and intramuscular fat . Overall , M increased ( P < 0.01 ) , and the change in M ( postintervention - preintervention ) was associated with the change in insulin-stimulated GS fractional activity ( partial r = 0.44 , P < 0.005 ) . In IGT , the change ( postintervention - preintervention ) in insulin-stimulated GS total activity was greater following AEX + CR than CR alone ( P < 0.05 ) . In IGT , insulin-stimulated GS-independent ( P < 0.005 ) and fractional activity ( P = 0.06 ) increased following AEX + CR . We conclude that the greatest benefits at the whole body and cellular level ( insulin activation of GS ) in older women at highest risk for diabetes are derived from a lifestyle intervention that includes exercise and diet Objective To evaluate the long-term clinical effect of Tangyiping Granules ( 糖异平颗粒 , TYP ) on patients with impaired glucose tolerance ( IGT ) to achieve normal glucose tolerance ( NGT ) and hence preventing them from conversion to diabetes mellitus ( DM ) . Methods In total , 127 participants with IGT were r and omly assigned to the control ( 63 cases , 3 lost to follow-up ) and treatment groups ( 64 cases , 4 lost to follow-up ) according to the r and om number table . The control group received lifestyle intervention alone , while the patients in the treatment group took orally 10 g of TYP twice daily in addition to lifestyle intervention for 12 weeks . The rates of patients achieving NGT or experiencing conversion to DM as main outcome measure were observed at 3 , 12 , and 24 months after TYP treatment . The secondary outcome measures included fasting plasma glucose ( FPG ) , 2-h postpr and ial plasma glucose ( 2hPG ) , glycosylated hemoglobin ( HbA1c ) , fasting insulin ( FINS ) , 2-h insulin ( 2hINS ) , homeostatic model assessment of insulin resistance ( HOMA-IR ) , blood lipid and patients ' complains of Chinese medicine ( CM ) symptoms before and after treatment . Results A higher proportion of the treatment group achieved NGT compared with the control group after 3- , 12- and 24-month follow-up ( 75.00 % vs. 43.33 % , 58.33 % vs. 35.00 % , 46.67 % vs. 26.67 % , respectively , P<0.05 ) . The IGT to DM conversion rate of the treatment group was significantly lower than that of the control group at the end of 24-month follow-up ( 16.67 % vs. 31.67 % , P<0.05 ) . Before treatment , FPG , 2hPG , HbA1c , FINS , 2hINS , HOMA-IR , triglyceride ( TG ) , total cholesterol , low- and high-density lipoprotein cholesterol levels had no statistical difference between the two groups ( P>0.05 ) . After treatment , the 2hPG , HbA1c , HOMA-IR , and TG levels of the treatment group decreased significantly compared with those of the control group ( P<0.05 ) . CM symptoms such as exhaustion , irritability , chest tightness and breathless , spontaneous sweating , constipation , and dark thick and greasy tongue were significantly improved in the treatment group as compared with the control group ( P<0.05 ) . No severe adverse events occurred . Conclusion TYP administered at the IGT stage with a disciplined lifestyle delayed IGT developing into type 2 DM OBJECTIVE Although prospect i ve studies indicate that insulin resistance and insulin secretory dysfunction predict type 2 diabetes , they provide limited information on the relative contributions of both abnormalities to worsening glucose tolerance at different developmental stages of the disease . We therefore assessed the predictive effect of insulin resistance and insulin secretory dysfunction separately for the progression from normal glucose tolerance ( NGT ) to impaired glucose tolerance ( IGT ) and from IGT to diabetes . RESEARCH DESIGN AND METHODS  Insulin-stimulated glucose disposal ( M ) ( hyperinsulinemic clamp ) , acute insulin secretory response ( AIR ) ( 25-g intravenous glucose tolerance test ) , and body composition  ( hydrodensitometry or dual-energy X-ray absorptiometry ) were measured in 254 Pima Indians with NGT and in 145 Pima Indians with IGT , who were then followed for 0.5 - 13 years . RESULTS After follow-ups of 4.4 + /- 3.1 and 5.5 + /- 3.4 years , 79 ( 31 % ) of the subjects with initial NGT had developed IGT , and 64 ( 44 % ) of the subjects with initial IGT had developed diabetes . In proportional-hazards analyses with adjustment for age , sex , and percent body fat , low M and low AIR were independent predictors of both the progression from NGT to IGT ( relative hazards [ 95 % CI ] for 10th vs. 90th percentile : M 2.4 [ 1.2 - 4.7 ] , P < 0.02 ; AIR 2.1 [ 1.1 - 4.1 ] , P < 0.04 ) and from IGT to diabetes ( M 2.5 [ 1.3 - 5.0 ] , P < 0.01 ; AIR 1.8 [ 0.99 - 3.3 ] , P = 0.055 ) . CONCLUSIONS During each stage of the development of type 2 diabetes , insulin resistance and insulin secretory dysfunction are independent predictors of worsening glucose tolerance and are , therefore , both targets for the primary prevention of the disease AIMS Previous cross-sectional studies have established that South African Indians have a high prevalence of Type 2 diabetes mellitus . A prospect i ve community study was undertaken to determine the incidence of Type 2 diabetes and the risk factors associated with its development in a cohort of South African Indians who had been studied 10 years previously . METHODS This is a report on 563 subjects who participated both at baseline and at the 10-year follow-up study . In the baseline study , 2479 subjects ( > 15 years ) were studied ; using 1985 World Health Organization criteria for glucose tolerance based on 75 g oral glucose tolerance tests ( OGTT ) , the crude prevalence of diabetes mellitus ( Diabetes ) was 9.8 % and of impaired glucose tolerance ( IGT ) 5.8 % ( age and sex-adjusted prevalence 13 % and 6.9 % , respectively ) . RESULTS At the 10-year follow-up study , 563 of the subjects who could be traced consented to a repeat OGTT ; of these , 91 ( 16.2 % ) were classified as Diabetes and 41 ( 7.3 % ) as IGT . Of the subjects who did not have diabetes at baseline ( n = 517 ) , 49 ( 9.5 % ) progressed to diabetes ( PTD ) and 40 ( 7.7 % ) had IGT . The crude cumulative incidence of diabetes was 9.5 % ( rate of progression 0.95 % per annum ; incidence density 9.5/1000 person years ) with an age and sex-adjusted cumulative incidence of 8.3 % ( rate of progression 0.95 % per annum ; incidence density 8.3/1000 person years ) . Examination of risk factors predictive of subsequent diabetes development was undertaken by analysis of baseline ( year 0 ) variables in the 517 subjects who did not have diabetes at baseline . In multivariate analysis using a logistic regression model , the significant predictive risk factors for future diabetes included 2-h post load plasma glucose ( 2 PG ) ( P < 0.0001 , odds ratio ( OR ) 1.7 , 95 % confidence interval ( CI ) 1.4 - 2.1 ) , body mass index ( BMI ) ( P < 0.006 , OR 1.1 , 95 % CI 1.0 - 1.3 ) and obesity ( P < 0.01 , OR 4.6 , 95 % CI 1.4 - 14.7 ) . CONCLUSIONS This long-term study has shown that in South African Indians there is a high incidence of Type 2 diabetes , and in this population significant predictors include higher baseline blood glucose , BMI and obesity Objective : To compare the neuropathy associated with impaired glucose tolerance ( IGT ) and diabetes mellitus ( DM ) determined by oral glucose tolerance testing ( OGTT ) . Methods : Patients with peripheral neuropathy of unknown cause were prescribed OGTT .  Duration of neuropathic symptoms , neuropathic pain , neuropathy classification , nerve conduction test results , and intraepidermal nerve fiber densities ( IENFD ) were compared between IGT and DM groups . Results : Seventy-three patients completed OGTT ; 41 ( 56 % ) had abnormal results . Of these 41 patients , 26 had IGT and 15 had DM . Patients with IGT had less severe neuropathy than patients with diabetes , as measured by sural nerve amplitudes ( p = 0.056 ) , sural nerve conduction velocities ( p = 0.03 ) , and distal leg IENFD ( p = 0.01 ) . Patients with IGT had predominantly small fiber neuropathy , compared to patients with DM ( p = 0.05 ) , who had more involvement of large nerve fibers . Conclusions : The neuropathy associated with IGT is milder than the neuropathy associated with DM . Small nerve fibers are prominently affected and may be the earliest detectable sign of neuropathy in glucose dysmetabolism . OGTT is appropriate in patients with idiopathic neuropathy BACKGROUND A prospect i ve evaluation of the relationship between insulin secretion and insulin sensitivity , derived from the fasting state , is needed in clinical practice in order to identify the worsening of glucose metabolism . In this study the authors examine whether the product of insulin sensitivity and insulin secretion , assessed from the fasting state , predicts progression from normal glucose tolerance ( NGT ) to impaired fasting glucose ( IFG ) and from impaired glucose tolerance ( IGT ) to type 2 diabetes mellitus ( T2DM ) . MATERIAL S AND METHODS A cohort of 300 subjects with NGT and 75 subjects with IGT were followed up over a 5-year period . Insulin sensitivity was calculated using the Belfiore index ( B ) and insulin secretion by the homeostasis model analysis beta-cell ( HOMA-beta cell ) index : the product of B-beta is expressed as : ( 40 x Ins(0 ) pmol L(-1))/Glu(0 ) mmol L(-1){[(Glu(0 ) mmol L(-1)x Ins(0 ) pmol L(-1 ) ) + 1 ] - 3.5[(Glu(0 ) mmol L(-1 ) x Ins(0 ) pmol L(-1 ) ) - 1 ] } , where Glu(0 ) is fasting glucose and Ins(0 ) is fasting insulin . RESULTS From baseline at the end of the follow-up period , the product B-beta decreased 10.7 % and 52.2 % in progressors to IGT and T2DM , respectively . The product B-beta predicts the progression from NGT to IGT [ relative risk ( RR ) 2.7 , CI(95 % ) 1.2 - 9.1 ] and from IGT to T2DM ( RR 5.3 , CI(95 % ) 1.3 - 8.55 ) . The cut-off point for the product B-beta that better predicts progression from NGT to IGT is 0.25 ( sensitivity 88 % , specificity 92 % ) and from IGT to T2DM 0.15 ( sensitivity 92 % , specificity 95 % ) . CONCLUSIONS Adaptation of insulin secretion to compensate for decreased insulin sensitivity during transition to IGT and T2DM can be successfully assessed with simple measures derived from the fasting state . The product B-beta predicts the development to IGT and T2DM OBJECTIVE To determine the risk factors for peripheral arterial disease ( PAD ) in a diabetic population and to examine whether different levels of these risk factors might explain why diabetic subjects have an increased risk of PAD compared with normal glucose tolerance subjects . RESEARCH DESIGN AND METHODS There were 1,592 men and women aged 55 - 74 years selected at r and om from the age-sex registers of 11 general practice s in Edinburgh , Scotl and . Subjects underwent a comprehensive medical examination , including assessment for PAD  ( intermittent claudication on World Health Organization question naire or major asymptomatic disease on noninvasive testing ) and a glucose tolerance test . RESULTS Of the subjects , 288 ( 18.7 % ) were found to have diabetes or impaired glucose tolerance ( IGT ) . The prevalence of PAD was greater in those with diabetes/IGT ( 20.6 % ) compared with those with normal glucose tolerance ( 12.5 % ) ( odds ratio [ OR ] 1.64 , 95 % CI 1.17 - 2.31 ) . Among the diabetes/IGT group , mean levels of smoking , systolic blood pressure , and triglycerides were higher in subjects with PAD than in those without PAD ( P < or = 0.05 ) . Mean levels of systolic blood pressure and plasma triglycerides were also higher in diabetic subjects than in nondiabetic subjects with PAD ( P < or = 0.05 ) . In multivariate analysis , those with diabetes/IGT no longer had a significantly higher risk of PAD after adjusting separately for systolic blood pressure ( OR 1.22 , 95 % CI 0.85 - 1.73 ) and plasma triglycerides ( OR 1.26 , 95 % CI 0.89 - 1.79 ) . Simultaneous adjustment for both systolic blood pressure and triglycerides reduced the risk of PAD among diabetic subjects to 1.11 ( 95 % CI 0.78 - 1.58 ) . CONCLUSIONS Increased mean levels of triglycerides and systolic blood pressure may help to explain the higher prevalence of PAD in diabetic subjects compared with that in normal glucose tolerance subjects Abstract Aims /hypothesisThe objective of this prevention programme was to study whether combining pioglitazone with lifestyle modification would enhance the efficacy of lifestyle modification in preventing  type 2 diabetes in Asian Indians with impaired glucose tolerance . Methods In a community-based , placebo-controlled 3 year prospect i ve study , 407 participants with impaired glucose tolerance ( mean age 45.3 ± 6.2 years , mean BMI 25.9 ± 3.3 kg/m2 ) were sequentially grouped to receive either : lifestyle modification plus pioglitazone , 30 mg ( n = 204 ) or lifestyle modification plus placebo ( n = 203 ) . The participants and investigators were blinded to the assignment . The primary outcome was development of diabetes . Results At baseline , both groups had similar demographic , anthropometric and biochemical characteristics . At year 3 , the response rate was 90.2 % . The cumulative incidence of diabetes was 29.8 % with pioglitazone and 31.6 % with placebo ( unadjusted HR 1.084 [ 95 % CI 0.753–1.560 ] , p = 0.665 ) . Normoglycaemia was achieved in 40.9 % and 32.3 % of participants receiving pioglitazone and placebo , respectively ( p = 0.109 ) . In pioglitazone group , two deaths and two non-fatal hospitalisations occurred due to cardiac problems ; in the placebo group there were two occurrences of cardiac disease . Conclusions /interpretationDespite good adherence to lifestyle modification and drug therapy , no additional effect of pioglitazone was seen above that achieved with placebo . The effectiveness of the intervention in both groups was comparable with that of lifestyle modification alone , as reported from the Indian Diabetes Prevention Programme-1 . The results are at variance with studies that showed significant relative risk reduction in conversion to diabetes with pioglitazone in Americans with IGT . An ethnicity-related difference in the action of pioglitazone in non-diabetic participants may be one explanation . Trial registration : Clinical Trials.gov NCT00276497 Funding : This study was funded by the India Diabetes Research OBJECTIVE To investigate whether a pragmatic structured education program with and without pedometer use is effective for promoting physical activity and improving glucose tolerance in those with impaired glucose tolerance ( IGT ) . RESEARCH DESIGN AND METHODS Overweight and obese individuals with IGT were recruited from ongoing screening studies at the University Hospitals of Leicester , U.K. Participants were r and omly assigned to one of three groups . Group 1 received a 3-h group-based structured education program design ed to promote walking activity using personalized steps-per-day goals and pedometers . Group 2 received a 3-h group-based structured education program design ed to promote walking activity using generic time-based goals . Group 3 received a brief information leaflet ( control condition ) . Outcomes included an oral glucose tolerance test , st and ard anthropometric measures , ambulatory activity , and psychological variables . Follow-up was conducted at 3 , 6 , and 12 months . RESULTS A total of 87 individuals ( 66 % male , mean age 65 years ) were included in this study . At 12 months , significant decreases in 2-h postchallenge glucose and fasting glucose of −1.31 mmol/l ( 95 % CI −2.20 to −0.43 ) and −0.32 mmol/l ( −0.59 to −0.03 ) , respectively , were seen in the pedometer group compared with the control group . No significant improvements in glucose control were seen in those given the st and ard education program . CONCLUSIONS This study suggests that a pragmatic structured education program that incorporates pedometer use is effective for improving glucose tolerance in those with IGT . This result is likely to have important implication s for future primary care – based diabetes prevention initiatives Obese subjects with impaired glucose tolerance ( IGT ) are more susceptible than healthy individuals to oxidative stress and cardiovascular disease . This r and omised controlled investigation was design ed to test the hypothesis that α-lipoic acid supplementation and exercise training may elicit favourable clinical changes in obese subjects with IGT . All data were collected from 24 obese ( BMI ≥ 30 kg/m2 ) IGT patients . Following participant r and omisation into two groups , fasting venous blood sample s were obtained at baseline , and before and following intervention . The first group consisted of 12 participants who completed a 12 week control phase followed by 12 weeks of chronic exercise at 65 % HRmax for 30 minutes a day , 5 days per week , while ingesting 1 gram per day of α-lipoic acid for 12 weeks . The second group consisted of 12 participants who completed the same 12 week control phase , but this was followed by 12 weeks of 1 gram per day of α-lipoic acid supplementation only ( no exercise ) . The main findings show a comparatively greater rate of low density lipoprotein ( LDL ) oxidation in the group consisting of α-lipoic acid only ( p < 0.05 vs. pre intervention ) , although total oxidant status was lower post intervention ( p < 0.05 vs. baseline ) in this group . However , exercise and α-lipoic acid in combination attenuates LDL oxidation . Furthermore , in the α-lipoic acid supplement plus exercise training  group , total antioxidant capacity was significantly increased ( p < 0.05 vs. baseline and pre intervention ) . Body fat percentage and waist and hip circumference decreased following exercise training ( p < 0.05 vs. post intervention ) . There were no selective treatment differences for a range of other clinical outcomes including glycaemic regulation ( p > 0.05 ) . These findings report that α-lipoic acid ingestion may increase the atherogenicity of LDL when ingested in isolation of exercise , suggesting that in IGT the use of this antioxidant treatment does not ameliorate metabolic disturbances , but instead may detrimentally contribute to the pathogenesis of atherosclerosis and development of CVD . However , when α-lipoic acid is combined with exercise , this atherogenic effect is abolished BACKGROUND Physical activity remains a valuable prevention for metabolic disease . The effects of Nordic walking on cardiovascular risk factors were determined in overweight individuals with normal or disturbed glucose regulation . METHODS We included 213 individuals , aged 60 ± 5.3 years and with body mass index ( BMI ) of 30.2 ± 3.8 kg/m(2 ) ; of these , 128 had normal glucose tolerance ( NGT ) , 35 had impaired glucose tolerance ( IGT ) and 50 had type 2 diabetes mellitus ( T2DM ) . Participants were r and omized to unaltered physical activity or to 5 h per week of Nordic walking with poles , for a 4-month period . Dietary habits were unaltered . BMI , waist circumference , blood pressure , glucose tolerance , clinical chemistry , maximal oxygen uptake ( peak VO(2 ) ) and self-reported physical activity ( question naire ) were assessed at the time of inclusion and after 4 months . The participants in the exercise-intervention group kept a walking diary . RESULTS In the NGT exercise group , self-reported physical activity increased markedly , and body weight ( -2.0 ± 3.8 kg ) , BMI ( -0.8 ± 1.4 kg/m(2 ) ) and waist circumference ( -4.9 ± 4.4 cm ) ( mean ± SD ) decreased . Exercise power output ( 12.9 ± 9.9 W ) and peak VO(2 ) ( 2.7 ± 2.8 mL/kg/min ) increased in the IGT exercise group . More cardiovascular risk factors were improved after exercise intervention in people with NGT compared with those with IGT or T2DM . Exercise capacity improved significantly in all three groups of participants who reported at least 80 % compliance with the scheduled exercise . CONCLUSIONS Nordic walking  improved anthropometric measurements and exercise capacity . However , unsupervised Nordic walking may not provide a sufficient increase in exercise intensity to achieve ultimate health-promoting benefits on the cardiovascular parameters assessed in this study , particularly for those with disturbed glucose regulation AIM To determine the relationships between maternal and fetal outcomes and gestational diabetes mellitus ( GDM ) , impaired fasting glucose ( IFG ) and impaired glucose tolerance ( IGT ) , respectively . METHODS A retrospective cohort study design was used with 149 patients with abnormal oral glucose tolerance test ( OGTT ) and 149 normal patients . Statistical analysis used was the chi-squared test , Fisher 's exact test or the Student 's t-test , as appropriate . P < 0.05 was considered significant . RESULTS The level of hyperglycemia according to the OGTT ( World Health Organization criteria ) was associated with pre-eclampsia , polyhydramnios and macrosomia in GDM patients . There was no increase in the complications of preterm labor and premature rupture of membranes , despite the increased risk of polyhydramnios . Although treated with insulin , macrosomia still occurred in patients with GDM , but there was no shoulder dystocia as there was an increase in the incidence of cesarean section ( CS ) . The IGT group was not associated with adverse fetal or maternal outcomes , but there was an increase in intervention and the incidence of CS . The IFG group was associated with a significantly increased risk of pre-eclampsia and macrosomia . These findings challenge the concept of IFG being a lesser pathology than GDM . Further prospect i ve studies with a larger number of patients are needed to ascertain the significance of these findings . CONCLUSION There was an increased risk of pre-eclampsia and macrosomia in both the GDM and IFG patients , but IGT was not associated with adverse fetal or maternal outcomes Aims /hypothesisTo estimate the prevalence of  undiagnosed diabetes mellitus , impaired glucose tolerance ( IGT ) and impaired fasting glucose ( IFG ) , and their relations with cardiovascular risk factors in the general population aged 55 to 74 years in Southern Germany . Methods Oral glucose tolerance tests were carried out in a r and om sample of 1353 subjects aged 55 to 74 years participating in the KORA ( Cooperative Health Research in the Region of Augsburg ) Survey 2000 . Prevalences of glucose tolerance categories ( 1999 WHO criteria ) were adjusted for sample probabilities . The numbers needed to screen ( NNTS ) to identify one person with undiagnosed diabetes were estimated from age-adjusted logistic regression models . Results Sample design -based prevalences of known and unknown diabetes , IGT , and IFG were 9.0 % , 9.7 % , 16.8 % , 9.8 % in men , and 7.9 % , 6.9 % , 16.0 % , 4.5 % in women , respectively . In both sexes , participants with undiagnosed diabetes had higher BMI , waist circumference , systolic blood pressure , triglycerides , uric acid , and lower HDL-cholesterol than normoglycaemic subjects . A combination of abdominal adiposity , hypertension , and parental diabetes in men result ed in a NNTS of 2.9 ( 95%CI : 2.0–4.6 ) . In women , the combination of increased triglycerides , hypertension and parental diabetes history yielded a NNTS of 3.2 ( 95%CI : 2.2–5.1 ) . Conclusion /interpretationAbout 40 % of the population aged 55 to 74 years in the Augsburg region have disturbed glucose tolerance or diabetes . Half of the total cases with diabetes are undiagnosed . Cardiovascular risk factors worsen among glucose tolerance categories , indicating the need for screening and prevention . Screening for undiagnosed diabetes could be most efficient in individuals with abdominal adiposity ( men ) , hypertriglyceridaemia ( women ) , hypertension , and parental diabetes history Background : This study aim ed to explore the feasibility and effect of an intervention in clinical practice with isolated physical activity in individuals with IGT , recruited by the FINDRISC question naire . Methods : The question naire was sent to a population of 9734 individuals , 35–75 years old , in Sweden . Those with a risk score ≥15 were encouraged to perform an oral glucose tolerance test . Individuals with IGT were invited to participate in a r and omized controlled trial with a focus on physical activity . The participants were allocated to one of three arms ; basic intervention , intensive intervention or to care as usual . A total of 52 individuals were carefully examined and question naires about diet and lifestyle were completed at baseline and after one year . All analyses were adjusted for differences in age and sex , and calorie intake when relevant . Results : The prevalence of chronic diseases in the study population was high , creating considerable difficulties in conducting a st and ardized test for fitness . Waist circumference ( p=0.020 ) , sagittal diameter ( p=0.035 ) , body weight ( p=0.038 ) and BMI ( p=0.043 ) decreased significantly more in the intensive care group than in care as usual and the basic care group . However , the significance was abolished when differences in energy intake were accounted for . Conclusions : In an intention to treat , prospect i ve lifestyle interventions with physical activity are feasible , but a high prevalence of comorbidities needs to be considered . Also , an intervention focused on isolated physical activity inevitably led to changes in diet with weight loss and significant improvement of essential risk factors in spite of the participants ’ burden of chronic diseases OBJECTIVE Participants in the Diabetes Prevention Program ( DPP ) r and omized to intensive lifestyle modification  ( ILS ) or metformin had a significantly reduced incidence of diabetes compared with those r and omized to placebo , yet most were still at risk because they had pre-diabetes . We explored the effect of baseline characteristics , weight change , ILS , and metformin on regression from pre-diabetes to the lowest-risk state of normal glucose regulation ( NGR ) defined by American Diabetes Association criteria . RESEARCH DESIGN AND METHODS The DPP was a prospect i ve r and omized trial . Cox proportional hazards modeling was used to identify predictors of regression from pre-diabetes to NGR over 3 years of follow-up . RESULTS Lower baseline fasting ( hazard ratio 1.52 , P < 0.01 ) and 2-h ( 1.24 , P < 0.01 ) glucose predicted regression to NGR , as did younger age ( 1.07 , P < 0.01 ) and greater insulin secretion ( 1.09 , P = 0.04 ) .  ILS  ( 2.05 , P < 0.01 ) and weight loss ( 1.34 , P < 0.01 ) had significant and independent effects on regression . A nonsignificant trend for regression was also observed for metformin ( 1.25 , P = 0.06 ) , male sex ( 1.17 , P = 0.08 ) , and insulin sensitivity ( 1.07 , P = 0.09 ) . In those entering the study with both impaired fasting glucose ( IFG ) and impaired glucose tolerance ( IGT ) , male sex and insulin sensitivity predicted regression to isolated IFG , whereas ILS , metformin , female sex , and greater insulin secretion predicted regression to isolated IGT . CONCLUSIONS Insulin secretion , and other biologic processes retained with younger age , are key in restoring NGR in people with pre-diabetes . However , NGR may also be attained through weight loss and additional aspects of ILS Aims We prospect ively studied Japanese workers with impaired fasting glucose ( IFG ) and /or impaired glucose tolerance ( IGT ) and analysed possible risk factors for diabetes , including psychosocial factors such as stress . Methods The participants were 128 male Japanese company employees ( mean age , 49.3 ± 5.9 years ) with IFG and /or IGT diagnosed by oral glucose tolerance test ( OGTT ) . Participants were prospect ively studied for 5 years with annual OGTTs . The Kaplan – Meier method and Cox 's proportional hazard model were used to analyse the incidence of diabetes and the factors affecting glucose tolerance , including anthropometric , biochemical and social – psychological factors . Results Of 128 participants , 36 ( 28.1 % ) developed diabetes and 39 ( 30.5 % ) returned to normal glucose tolerance ( NGT ) during a mean follow-up of 3.2 years . Independent risk factors for diabetes were night duty [ hazard ratio ( HR ) = 5.48 , P = 0.002 ] , higher fasting plasma glucose ( FPG ) levels within 6.1–6.9 mmol/l ( HR = 1.05 , P = 0.031 ) , stress ( HR = 3.81 , P = 0.037 ) and administrative position ( HR = 12.70 , P = 0.045 ) , while independent factors associated with recovery were lower FPG levels ( HR = 0.94 , P = 0.017 ) , being a white-collar worker ( HR = 0.34 , P = 0.033 ) , non-smoking ( HR = 0.31 , P = 0.040 ) and lower serum alanine aminotransferase ( ALT ) levels ( HR = 0.97 , P = 0.042 ) . Conclusions In addition to FPG levels at baseline , psychosocial factors ( night duty , stress and administrative position ) are risk factors for Type 2 diabetes , while being a white-collar worker , a non-smoker and lower serum ALT levels are factors associated with return to NGT in Japanese workers with IFG and /or IGT AIMS To evaluate the efficacy of interventions to promote a healthy diet and physical activity in people with impaired glucose tolerance ( IGT ) . METHODS A r and omised controlled trial in Newcastle upon Tyne , UK , 1995 - 98 . Participants included 67 adults ( 38 men ; 29 women ) aged 24 - 75 years with IGT . The intervention consisted of regular diet and physical activity counselling based on the stages of change model . Main outcome measures were changes between baseline and 6 months in nutrient intake ; physical activity ; anthropometric and physiological measurements including serum lipids ; glucose tolerance ; insulin sensitivity . RESULTS The difference in change in total fat consumption was significant between intervention and control groups ( difference -21.8 ( 95 % confidence interval ( CI ) -37.8 to -5.8 ) g/day , P=0.008 ) . A significantly larger proportion of intervention participants reported taking up vigorous activity than controls ( difference 30.1 , ( 95 % CI 4.3 - -52.7)% , P=0.021 ) . The change in body mass index was significantly different between groups ( difference -0.95 ( 95 % CI -1.5 to -0.4 ) kg/m(2 ) , P=0.001 ) . There was no significant difference in change in mean 2-h plasma glucose between groups ( difference -0.19 ( 95 % CI -1.1 to 0.71 ) mmol/l , NS ) or in serum cholesterol ( difference 0.02 ( 95 % CI -0.26 to 0.31 ) mmol/l , NS ) . The difference in change in fasting serum insulin between groups was significant ( difference -3.4 ( 95 % CI -5.8 to -1.1 ) mU/l , P=0.005 ) . CONCLUSIONS After 6 months of intensive lifestyle intervention  in participants with IGT , there were changes in diet and physical activity , some cardiovascular risk factors and insulin sensitivity , but not glucose tolerance . Further follow-up is in progress to investigate whether these changes are sustained or augmented over 2 years
Similar effects also appeared in SBP and DBP categories regardless of follow-up duration .
PA+D interventions had larger improvement effects on CVD risk factors than PA alone interventions .
In adults without IGT or diabetes , lifestyle interventions result ed in significant improvements in SBP , DBP , TC , LDL-C , HDL-C , and TG , and might further reduce CVD risk
Structured lifestyle interventions can reduce diabetes incidence and cardiovascular disease ( CVD ) risk among persons with impaired glucose tolerance ( IGT ) , but it is unclear whether they should be implemented among persons without IGT .
We conducted a systematic review and meta-analyses to assess the effectiveness of lifestyle interventions on CVD risk among adults without IGT or diabetes .