Childhood risk factors predict cardiovascular disease, impaired fasting glucose plus type 2 diabetes mellitus, and high blood pressure 26 years later at a mean age of 38 years: the Princeton-lipid research clinics follow-up study. Type 2 diabetes mellitus: a high-risk condition for cardiovascular disease irrespective of the different degrees of obesity. Improving diabetes care: multi-component cardiovascular disease risk reduction strategies for people with diabetes in South Asia--the CARRS multi-center translation trial. Motivational interviewing and problem solving treatment to reduce type 2 diabetes and cardiovascular disease risk in real life: a randomized controlled trial Translating the Diabetes Prevention Program Into an Urban Medically Underserved Community Cost-effectiveness of interventions to control cardiovascular diseases and type 2 diabetes mellitus in South Asia: protocol for a systematic review Study protocol for BeWEL: The impact of a BodyWEight and physicaL activity intervention on adults at risk of developing colorectal adenomas Effects of low dose metformin in adolescents with type I diabetes mellitus: a randomized, double-blinded placebo-controlled study. Patients' education, and its impact on care outcomes, resource consumption and working conditions: data from the International Diabetes Management Practices Study (IDMPS). Isfahan Healthy Heart Programme: a comprehensive integrated community-based programme for cardiovascular disease prevention and control. Design, methods and initial experience Economic evaluation of a lifestyle intervention in primary care to prevent type 2 diabetes mellitus and cardiovascular diseases: a randomized controlled trial Knowledge of dietary and behaviour-related determinants of non-communicable disease in urban Senegalese women. A Randomised Controlled Trial to Reduce Sedentary Time in Young Adults at Risk of Type 2 Diabetes Mellitus: Project STAND (Sedentary Time ANd Diabetes) A Comprehensive Lifestyle Intervention to Prevent Type 2 Diabetes and Cardiovascular Diseases: the German CHIP Trial Cardiovascular disease markers in type 2 diabetes: the effects of a moderate home-based exercise training programme Rationale and design of the ADDITION-Leicester study, a systematic screening programme and Randomised Controlled Trial of multi-factorial cardiovascular risk intervention in people with Type 2 Diabetes Mellitus detected by screening Prevalence and correlates of diabetes mellitus and impaired glucose tolerance among adults in Luzon, Philippines. Defining Obesity Cut Points in a Multiethnic Population Effectiveness of PRECEDE model for health education on changes and level of control of HbA1c, blood pressure, lipids, and body mass index in patients with type 2 diabetes mellitus No excess 12-year mortality in men with impaired glucose tolerance who participated in the Malmö Preventive Trial with diet and exercise The effects of Hartcoach, a life style intervention provided by telephone on the reduction of coronary risk factors: a randomised trial Prevention of Type II diabetes in subjects with impaired glucose tolerance: the Diabetes Prevention Study (DPS) in Finland
Study design and 1-year interim report on the feasibility of the lifestyle intervention programme Cardiorespiratory Fitness in Childhood and Adolescence Affects Future Cardiovascular Risk Factors: A Systematic Review of Longitudinal Studies A community based primary prevention programme for type 2 diabetes integrating identification and lifestyle intervention for prevention: the Let's Prevent Diabetes cluster randomised controlled trial. Design of a RCT evaluating the (cost-) effectiveness of a lifestyle intervention for male construction workers at risk for cardiovascular disease: The Health under Construction study Impact of Periodic Follow-Up Testing Among Urban American Indian Women With Impaired Fasting Glucose Two-Year Results of Translating the Diabetes Prevention Program Into an Urban, Underserved Community Outcome of intensive integrated intervention in participants with impaired glucose regulation in China Chromium Picolinate and Biotin Combination Reduces Atherogenic Index of Plasma in Patients with Type 2 Diabetes Mellitus: A Placebo-Controlled, Double-Blinded, Randomized Clinical Trial The epidemic of obesity and diabetes: trends and treatments. Resveratrol Ameliorates Arterial Stiffness Assessed by Cardio-Ankle Vascular Index in Patients With Type 2 Diabetes Mellitus. Cardiovascular risk factors in multi-ethnic middle school students: the HEALTHY primary prevention trial.
The objective was to assess whether pediatric risk factors predict cardiovascular disease ( CVD ) , impaired fasting glucose ( IFG ) + type 2 diabetes mellitus ( T2DM ) , and high blood pressure ( HBP ) in young adulthood . We performed a prospect i ve follow-up of 909 public-parochial suburban schoolchildren first studied at ages 6 to 18 years and 26 years later at a mean age of 38 years .  Pediatric triglycerides ( TGs ) , blood pressure , low-density lipoprotein cholesterol , body mass index , and glucose above and high-density lipoprotein cholesterol below established pediatric cutoffs , along with race , cigarette smoking , family history of CVD , T2DM , and HBP , were assessed as determinants of young adult CVD , a composite variable including IFG + T2DM and HBP . By stepwise logistic regression , adult CVD ( 19 yes , 862 no ) was associated with pediatric high TG ( odds ratio [ OR ] , 5.85 ; 95 % confidence interval [ CI ] , 2.3 - 14.7 ) . High TG in pediatric prob and s with young adult CVD was familial and was associated with early CVD in their high-TG parents . Adult IFG + T2DM ( 114 yes , 535 no ) was associated with parental T2DM ( OR , 2.2 ; 95 % CI , 1.38 - 3.6 ) , high childhood glucose ( OR , 4.43 ; 95 % CI , 2 - 9.7 ) , and childhood cigarette smoking ( OR , 1.64 ; 95 % CI , 1.03 - 2.61 ) . Adult HBP ( 133 yes , 475 no ) was associated with pediatric high body mass index ( OR , 2.7 ; 95 % CI , 1.7 - 4.3 ) and HBP ( OR , 2.5 ; 95 % CI , 1.5 - 4.3 ) . Pediatric risk factors are significantly , independently related to young adult CVD , IFG + T2DM , and HBP . Identification of pediatric risk factors for CVD  , IFG + T2DM , and HBP facilitates initiation of primary prevention programs to reduce development of adult CVD , IFG + T2DM , and HBP BACKGROUND Measurement of body weight with body mass index ( BMI ) is often utilized to stratify cardiovascular disease ( CVD ) risk . AIM To determine CVD risk profile and disease burden in subjects with type 2 diabetes mellitus ( T2DM ) across different categories of body weight as defined by BMI . DESIGN Prospect i ve observational study . METHODS CVD risk including metabolic syndrome ( MetS ) and prevalence of macrovascular complications were determined for each category of body weight as defined by the World Health Organisation ( WHO ) classification . RESULTS A total of 390 subjects were included in this study of which 35.9 % were non-obese ( BMI < 30 kg/m(2 ) ) . Although increasing obesity as defined by BMI was associated with higher prevalence of central abdominal obesity , hypertension and MetS ( P < 0.05 ) , dyslipidaemia and macrovascular complications were not significantly different across the various body weight categories ( P = NS ) . Similar observation was seen in non-obese ( BMI < 30 kg/m(2 ) ) and obese subjects ( BMI > 30 kg/m(2 ) ) . Among non-obese ( including normal weight ) cohort , the majority of these subjects had adverse CVD risk profile including presence of at least two co-existing risk factors . CONCLUSION Subjects with T2DM possess adverse CVD risk factors with significant burden of macrovascular disease irrespective of their baseline body weight AIMS Cardiovascular disease ( CVD ) is the leading cause of morbidity and mortality in people with diabetes in South Asia . The CARRS Translation Trial tests the effectiveness , cost-effectiveness , and sustainability of a clinic-based multi-component CVD risk reduction intervention among people with diabetes in India and Pakistan . METHODS We r and omly assigned 1146 adults with diabetes recruited from 10 urban clinic sites , to receive usual care by physicians or to receive an integrated multi-component CVD risk reduction intervention . The intervention involves electronic health record management , decision-support prompts to the healthcare team , and the support of a care coordinator to actively facilitate patient and provider adherence to evidence -based guidelines . The primary outcome is a composite of multiple CVD risk factor control ( blood glucose and either blood pressure or cholesterol , or all three ) . Other outcomes include control of the individual CVD risk factors , process and patient-centered measures , cost-effectiveness , and acceptability/feasibility . CONCLUSION The CARRS Translation Trial tests a low-cost diabetes care delivery model in urban South Asia to achieve comprehensive cardio-metabolic disease case-management of high-risk patients ( clinical trials.gov number : NCT01212328 ) 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 —The objective of this study was to determine if a community-based modified Diabetes Prevention Program Group Lifestyle Balance ( GLB ) intervention , for individuals with metabolic syndrome , was effective in decreasing risk for type 2 diabetes and cardiovascular disease ( CVD ) in an urban medically underserved community , and subsequently to determine if improvements in clinical outcomes could be sustained in the short term . RESEARCH DESIGN AND METHODS —This nonr and omized prospect i ve intervention study used a one-group design to test the effectiveness of a community-based GLB intervention .  Residents from 11 targeted neighborhoods were screened for metabolic syndrome ( n = 573 ) and took part in a 12-week GLB intervention ( n = 88 ) that addressed safe  weight loss and physical activity . RESULTS —A marked decline in weight ( 46.4 % lost ≥5 % and 26.1 % lost ≥7 % ) was observed in individuals after completion of the intervention . Of these subjects , 87.5 % ( n = 28 ) and 66.7 % ( n = 12 ) sustained the 5 % and 7 % reduction , respectively , at the 6-month re assessment . Over one-third of the population ( 43.5 % , n = 30 ) experienced improvements in one or more component of metabolic syndrome , and 73.3 % ( n = 22 ) sustained this improvement at the 6-month re assessment . Additional improvements occurred in waist circumference ( P < 0.009 ) and blood pressure levels ( P = 0.04 ) after adjustment for age , sex , race , mean number of GLB classes attended , and time . CONCLUSIONS —Adults in an urban medically underserved community can decrease their risk for type 2 diabetes and CVD through participation in a GLB intervention , and short-term sustainability is feasible . Future research will include long-term follow-up of these subjects Introduction While a number of strategies are being implemented to control cardiovascular diseases ( CVDs ) and type 2 diabetes mellitus ( T2DM ) , the cost-effectiveness of these in the South Asian context has not been systematic ally evaluated . We aim to systematic ally review the economic ( cost-effectiveness ) evidence available on the individual- , group- and population -level interventions for control of CVD and T2DM in South Asia . Methods and analysis This review will consider all relevant economic evaluations , either conducted alongside r and omised controlled trials or based on decision modelling estimates . These studies must include participants at risk of developing CVD/T2DM or with established disease in one or more of the South Asian countries ( India , Bangladesh , Pakistan , Sri Lanka , Nepal , Maldives , Bhutan and Afghanistan ) . We will identify relevant papers by systematic ally search ing all major data bases and registries . Selected articles will be screened by two independent research ers . Method ological quality of the studies will be assessed using a modified Drummond and a Phillips checklist . Cochrane guidelines will be followed for bias assessment in the effectiveness studies . Results Results will be presented in line with the PRISMA ( Preferred Reporting Items for Systematic review and Meta- analysis ) checklist , and overall quality of evidence will be presented as per the GRADE ( Grade s of Recommendation , Assessment , Development and Evaluation ) approach . Ethics and dissemination The study has received ethics approval from the All India Institute of Medical Sciences , New Delhi , India . The results of this review will provide policy-relevant recommendations for the uptake of cost-effectiveness evidence in prioritising decisions on essential chronic disease care packages for South Asia . Study registration number PROSPERO CRD42013006479 Background Colorectal cancer ( CRC ) is the third most commonly diagnosed cancer and the second highest cause of cancer death in the UK . Most cases occur in people over 50 years and CRC often co-exists with other lifestyle related disorders including obesity , type 2 diabetes mellitus ( T2DM ) and cardiovascular disease ( CVD ) . These diseases share risk factors related to the metabolic syndrome including large body size , abnormal lipids and markers of insulin resistance indicating common aetiological pathways . Methods / Design This 3 year study will be a two-arm , multicentre , r and omised controlled trial comparing the BeWEL lifestyle ( diet , physical activity and behaviour change ) programme against usual care . The pre-trial development will take 6 months and participants will be recruited over a 12 month period and undertake the intervention and follow up for 12 months ( total 24 months recruitment and intervention implementation ) with a further 6 months for data collection , analysis and interpretation . Four hundred and fifty two participants who have had a colorectal adenoma detected and removed ( through the national colorectal screening programme ) will provide 80 % power to detect a weight loss of 7 % over 12 months . Primary outcomes are changes in body weight and waist circumference . Secondary outcomes will include cardiovascular risk factors , psycho-social measures and intervention costs . Discussion The results from this study will enhance the evidence base for lifestyle change in patients at higher risk of chronic disease including obesity related cancers . International St and ard R and omised Controlled Trials No : IS RCT BACKGROUND Insulin resistance increases during adolescence in those with type 1 diabetes mellitus ( T1DM ) , complicating glycemic control and potentially increasing cardiovascular disease ( CVD ) risk . Metformin , typically used in type 2 diabetes mellitus ( T2DM ) , is a possible adjunct therapy in T1DM to help improve glycemic control and insulin sensitivity . OBJECTIVE We hypothesized that metformin would improve metabolic parameters in adolescents with T1DM . DESIGN , SETTING , AND PARTICIPANTS This r and omized , double-blinded , placebo-controlled trial included 74 pubertal adolescents ( ages : 13 - 20 yr ) with T1DM . Participants were r and omized to receive either metformin or placebo for 6 months . Glycated hemoglobin ( HbA1c ) , insulin dose , waist circumference , body mass index ( BMI ) , and blood pressure were measured at baseline , 3 and 6 months , with fasting lipids measured at baseline and 6 months . RESULTS Total daily insulin dose , BMI z-score and waist circumference significantly decreased at 3 and 6 months compared to baseline within the metformin group , even among normal-weight participants . In the placebo group , total insulin dose and systolic blood pressure increased significantly at 3 months and total insulin dose increased significantly at 6 months . No significant change was observed in HbA1c at any time point between metformin and placebo groups or within either group . CONCLUSIONS Low-dose metformin likely improves BMI as well as insulin sensitivity in T1DM adolescents , as indicated by a decrease in total daily insulin dose . The decrease in waist circumference indicates that fat distribution is also likely impacted by metformin in T1DM . Further studies with higher metformin doses and more detailed measurements are needed to confirm these results , their underlying mechanisms , and potential impact on CVD in T1DM youth AIM To evaluate the impact of diabetes education provided to patients with type 2 diabetes mellitus ( T2DM ) in non-controlled studies ( " real-world conditions " ) on quality of care , re source consumption and conditions of employment . METHODS This cross-sectional study and longitudinal follow-up describe the data ( demographic and socioeconomic profiles , clinical characteristics , treatment of hyperglycaemia and associated cardiovascular risk factors , re source consumption ) collected during the second phase ( 2006 ) of the International Diabetes Management Practice s Study ( IDMPS ) . Patients received diabetes education directly from the practice nurse , dietitian or educator , or were referred to ad hoc group-education programmes ; all programmes emphasized healthy lifestyle changes , self-care and active participation in disease control and treatment . Educated vs non-educated T2DM patients ( n=5692 in each group ) , paired by age , gender and diabetes duration , were r and omly recruited for the IDMPS by participating primary -care physicians from 27 countries in Eastern Europe , Asia , Latin America and Africa . Outcome measures included clinical ( body weight , height , waist circumference , blood pressure , foot evaluation ) , metabolic ( HbA(1c ) levels , blood lipid profile ) and biochemical control measures . Treatment goals were defined according to American Diabetes Association guidelines . RESULTS T2DM patients ' education significantly improved the percentage of patients achieving target values set by international guidelines . Educated patients increased their insulin use and self-care performance , had a lower rate of chronic complications and a modest increase in cost of care , and probably higher salaries and slightly better productivity . CONCLUSION Diabetes education is an efficient tool for improving care outcomes without having a major impact on healthcare costs The Isfahan Healthy Heart Programme ( IHHP ) is a five to six year comprehensive integrated community-based programme for cardiovascular diseases ( CVD ) prevention and control via reducing CVD risk factors and improvement of cardiovascular healthy behaviour in a target population . IHHP started late in 1999 and will be finished in 2005 - 2006 . A primary survey was done to collect baseline data from interventional ( Isfahan and Najaf-Abad ) and reference ( Arak ) communities . In a two-stage sampling method , we r and omly selected 5 to 10 percent of households from r and omly selected clusters . Then individuals aged ≥19 years were selected for the survey . This way , data from 12,600 individuals ( 6300 in interventional counties and 6300 in the reference county ) was collected and stratified according to living area ( urban vs. rural ) and different age and sex groups . The sample s underwent a 30-minute interview to complete vali date d question naires containing questions on demography , socioeconomic status , smoking behaviour , physical activity , nutritional habits and other behaviour regarding CVD . Blood pressure and body mass index ( BMI ) measurements were done and fasting blood sample s were taken for two hours post load plasma glucose ( 2 hpp ) , serum ( total , HDL and LDL ) cholesterol and triglyceride levels . A twelve-lead electrocardiogram was recorded in all persons above 35 years of age . Community-wide surveillance of deaths , hospital discharges , myocardial infa rct ion and stroke registry was carried out in the intervention and control areas . Four to five years of interventions based on different categories such as mass media , community partnerships , health system involvement and policy and legislation have started in the intervention area while Arak will be followed without intervention . Considering the results of the baseline surveys . ( assessment s needed , the objectives , existing re sources and the possibility of national implementation ) the interventions were planned . They were set based on specific target groups like school children , women , work-site , health personnel , high-risk persons , and community leaders were actively engaged as decision makers . A series of teams was arranged for planning and implementation of the intervention strategies . Monitoring will be done on small sample s to assess the effect of different interventions in the intervention area . While four periodic surveys will be conducted on independent sample s to assess health behaviours related to CVD risk factors in the intervention and reference areas , the original pre-intervention subjects aged more than 35 years will be followed in both areas to assess the individual effect of interventions and outcomes like sudden death , fatal and nonfatal MI and stroke . The whole baseline survey will be repeated on the original and an independent sample in both communities at the end of the study Background Cost-effectiveness studies of lifestyle interventions in people at risk for lifestyle-related diseases , addressing ‘ real-world ’ implementation , are needed . This study examines the cost-effectiveness of a primary care intervention from a societal perspective , compared with provision of health brochures , alongside a r and omized controlled trial . Methods Adults aged 30 - 50 years , at risk of type 2 diabetes ( T2DM ) and /or cardiovascular disease ( CVD ) , were recruited from twelve general practice s in The Netherl and s. They were r and omized to the intervention ( n = 314 ) or control group ( n = 308 ) . The intervention consisted of up to six face-to-face counseling sessions with a trained practice nurse , followed by three-monthly sessions by phone . Costs were collected using three-monthly retrospective question naires . Quality of life was measured with the EuroQol-5D-3L , at baseline , 6 , 12 and 24 months . Nine-year risk of developing T2DM and ten-year risk of CVD mortality were estimated using the ARIC and SCORE formulae , respectively , based on measurements at baseline and 24 months while applying a fixed age of 60 years at both time points . Results Small , statistically non-significant differences in effects were found between the intervention and control group with regard to risk scores and Quality Adjusted Life Years ( QALYs ) gained . The mean difference in costs between the intervention and control group was € -866 ( 95 % confidence interval -2372 ; 370 ) . The probability that the intervention was cost-effective varied from 93 % at € 8000/QALY to 88 % at € 80,000/QALY . Conclusion A primary care lifestyle intervention aim ed at adults at increased risk of T2DM and /or CVD  could result in cost savings over a two-year period . However , due to method ological uncertainty no advice can be given regarding the implementation of the intervention in Dutch general practice s . Trial registration Current Controlled Trials IS RCT N59358434 OBJECTIVE To assess knowledge of dietary and behaviour-related determinants of non-communicable disease ( NCD ) of urban Senegalese women . DESIGN A cross-sectional , population study using an interviewer-administered knowledge question naire , developed and vali date d for this study . The question naire consisted of 24 items with six scores measuring knowledge of : ( 1 )  diet- and behaviour-related causes of NCD ; ( 2 ) diet quality -NCD relationship ; ( 3 )  fruit and vegetable link with NCD ; ( 4 ) health consequences of obesity ; ( 5 ) causes of cardiovascular disease ( CVD ) ; and ( 6 ) causes of certain cancers . SUBJECTS A r and om sample of 301 women aged 20 - 50 years . RESULTS The knowledge scores developed suggest that the health consequences of obesity ( mean score of 65.4 % ) were best understood followed by causes of CVD ( mean score of 60.6 % ) , because obesity , smoking , high blood cholesterol and dietary fat were well recognised as risk factors for CVD . Subjects scored least for their knowledge of the protective effect of fruit and vegetables ( mean score of 19.9 % ) . Knowledge of causes of certain cancers ( mean score of 36.1 % ) was also low . Women who worked outside the home had better knowledge for two scores but otherwise no relationship was found between knowledge and literacy , formal education or body mass index . CONCLUSIONS Findings suggest reasonable overall knowledge concerning diet and behaviour with NCD , especially given the relatively new context of the obesity epidemic in Senegal . However , there was poor knowledge of the benefit of eating fruit and vegetables and other preventable causes of certain cancers . Education targeting the benefits of vegetables and fruit may have the greatest impact on NCD prevention Aims Type 2 diabetes mellitus ( T2DM ) , a serious and prevalent chronic disease , is traditionally associated with older age . However , due to the rising rates of obesity and sedentary lifestyles , it is increasingly being diagnosed in the younger population . Sedentary ( sitting ) behaviour has been shown to be associated with greater risk of cardio-metabolic health outcomes , including T2DM . Little is known about effective interventions to reduce sedentary behaviour in younger adults at risk of T2DM . We aim ed to investigate , through a r and omised controlled trial ( RCT ) design , whether a group-based structured education workshop focused on sitting reduction , with self-monitoring , reduced sitting time . Methods Adults aged 18–40 years who were either overweight ( with an additional risk factor for T2DM ) or obese were recruited for the Sedentary Time ANd Diabetes ( ST AND ) RCT . The intervention programme comprised of a 3-hour group-based structured education workshop , use of a self-monitoring tool , and follow-up motivational phone call . Data were collected at three time points : baseline , 3 and 12 months after baseline . The primary outcome measure was accelerometer-assessed sedentary behaviour after 12 months . Secondary outcomes included other objective ( activPAL ) and self-reported measures of sedentary behaviour and physical activity , and biochemical , anthropometric , and psycho-social variables . Results 187 individuals ( 69 % female ; mean age 33 years ; mean BMI 35 kg/m2 ) were r and omised to intervention and control groups . 12 month data , when analysed using intention-to-treat analysis ( ITT ) and per- protocol analyses , showed no significant difference in the primary outcome variable , nor in the majority of the secondary outcome measures . Conclusions A structured education intervention design ed to reduce sitting in young adults at risk of T2DM was not successful in changing behaviour at 12 months . Lack of change may be due to the brief nature of such an intervention and lack of focus on environmental change . Moreover , some participants reported a focus on physical activity rather than reductions in sitting per se . The habitual nature of sedentary behaviour means that behaviour change is challenging . Trial Registration Controlled-Trials.com IS RCT The prevalence of type 2 diabetes is continuously increasing . This chronic metabolic disorder is difficult to treat and imposes a considerable economic burden on the healthcare system . In view of the fact that type 2 diabetes is primarily caused by behavioral factors , effective preventive strategies are urgently needed . We examined the effects of a holistic lifestyle intervention on clinical and laboratory parameters as well as on the long-term diabetes risk in patients at risk to develop diabetes . We conducted a r and omized controlled trial in a primary care setting in Hannover , Germany , with 83 patients diagnosed as (pre)diabetic or at risk for diabetes . CHIP Germany is a 40-hour coaching lifestyle intervention program for the primary and secondary prevention of type 2 diabetes and cardiovascular diseases . The intervention included a comprehensive nutrition and health educational program based on the American CHIP approach . The primary outcome parameter was the body mass index ( BMI ) . Secondary outcome parameters included body weight , blood pressure , fasting glucose , HbA1c , blood lipids , and the FINDRISK score , which assesses long-term diabetes risk . At the final measurement after 12 months , in the intervention group the BMI was reduced by 1.4 versus 0.2 kg/m2 in controls ( p = .119 ) . The mean sustained weight loss after 12 months was −4.1 kg in the intervention group versus −0.8 kg in controls . Furthermore , we found a trend toward a stronger reduction in blood pressure , fasting glucose , and HbA1c as well as an improved FINDRISK score in the intervention group , compared to controls . Although failing to reach statistical significance at the final assessment , this comprehensive lifestyle intervention showed a noticeable reduction in several cardiometabolic risk factors which may facilitate the prevention of diabetes 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 Earlier diagnosis followed by multi-factorial cardiovascular risk intervention may improve outcomes in Type 2 Diabetes Mellitus ( T2DM ) . Latent phase identification through screening requires structured , appropriately targeted population -based approaches . Providers responsible for implementing screening policy await evidence of clinical and cost effectiveness from r and omised intervention trials in screen-detected T2DM cases . UK South Asians are at particularly high risk of abnormal glucose tolerance and T2DM . To be effective national screening programmes must achieve good coverage across the population by identifying barriers to the detection of disease and adapting to the delivery of earlier care . Here we describe the rationale and methods of a systematic community screening programme and r and omised controlled trial of cardiovascular risk management within a UK multiethnic setting ( ADDITION-Leicester ) . Design A single-blind cluster r and omised , parallel group trial among people with screen-detected T2DM comparing a protocol driven intensive multi-factorial treatment with conventional care . Methods ADDITION-Leicester consists of community-based screening and intervention phases within 20 general practice s coordinated from a single academic research centre . Screening adopts a universal diagnostic approach via repeated 75g-Oral Glucose Tolerance Tests within an eligible non-diabetic population of 66,320 individuals aged 40 - 75 years ( 25 - 75 years South Asian ) . Volunteers also provide detailed medical and family histories ; complete health question naires , undergo anthropometric measures , lipid profiling and a proteinuria assessment . Primary outcome is reduction in modelled Coronary Heart Disease ( UKPDS CHD ) risk at five years .  Seven thous and ( 30 % of South Asian ethnic origin ) volunteers over three years will be recruited to identify a screen-detected T2DM cohort ( n = 285 ) powered to detected a 6 % relative difference ( 80 % power , alpha 0.05 ) between treatment groups at one year . R and omisation will occur at practice -level with newly diagnosed T2DM cases receiving either conventional ( according to current national guidelines ) or intensive ( algorithmic target-driven multi-factorial cardiovascular risk intervention ) treatments . Discussion ADDITION-Leicester is the largest multiethnic ( targeting > 30 % South Asian recruitment ) community T2DM and vascular risk screening programme in the UK . By assessing feasibility and efficacy of T2DM screening , it will inform national disease prevention policy and contribute significantly to our underst and ing of the health care needs of UK South Asians . Trial registration Clinical trial.gov ( NCT00318032 ) 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 Background — Body mass index ( BMI ) is widely used to assess risk for cardiovascular disease and type 2 diabetes . Cut points for the classification of obesity ( BMI > 30 kg/m2 ) have been developed and vali date d among people of European descent . It is unknown whether these cut points are appropriate for non-European population s. We assessed the metabolic risk associated with BMI among South Asians , Chinese , Aboriginals , and Europeans . Methods and Results — We r and omly sample d 1078 subjects from 4 ethnic groups ( 289 South Asians , 281 Chinese , 207 Aboriginals , and 301 Europeans ) from 4 regions in Canada . Principal components factor analysis was used to derive underlying latent or “ hidden ” factors associated with 14 clinical and biochemical cardiometabolic markers . Ethnic-specific BMI cut points were derived for 3 cardiometabolic factors . Three primary latent factors emerged that accounted for 56 % of the variation in markers of glucose metabolism , lipid metabolism , and blood pressure . For a given BMI , elevated levels of glucose- and lipid-related factors were more likely to be present in South Asians , Chinese , and Aboriginals compared with Europeans , and elevated levels of the blood pressure – related factor were more likely to be present among Chinese compared with Europeans . The cut point to define obesity , as defined by distribution of glucose and lipid factors , is lower by ≈6 kg/m2 among non-European groups compared with Europeans . Conclusions — Revisions may be warranted for BMI cut points to define obesity among South Asians , Chinese , and Aboriginals . Using these revised cut points would greatly increase the estimated burden of obesity-related metabolic disorders among non-European population Background Individual health education is considered to be essential in the overall care of patients with type 2 diabetes ( DM2 ) , although there is some uncertainty regarding its metabolic control benefits . There have been very few r and omized studies on the effects of individual education on normal care in DM2 patients with a control group , and none of these have assessed the long-term results . Therefore , this study aims to use this design to assess the effectiveness of the PRECEDE ( Predisposing , Reinforcing , Enabling , Causes in Educational Diagnosis , and Evaluation ) education model in the metabolic control and the reduction of cardiovascular risk factors , in patients with type 2 diabetes . Methods An open community effectiveness study was carried out in 8 urban community health centers in the North-East Madrid Urban Area ( Spain ) . Six hundred patients with DM2 were r and omized in two groups : PRECEDE or conventional model for health promotion education . The main outcome measures were glycated hemoglobin A1c , body mass index ( BMI ) , blood pressure , lipids and control criteria during the 2-year follow-up period . Results Glycated hemoglobin A1c and systolic blood pressure ( SBP ) levels decreased significantly in the PRECEDE group ( multivariate analysis of covariance , with baseline glycated hemoglobin A1c , SBP , and variables showing statistically significant differences between groups at baseline visits ) . The decrease levels in diastolic blood pressure ( DBP ) , triglycerides and LDL cholesterol were nonsignificant . PRECEDE increased compliance in all control criteria , except for LDL cholesterol . BMI did not change during the study in either of the two models analyzed . Conclusions PRECEDE health education model is a useful method in the overall treatment in patients with type 2 diabetes , which contributes to decrease glycated hemoglobin A1c and SBP levels and increase the compliance in all the control criteria , except for LDL cholesterol . Trial registration number Clinical Trials.gov 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 Background Cardiovascular disease ( CVD ) is the leading cause of death worldwide . Secondary prevention is essential , but participation rates for cardiac rehabilitation are low . Furthermore , current programmes do not accomplish that patients with CVD change their lifestyle in a way that their individual risk factors for recurrent events decrease , therefore more effective interventions are needed . In this study , the effectiveness of the Hartcoach-programme , a telephonic secondary prevention program focussing on self management , is studied . Methods / design A multicenter , r and omised parallel-group study is being conducted . Participants are 400 patients with acute myocardial infa rct ion ( STEMI , NSTEMI , ) and patients with chronic or unstable angina pectoris ( IAP ) . Patients are recruited through the participating hospitals and r and omly assigned to the experimental group ( Hartcoach-programme plus usual care ) or the control group ( usual care).The Hartcoach-programme consists of a period of six months during which the coach contacts the patient every four to six weeks by telephone . Coaches train patients to take responsibility for the achievement and maintenance of the defined target levels for their particular individual modifiable risk factors . Target levels and treatment goals are agreed by the nurse and patient together . Data collection is blinded and occurs at baseline and after 26 weeks ( post-intervention ) . Primary outcome is change in cardiovascular risk factors ( cholesterol , body mass index , waist circumference , blood pressure , physical activity and diet ) . Secondary outcomes include chances in glucose , HbA1c , medication adherence , self-management and quality of life . Discussion This study evaluates the effects of the Hartcoach-programme on the reduction of individual risk factors of patients with CVDs . Patients who are not invited to follow a hospital based rehabilitation programme or patients who are unable to adhere to such a programme , may be reached by this home based Hartcoach-programme . If positive results are found , the implementation of the Hartcoach-programme will be extended , having implication s for the management of many people with CVD.Trial registration Aims /hypothesis . The aim of the Diabetes Prevention Study is to assess the efficacy of an intensive diet-exercise programme in preventing or delaying  Type II ( non-insulin-dependent ) diabetes mellitus in subjects with impaired glucose tolerance , to evaluate the effects of the intervention programme on cardiovascular risk factors and to assess the determinants for the progression to diabetes in persons with impaired glucose tolerance . Methods . A total of 523 overweight subjects with impaired glucose tolerance ascertained by two oral glucose tolerance tests were r and omised to either a control or intervention group . The control subjects received general information at the start of the trial about the lifestyle changes necessary to prevent diabetes and about annual follow-up visits . The intervention subjects had seven sessions with a nutritionist during the first year and a visit every 3 months thereafter aim ed at reducing weight , the intake of saturated fat and increasing the intake of dietary fibre . Intervention subjects were also guided individually to increase their physical activity .  Results . During the first year , weight loss in the first 212 study subjects was 4.7 ± 5.5 vs 0.9 ± 4.1 kg in the intervention and control group , respectively ( p < 0.001 ) . The plasma glucose concentrations ( fasting : 5.9 ± 0.7 vs 6.4 ± 0.8 mmol/l , p < 0.001 ; and 2-h 7.8 ± 1.8 vs 8.5 ± 2.3 mmol/l , p < 0.05 ) were significantly lower in the intervention group after the first year of intervention . Favourable changes were also found in blood pressure , serum lipids and anthropometric indices in the intervention group . Conclusion /interpretation . The interim results show the efficacy and feasibility of the lifestyle intervention programme . [ Diabetologia ( 1999 ) 42 : 793–801 Background Although cardiorespiratory fitness ( CRF ) in childhood and adolescence may be linked to future cardiovascular health , there is currently limited evidence for a longitudinal association . Objectives To provide a systematic review on the prospect i ve association between CRF in childhood and adolescence and cardiovascular disease ( CVD ) risk factors at least 2 years later . Methods Using a systematic search of Medline , Embase , and SPORTD iscus , relevant articles were identified by the following criteria : generally healthy children and adolescents between 3 and 18 years of age with CRF assessed at baseline , and a follow-up period of ≥ 2 years . The outcome measures were CVD risk factors . We appraised quality of the included articles with STROBE and QUIPS checklists . Results After screening 7524 titles and abstract s , we included 38 articles , assessing 44,169 children and adolescents followed up for a median of 6 years . Eleven articles were of high quality . There was considerable heterogeneity in methodology , measurement of CRF , and outcomes , which hampered meta- analysis . In approximately half of the included articles higher CRF in childhood and adolescence was associated with lower body mass index ( BMI ) , waist circumference , body fatness and lower prevalence of metabolic syndrome in later life . No associations between CRF in childhood and adolescence and future waist-to-hip ratio , blood pressure , lipid profile , and glucose homeostasis were observed . Conclusion Although about half of the included articles reported inverse associations between CRF in childhood and adolescence and future BMI , body fatness , and metabolic syndrome , evidence for other CVD risk factors was unconvincing . Many articles did not account for important confounding factors such as adiposity . Recommendations for future research include st and ardizing the measurement of CRF , i.e. by reporting VO2max , using st and ardized outcome assessment s , and performing individual patient data meta-analyses OBJECTIVES Prevention of type 2 diabetes ( T2DM ) is a priority in healthcare , but there is a lack of evidence investigating how to effectively translate prevention research into a UK primary care setting . We assessed whether a structured education programme targeting lifestyle and behaviour change was effective at preventing progression to T2DM  in people with pre-diabetes . MATERIAL S AND METHODS Forty-four general practice s were r and omised to receive either st and ard care or a 6hour group structured education programme with an annual refresher course , and regular phone contact . Participants were followed up for 3years . The primary outcome was progression to T2DM . RESULTS Eight hundred and eighty participants were included ( 36 % female , mean age 64years , 16 % ethnic minority group ) ; 131 participants developed T2DM . There was a non-significant 26 % reduced risk of developing T2DM in the intervention arm compared to st and ard care ( HR 0.74 , 95 % CI 0.48 , 1.14 , p=0.18 ) . The reduction in T2DM risk when excluding those who did not attend the initial education session was also non-significant ( HR 0.65 , 0.41 , 1.03 , p=0.07 ) . There were statistically significant improvements in HbA1c ( -0.06 , -0.11 , -0.01 ) , LDL cholesterol ( -0.08 , -0.15 , -0.01 ) , sedentary time ( -26.29 , -45.26 , -7.32 ) and step count ( 498.15 , 162.10 , 834.20 ) when data were analysed across all time points . CONCLUSIONS This study suggests that a relatively low re source , pragmatic diabetes prevention programme result ed in modest benefits to biomedical , lifestyle and psychosocial outcomes , however the reduction to the risk of T2DM did not reach significance . The findings have important implication s for future research and primary care Background Of all workers in Dutch construction industry , 20 % has an elevated risk of cardiovascular disease ( CVD ) . A major risk factor for CVD risk is an unhealthy lifestyle . The aim of our study is to design a lifestyle intervention for construction workers with an elevated CVD risk , and to evaluate its ( cost- ) effectiveness . Methods / Design In a RCT , 692 participants will be r and omised to either the control or the intervention group . The control group will receive usual care . For the intervention group , a lifestyle intervention has been design ed based on interviews and current literature . The intervention will last 6 months and will comprise 3 face-to-face and 4 telephone contacts , consisting of individual counselling aim ed at increasing daily physical activity ( PA ) and improving dietary behaviour , and /or smoking cessation . Counselling will take place at the Occupational Health Service ( OHS ) , and will be done according to motivational interviewing ( MI ) . Additional written information about healthy lifestyle will also be provided to those in the intervention group . At baseline , after 6 and after 12 months , measurements will take place . Primary outcome variables will be the lifestyle behaviours of concern , i.e. daily PA , dietary intake , and smoking status . Secondary outcome variables will be body mass index ( BMI ) , systolic and diastolic blood pressure , total and HDL blood cholesterol , Hba1c and cardio-respiratory fitness ( CRF ) . Sickness absenteeism and cost-effectiveness will be assessed as well . Multilevel analysis will be performed to compare all outcome measures between the intervention group and the control group . Discussion By improving lifestyle , CVD risk may be lowered , yielding benefits for both employee and employer . If proven effective , this lifestyle intervention will be implemented on a larger scale within the Occupational Health Services in construction industry . Trial registration Current Controlled Trials IS RCT Introduction Impaired fasting glucose ( IFG ) often progresses to type 2 diabetes . Given the severity and prevalence of this disease , primary prevention is important . Intensive lifestyle counseling interventions have delayed or prevented the onset of type 2 diabetes , but it is not known whether less intensive , more easily replicable efforts can also be effective . Methods In a lifestyle intervention study design ed to reduce risks for type 2 diabetes , 200 American Indian women without diabetes , aged 18 to 40 years , were recruited from an urban community without regard to weight or IFG and block-r and omized into intervention and control groups on the basis of fasting blood glucose ( FBG ) . Dietary and physical activity behaviors were reported , and clinical metabolic , fitness , and body composition measures were taken at baseline and at periodic follow-up through 18 months . American Indian facilitators used a group- discussion format during the first 6 months to deliver a culturally influenced educational intervention on healthy eating , physical activity , social support , and goal setting . We analyzed a subset of young American Indian women with IFG at baseline ( n = 42 ) , selected from both the intervention and control groups . Results Among the women with IFG , mean FBG significantly decreased from baseline to follow-up ( P < .001 ) and converted to normal ( < 5.6 mmol/L or < 100 mg/dL ) in 62.0 % of the 30 women who completed the 18-month follow-up , irrespective of participation in the group educational sessions . Other improved metabolic values included significant decreases in mean fasting blood total cholesterol and low-density lipoprotein cholesterol levels . The women reported significant overall mean decreases in intake of total energy , saturated fat , total fat , total sugar , sweetened beverages , proportion of sweet foods in the diet , and hours of TV watching . Conclusion Volunteers with IFG in this study benefited from learning their FBG values and reporting their dietary patterns ; they made dietary changes and improved their FBG and lipid profiles . If confirmed in larger sample s , these results support periodic dietary and body composition assessment , as well as glucose monitoring among women with IFG Purpose The purpose of the study was to examine the long-term effect of a Group Lifestyle Balance ( GLB ) program on weight , impaired fasting glucose , hypertension , and hyperlipidemia in an urban , medically underserved community . Methods This study was a single-arm prospect i ve intervention study that was design ed to test the effectiveness of a community-based GLB intervention . In sum , 638 residents from 11 targeted neighborhoods were screened for body mass index ≥ 25 kg/m2 and metabolic syndrome . Eligible individuals took part in a 12-week GLB intervention ( n = 105 ) that addressed weight loss and physical activity . Subjects were followed for 24 months . Results The probability of being at risk for diabetes and cardiovascular disease was significantly reduced by 25.7 % over the long-term follow-up . Of the participants who lost at least 5 % of their body weight following the intervention , 52.6 % maintained the 5 % weight loss at their last follow-up time , weighing about 20 lb less than they did at baseline . Conclusion Risk reduction and weight loss maintenance are possible following a GLB intervention and have substantial potential for future public health impact Introduction This study investigated the outcomes and identified influencing factors of intensive integrated intervention over 2 years in Chinese patients with impaired glucose regulation ( IGR ) . Methods Adults in Beijing , China , were screened for IGR using the 75 g oral glucose tolerance test . Participants with IGR received lifestyle and health education ; those who still had IGR after 1 year were r and omly assigned to either a routine care group or to an intensive integrated intervention group . Results Of 2344 adults screened , 463 had IGR . Of these , 210 adults had IGR after 1 year and were therefore recruited and r and omized to an intensive integrated intervention group ( n=106 ) or a control group ( n=104 ) . The percentage of patients who reached the set targets of plasma glucose , blood pressure , body mass index , or triglycerides was significantly higher in the intensive integrated intervention group . None of the patients within the intensive integrated intervention group progressed to diabetes , whereas eight ( 9.3 % ) cases of the control group developed type 2 diabetes mellitus ( T2DM ) . Logistic regression analysis showed that both an increase in waist circumference and systolic blood pressure ( SBP ) were positively correlated with the development of T2DM , whereas improvement in islet beta cell function was negatively correlated with the development of T2DM . Conclusions Intensive integrated intervention may significantly decrease the conversion rate of IGR to T2DM , and increase the conversion ratio to normal glucose tolerance . The increase of waist circumference or SBP and the deterioration of islet beta cell function may be important risk factors for progression from prediabetes to diabetes Background : The atherogenic index of plasma ( AIP ) , defined as logarithm [ log ] of the ratio of plasma concentration of triglycerides to high-density lipoprotein ( HDL ) cholesterol , has recently been proposed as a predictive marker for plasma atherogenicity and is positively correlated with cardiovascular disease risk . The nutrient combination of chromium picolinate and biotin ( CPB ) has been previously shown to reduce insulin resistance and hyperglycemia in patients with type 2 diabetes ( T2DM ) . Methods : Thirty-six moderately obese subjects with T2DM and with impaired glycemic control were r and omized to receive CPB or placebo in addition to their oral hyperglycemic agents for 4 weeks .  Measurements of blood lipids ( including ratio of triglycerides to HDL cholesterol ) , fructosamine , glucose , and insulin were taken at baseline and after 4 weeks . Results : At the final visit , the active group had a significantly lower AIP compared to the placebo group ( P < 0.05 ) . A significant difference in triglyceride level ( P < 0.02 ) and the ratio of low-density lipoprotein ( LDL ) to HDL cholesterol ( P < 0.05 ) was also observed between the groups at the final visit . In the active group , the changes in urinary chromium levels were inversely correlated with the change in AIP ( P < 0.05 ) . Urinary chromium levels were significantly increased in the CPB group . In the CPB group , glucose levels decreased at 1 hour and 2 hours and glucose area under the curve and fructosamine level were significantly decreased . Ratios of total to HDL cholesterol , LDL to HDL cholesterol , and non-HDL to HDL cholesterol were significantly decreased between the treatments at final visit . No significant adverse events were observed in the CPB or placebo groups . Conclusions : These results suggest that the combination of chromium picolinate and biotin may be a valuable nutritional adjuvant therapy to reduce AIP and correlated CVD risk factors in people with T2DM Cardiovascular disease remains the leading cause of death in women . Both obesity and diabetes mellitus are important independent risk factors for the development of cardiovascular disease . Obesity is the leading risk factor for type 2 diabetes . The Centers for Disease Control and Prevention report that 32 % of white and 53 % of black women are obese . Women with a body mass index ( BMI ) of 30 kg/m2 have a 28 times greater risk of developing diabetes than do women of normal weight . The risk of diabetes is 93 times greater if the BMI is 35 kg/m2.1 The presence of diabetes can increase a woman 's risk of heart disease 2-fold . In addition , the presence of diabetes overshadows the protective effects of the premenopausal state . In 2007 , 11.5 million of all women over the age of 20 ( 10.2 % ) had diabetes , and rates were slightly higher in ethnic minority groups : 10.4 % in Hispanic women and 11.8 % in non-Hispanic black women.2 The national prevalence rates of diabetes have increased in parallel with the rates of obesity ( Fig. 1 ) . Fig. 1 Age-adjusted percentage of U.S. adults who were obese or who had a diagnosis of diabetes mellitus . Screening Screening for obesity and diabetes is the 1st step to treatment and often reveals individuals who are at risk for but do not yet have overt disease . The United States Preventive Services Task Force ( USPSTF ) recommends that all adults be screened for obesity . Obesity signifies excess adipose tissue . The most widely used method for screening is determination of the BMI . The BMI is weight in kilograms divided by height in meters squared ( BMI = kg/m2 ) ( Table I ) . Most electronic medical records automatically calculate BMI if height and weight are entered . There are also many smart-phone applications and online calculators that can calculate BMI ( for example , http://www.nhlbisupport.com/ bmi ) . Other screening tools include  waist circumference and the waist-to-hip ratio . In women , a waist circumference > 35 in ( 88 cm ) or a waist-to-hip ratio > 0.7 indicates excess visceral fat and increased risk for disease . TABLE I. Body Mass Index ( BMI ) Classification Recommendations for screening for diabetes vary by guideline author . The USPSTF recommends screening asymptomatic patients who have  blood pressures > 135/80 mmHg  . The American Diabetes Association ( ADA ) recommends that individuals who are ≥18 years of age and have a BMI ≥25 kg/m2 and 1 additional risk factor for diabetes should be screened annually ( Table II).3 Individuals over the age of 45 without risk factors should be screened every 3 years . In January 2010 , the ADA released new recommendations for the use of hemoglobin A1C as a screening tool . An A1C greater than 6.5 % indicates diabetes . In addition , the results of screening tests for diabetes can identify individuals with “ prediabetes ” who have a markedly increased risk of developing overt disease.3 TABLE II . American Diabetes Association Recommendations on Screening for Type 2 Diabetes3 Non-Pharmaceutical Treatment Lifestyle-treatment options for diabetes mellitus and excess weight are similar , and 2 recent studies 4,5 have demonstrated the critical components for treating pre-diabetes and diabetes through weight loss , using caloric restriction and physical activity . The 1st study was the Diabetes Prevention Program.4 The purpose of the study was to identify individuals who were at risk for developing diabetes because of elevated fasting plasma glucose or impaired glucose tolerance levels that were not yet in the diagnostic range , in order to determine if metformin or an intensive lifestyle intervention could delay or prevent the onset of diabetes . More than 3,000 individuals with prediabetes were r and omized to receive placebo , metformin , or a 16-session lifestyle-modification program . The intensive lifestyle program set a goal of 7 % weight loss and 150 min/wk of moderate physical activity . Fifty percent of the lifestyle-intervention group lost 7 % of their body weight . The 3-year incidence of diabetes in the metformin group was 31 % lower than that in the placebo group . The incidence was 58 % lower in the lifestyle group than in the placebo group.4 The clinical implication s of this study are that we should 1 ) identify individuals with pre-diabetes and 2 ) recommend lifestyle modifications that result in a 7 % weight loss and include 150 min/wk of moderate physical activity . The 2nd study that examined lifestyle treatment of diabetes and obesity is the Look AHEAD Trial . The purpose of the study was to determine the effect of intentional weight loss on cardiovascular risk factors in individuals with diabetes . Approximately 5,100 individuals with type 2 diabetes and an elevated BMI were r and omized . Study conditions specified a 36-session intensive lifestyle intervention with the option of using partial meal replacements for caloric restriction or 4 sessions of st and ard diabetes support and education ( DSE ) . At 1 year , 55 % of the intensive-lifestyle-intervention group achieved 7 % weight loss . Hemoglobin A1C , systolic and diastolic blood pressure , and lipids improved significantly more in the intensive-lifestyle group than in the DSE group.5 The clinical implication of this study is that intentional weight loss of at least 7 % can improve the cardiovascular risk profile of patients with type 2 diabetes . Conclusions Excess weight affects two thirds of the U.S. adult population and increases risk for cardiovascular disease and diabetes . All patients should be screened for obesity and most should be screened for pre-diabetes and diabetes . The best treatment for diabetes is prevention . Prevention of diabetes can be accomplished through a 7 % weight loss through intensive lifestyle interventions that include caloric reduction and approximately 30 min of daily moderate physical activity . Practitioners will have access to these evidence -based programs soon . The Centers for Disease Control and Prevention are promoting community-based diabetes prevention programs throughout the country Resveratrol has been reported to have potent anti-atherosclerotic effects in animal studies . However , there are few interventional studies in human patients with atherosclerogenic diseases . The cardio-ankle vascular index ( CAVI ) reflects arterial stiffness and is a clinical surrogate marker of atherosclerosis . The aim of the present study was to investigate the effect of resveratrol on arterial stiffness assessed by CAVI in patients with type 2 diabetes mellitus (T2DM).In this double-blind , r and omized , placebo-controlled study , 50 patients with T2DM received supplement of a 100 mg resveratrol tablet ( total resveratrol : oligo-stilbene 27.97 mg/100 mg/day ) or placebo daily for 12 weeks . CAVI was assessed at baseline and the end of study . Body weight ( BW ) , blood pressure ( BP ) , glucose and lipid metabolic parameters , and diacron-reactive oxygen metabolites ( d-ROMs ; an oxidative stress marker ) were also measured . Resveratrol supplementation decreased systolic BP ( -5.5 ± 13.0 mmHg ) , d-ROMs ( -25.6 ± 41.8 U.CARR ) , and CAVI ( -0.4 ± 0.7 ) significantly ( P < 0.05 ) and decreased BW ( -0.8 ± 2.1 kg , P = 0.083 ) and body mass index ( -0.5 ± 0.8 kg/m2 , P = 0.092 ) slightly compared to baseline , while there were no significant changes in the placebo group . Decreases in CAVI and d-ROMs were significantly greater in the resveratrol group than in the placebo group . Multivariate logistic regression analysis identified resveratrol supplementation as an independent predictor for a CAVI decrease of more than 0.5.In conclusion , 12-week resveratrol supplementation may improve arterial stiffness and reduce oxidative stress in patients with T2DM . Resveratrol may be beneficial in preventing the development of atherosclerosis induced by diabetes . However , a large-scale cohort study is required to vali date the present findings OBJECTIVE The objective of this study was to examine the effects of an integrated , multi-component , school-based intervention programme on cardiovascular disease ( CVD ) risk factors among a multi-ethnic cohort of middle school students . METHODS HEALTHY was a cluster r and omized , controlled , primary prevention trial . Middle school was the unit of r and omization and intervention . Half of the schools were assigned to an intervention programme consisting of changes in the total school food environment and physical education classes , enhanced by educational outreach and behaviour change activities and promoted by a social marketing campaign consisting of reinforcing messages and images . Outcome data reported ( anthropometrics , blood pressure and fasting lipid levels ) were collected on a cohort of students enrolled at the start of 6th grade ( ∼11 - 12 years old ) and followed to end of 8th grade ( ∼13 - 14 years old ) . RESULTS Forty-two middle schools were enrolled at seven field centres ; 4363 students provided both informed consent and CVD data at baseline and end of study . The sample was 52.7 % female , 54.5 % Hispanic , 17.6 % non-Hispanic Black , 19.4 % non-Hispanic White and 8.5 % other racial/ethnic combinations , and 49.6 % were categorized as overweight or obese ( body mass index ≥ 85th percentile ) at baseline . A significant intervention effect was detected in the prevalence of hypertension in non-Hispanic Black and White males . The intervention produced no significant changes in lipid levels . CONCLUSIONS The prevalence of some CVD risk factors is high in minority middle school youth , particularly males . A multi-component , school-based programme achieved only modest reductions in these risk factors ; however , promising findings occurred in non-Hispanic Black and White males with hypertension
Community-based programmes achieved good results for most risk factors except BMI and ( glycated haemoglobin ) HbA1c .
INTRODUCTION Although cardiovascular disease ( CVD ) and type 2 diabetes mellitus ( T2DM ) prevention programmes have been effective in urban residents , their effectiveness in non-urban setting s , where cardio-metabolic risk is typically elevated , is unknown .
We systematic ally review ed the effectiveness of primary prevention programmes aim ed at reducing risk factors for CVD/T2DM , including blood pressure , body mass index ( BMI ) , blood lipid and glucose , diet , lifestyle , and knowledge in adults residing in non-urban areas .