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EMPOWER: a randomized trial using community health workers to deliver a lifestyle intervention program in African American women with Type 2 diabetes: design, rationale, and baseline characteristics. Targeting dietary fat or glycemic load in the treatment of obesity and type 2 diabetes: a randomized controlled trial. Effects of a pharmaceutical care model on medication adherence and glycemic control of people with type 2 diabetes Dulce Wireless Tijuana: A Randomized Control Trial Evaluating the Impact of Project Dulce and Short-Term Mobile Technology on Glycemic Control in a Family Medicine Clinic in Northern Mexico
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 AIMS This preliminary RCT investigated whether an integrated lifestyle modification program that focuses on reducing postpr and ial blood glucose through replacing high with low glycemic load foods and increasing routine physical activities guided by systematic self-monitoring of blood glucose ( GEM ) could improve metabolic control of adults with type 2 diabetes mellitus , without compromising other physiological parameters . METHODS Forty-seven adults ( mean age 55.3 years ) who were diagnosed with type 2 diabetes mellitus for less than 5 years ( mean 2.1 years ) , had HbA1c ≥ 7 % ( mean 8.4 % ) and were not taking blood glucose lowering medications , were r and omized to routine care or five 1-h instructional sessions of GEM .  Assessment s at baseline and 6 months included a physical exam , metabolic and lipid panels , and psychological question naires . RESULTS The GEM intervention led to significant improvements in HbA1c ( decreasing from 8.4 to 7.4 % [ 69 - 57 mmol/mol ] compared with 8.3 to 8.3 % [ 68 - 68 mmol/mol ] for routine care ; Interaction p<.01 ) and psychological functioning without compromising other physiological parameters . CONCLUSIONS Consistent with a patient-centered approach , GEM appears to be an effective lifestyle modification option for adults recently diagnosed with type 2 diabetes mellitus 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 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 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 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 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 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 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 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 BACKGROUND Currently , there is an increased prevalence of diabetes mellitus among the aging adult population . To minimize adverse effects on glycemic control , prevention and management of general and oral complications in patients with diabetes are essential . The objective of this study is to assess the effectiveness of the lifestyle change plus dental care ( LCDC ) program to improve glycemic and periodontal status in aging patients with diabetes . METHODS A cluster , r and omized , controlled trial was conducted in Health Centers 54 ( intervention ) and 59 ( control ) from October 2013 to April 2014 . Sixty-six patients with diabetes per health center were included . At baseline , the intervention group attended 20-minute lifestyle and oral health education , individual lifestyle counseling , application of a self-regulation manual , and individual oral hygiene instruction . At month 3 , the intervention group received individual lifestyle counseling and oral hygiene instruction . The intervention group received booster education every visit by viewing a 15-minute educational video . The control group received a routine program . Participants were assessed at baseline and 3- and 6-month follow-up for glycemic and periodontal status . Data were analyzed by using descriptive statistic , χ(2 ) test , Fisher exact test , t test , and repeated- measures analysis of variance . RESULTS After the 6-month follow-up , participants in the intervention group had significantly lower glycated hemoglobin , fasting plasma glucose , plaque index , gingival index , probing depth , and attachment loss when compared with the control group . CONCLUSION The combination of lifestyle change and dental care in one program improved both glycemic and periodontal status in older patients with diabetes 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 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 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 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 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 = 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 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 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 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 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 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 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 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 BACKGROUND Lifestyle modifications may affect the development of diabetes and prevent complications . However , there is no direct evidence to show that lifestyle intervention is beneficial for patients with established type 2 diabetes . OBJECTIVE The ultimate goal is to determine whether long-term lifestyle intervention can improve glycemic control and prevent complications in patients with type 2 diabetes . This initial report on a multi-year study describes protocol s and the analysis of baseline data and three-year interim results . DESIGN The study was a r and omized , controlled , multi-centre , prospect i ve intervention trial . The trial included patients from 59 Japanese institutes specializing in diabetes care . PATIENTS The study enrolled 2 205 patients with previously diagnosed type 2 diabetes . INTERVENTION The lifestyle modification program included intensive lifestyle management at each outpatient clinic visit and frequent telephone counseling . The intervention group received educational material s concerning the importance of lifestyle and behavioural changes , a diary to record progress of laboratory and other data , and a pedometer . MEASUREMENTS Parameters and indices related to glycemic control , diabetic complications , dyslipidemia , hypertension , obesity , and atherosclerosis were measured several times a year . RESULTS Small but significant differences in HbA1c levels between the intervention ( INT ) and conventional ( CON ) therapy groups appeared as early as two years after the start of intervention and were maintained in the third year ( CON group , 7.78 + /- 1.27 % vs. INT group , 7.62 + /- 1.20 % , the initial HbA1c level was 7.80 + /- 1.42 % for the CON group and 7.68 + /- 1.28 % for the INT group ) . Data on differences in occurrence of micro- or macrovascular complications are not yet available . CONCLUSIONS The effect of lifestyle modification on improving the glycemic control of patients with established type 2 diabetes mellitus was small but significant three years after initiation of the intervention Importance It is unclear whether a lifestyle intervention can maintain glycemic control in patients with type 2 diabetes . Objective To test whether an intensive lifestyle intervention results in equivalent glycemic control compared with st and ard care and , secondarily , leads to a reduction in glucose-lowering medication in participants with type 2 diabetes . Design , Setting , and Participants R and omized , assessor-blinded , single-center study within Region Zeal and and the Capital Region of Denmark ( April 2015-August 2016 ) . Ninety-eight adult participants with non – insulin-dependent type 2 diabetes who were diagnosed for less than 10 years were included . Participants were r and omly assigned ( 2:1 ; stratified by sex ) to the lifestyle group ( n = 64 ) or the st and ard care group ( n = 34 ) . Interventions All participants received st and ard care with individual counseling and st and ardized , blinded , target-driven medical therapy . Additionally , the lifestyle intervention included 5 to 6 weekly aerobic training sessions ( duration 30 - 60 minutes ) , of which 2 to 3 sessions were combined with resistance training . The lifestyle participants received dietary plans aim ing for a body mass index of 25 or less . Participants were followed up for 12 months . Main Outcomes and Measures Primary outcome was change in hemoglobin A1c ( HbA1c ) from baseline to 12-month follow-up , and equivalence was prespecified by a CI margin of ±0.4 % based on the intention-to-treat population . Superiority analysis was performed on the secondary outcome reductions in glucose-lowering medication . Results Among 98 r and omized participants ( mean age , 54.6 years [ SD , 8.9 ] ; women , 47 [ 48 % ] ; mean baseline HbA1c , 6.7 % ) , 93 participants completed the trial . From baseline to 12-month follow-up , the mean HbA1c level changed from 6.65 % to 6.34 % in the lifestyle group and from 6.74 % to 6.66 % in the st and ard care group ( mean between-group difference in change of −0.26 % [ 95 % CI , −0.52 % to −0.01 % ] ) , not meeting the criteria for equivalence ( P = .15 ) . Reduction in glucose-lowering medications occurred in 47 participants ( 73.5 % ) in the lifestyle group and 9 participants ( 26.4 % ) in the st and ard care group ( difference , 47.1 percentage points [ 95 % CI , 28.6 - 65.3 ] ) . There were 32 adverse events ( most commonly musculoskeletal pain or discomfort and mild hypoglycemia ) in the lifestyle group and 5 in the st and ard care group . Conclusions and Relevance Among adults with type 2 diabetes diagnosed for less than 10 years , a lifestyle intervention compared with st and ard care result ed in a change in glycemic control that did not reach the criterion for equivalence , but was in a direction consistent with benefit . Further research is needed to assess superiority , as well as generalizability and durability of findings . Trial Registration clinical trials.gov Identifier : 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 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 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 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 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 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 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 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 OBJECTIVE To evaluate a coherent , evidence -based hypothesis that specific modifiable lifestyle factors implicated in the development of diabetes and associated obesity are related to the onset of OAB . METHODS A hypothetical causative model for OAB involving modifiable lifestyle factors implicated in the development of diabetes and obesity was constructed , based on a systematic literature review . Secondary analysis of data was undertaken in a prospect i ve cohort of women aged 40 and over , living in Leicestershire , UK . Subjects included 3,411 women free from OAB at baseline and 277 incident cases of OAB . Reported diet , lifestyle , morbid , and social factors were measured at baseline and incident cases at 1-year follow-up . Graphical chain modeling was used to estimate the associations between variables and identify likely pathways involved . RESULTS All hypothesized lifestyle factors ( physical activity , high glycemic index , and high energy intake ) plus diabetes and obesity were retained within the graph as potential contributors . However , low physical activity was the only direct risk factor linked prospect ively to the onset of OAB ( RR 2.47 ; 95 % CI 1.82 , 3.36 ) , in addition to older age . CONCLUSIONS Poor lifestyle factors causally linked to diabetes and obesity may contribute to the onset of OAB ; low physical activity appears to be an important modifiable causal factor for OAB operating directly as well as indirectly via pathways involving obesity or diabetes . Further research is needed to demonstrate a causal link between lifestyle and OAB 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 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 ] OBJECTIVE A low – glycemic index diet is effective as a treatment for individuals with diabetes and has been shown to improve pregnancy outcomes when used from the first trimester . A low – glycemic index diet is commonly advised as treatment for women with gestational diabetes mellitus ( GDM ) . However , the efficacy of this advice and associated pregnancy outcomes have not been systematic ally examined . The purpose of this study was to determine whether prescribing a low – glycemic index diet for women with GDM could reduce the number of women requiring insulin without compromise of pregnancy outcomes . RESEARCH DESIGN AND METHODS All women with GDM seen over a 12-month period were considered for inclusion in the study . Women ( n = 63 ) were r and omly assigned to receive either a low – glycemic index diet or a conventional high-fiber ( and higher glycemic index ) diet . RESULTS Of the 31 women r and omly assigned to a low – glycemic index diet , 9 ( 29 % ) required insulin . Of the women r and omly assigned to a higher – glycemic index diet , a significantly higher proportion , 19 of 32 ( 59 % ) , met the criteria to commence insulin treatment ( P = 0.023 ) . However , 9 of these 19 women were able to avoid insulin use by changing to a low – glycemic index diet . Key obstetric and fetal outcomes were not significantly different . CONCLUSIONS Using a low – glycemic index diet for women with GDM effectively halved the number needing to use insulin , with no compromise of obstetric or fetal outcomes 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 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 % ) . ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● 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 Background Type 2 diabetes is a prevalent , chronic disease for which diet is an integral aspect of treatment . In our previous trial , we found that recommendations to follow a very low-carbohydrate ketogenic diet and to change lifestyle factors ( physical activity , sleep , positive affect , mindfulness ) helped overweight people with type 2 diabetes or prediabetes  improve glycemic control and lose weight . This was an in-person intervention , which could be a barrier for people without the time , flexibility , transportation , social support , and /or financial re sources to attend . Objective The aim was to determine whether an online intervention based on our previous recommendations ( an ad libitum very low-carbohydrate ketogenic diet with lifestyle factors ; “ intervention ” ) or an online diet program based on the American Diabetes Associations ’ “ Create Your Plate ” diet ( “ control ” ) would improve glycemic control and other health outcomes among overweight individuals with type 2 diabetes . Methods In this pilot feasibility study , we r and omized overweight adults ( body mass index ≥25 ) with type 2 diabetes ( glycated hemoglobin [ HbA1c ] 6.5%-9.0 % ) to a 32-week online intervention based on our previous recommendations ( n=12 ) or an online diet program based around a plate method diet ( n=13 ) to assess the impact of each intervention on glycemic control and other health outcomes . Primary and secondary outcomes were analyzed by mixed-effects linear regression to compare outcomes by group . Results At 32 weeks , participants in the intervention group reduced their HbA1c levels more ( estimated marginal mean [ EMM ] –0.8 % , 95 % CI –1.1 % to –0.6 % ) than participants in the control group ( EMM –0.3 % , 95 % CI –0.6 % to 0.0 % ; P=.002 ) . More than half of the participants in the intervention group ( 6/11 , 55 % ) lowered their HbA1c to less than 6.5 % versus 0 % ( 0/8 ) in the control group ( P=.02 ) . Participants in the intervention group lost more weight ( EMM –12.7 kg , 95 % CI –16.1 to –9.2 kg ) than participants in the control group ( EMM –3.0 kg , 95 % CI –7.3 to 1.3 kg ; P<.001 ) . A greater percentage of participants lost at least 5 % of their body weight in the intervention ( 10/11 , 90 % ) versus the control group ( 2/8 , 29 % ; P=.01 ) . Participants in the intervention group lowered their triglyceride levels ( EMM –60.1 mg/dL , 95 % CI –91.3 to –28.9 mg/dL ) more than participants in the control group ( EMM –6.2 mg/dL , 95 % CI –46.0 to 33.6 mg/dL ; P=.01 ) . Dropout was 8 % ( 1/12 ) and 46 % ( 6/13 ) for the intervention and control groups , respectively ( P=.07 ) . Conclusions Individuals with type 2 diabetes improved their glycemic control and lost more weight after being r and omized to a very low-carbohydrate ketogenic diet and lifestyle online program rather than a conventional , low-fat diabetes diet online program . Thus , the online delivery of these very low-carbohydrate ketogenic diet and lifestyle recommendations may allow them to have a wider reach in the successful self-management of type 2 diabetes . Trial Registration Clinical Trials.gov NCT01967992 ; https:// clinical trials.gov/ct2/show/NCT01967992 ( Archived by WebCite at http://www.webcitation.org/6o0fI9Mkq OBJECTIVE —In the Indian Diabetes Prevention Programme ( IDPP ) , a 3-year r and omized , controlled trial , lifestyle modification ( LSM ) and metformin helped to prevent type 2 diabetes in subjects with impaired glucose tolerance ( IGT ) . The direct medical costs and cost-effectiveness of the interventions relative to the control group are reported here . RESEARCH DESIGN AND METHODS —Relative effectiveness and costs of interventions ( LSM , metformin , and LSM and metformin ) in the IDPP were estimated from the health care system perspective . Costs of intervention considered were only the direct medical costs . Direct nonmedical , indirect , and research costs were excluded . The cost-effectiveness of interventions was measured as the amount spent to prevent one case of diabetes within the 3-year trial period . RESULTS —The direct medical cost to identify one subject with IGT was Indian rupees ( INR ) 5,278 ( $ 117 ) . Direct medical costs of interventions over the 3-year trial period were INR 2,739 ( $ 61 ) per subject in the control group , INR 10,136 ( $ 225 ) with LSM , INR 9,881 ( $ 220 ) with metformin , and INR 12,144 ( $ 270 ) with LSM and metformin . The number of individuals needed to treat to prevent a case of diabetes was 6.4 with LSM , 6.9 with metformin , and 6.5 with LSM and metformin . Cost-effectiveness to prevent one case of diabetes with LSM was INR 47,341 ( $ 1,052 ) , with metformin INR 49,280 ( $ 1,095 ) , and with LSM and metformin INR 61,133 ( $ 1,359 ) . CONCLUSIONS —Both LSM and metformin were cost-effective interventions for preventing diabetes among high risk-individuals in India and perhaps may be useful in other developing countries as well . The long-term cost-effectiveness of the interventions needs to be assessed Seventeen TM patients with impaired glucose tolerance ( IGT ) or non-insulin dependent diabetes mellitus ( NIDDM ) and hyperinsulinism were treated for 12 months with acarbose ( 100 mg . orally with breakfast , lunch and evening meals ) . An improvement in glucose tolerance was observed in 2 out of 11 TM patients with IGT and in all TM patients with NIDDM . Acarbose does not appear to directly improve insulin resistance but may have an indirect effect delaying the absorption of glucose of complex carbohydrates and disaccharides . It may be concluded that acarbose may represent a useful first-line therapy for improving glycemic control in TM patients with abnormalities of glucose homeostasis and hyperinsulinism Intentional weight loss is an important component of treatment for overweight patients with type 2 diabetes , but the effects on bone density are not known . We used data from the Look AHEAD trial to determine the impact of an intensive lifestyle weight loss intervention ( ILI ) compared with diabetes support and education ( DSE ) on changes in bone mineral density ( BMD ) over 12 months . Overweight and obese adults with type 2 diabetes were r and omly assigned to ILI or DSE . In a sub study of BMD conducted at 5 of 16 clinical centers , hip , spine , and whole body dual X-ray absorptiometry scans were obtained at baseline and 1-year later on 642 of 739 ILI and 632 of 740 DSE participants . At baseline , mean age was 58.4 years , and average body mass index was 35.2 kg/m(2 ) .  Total hip BMD T-score was < -2.5 in 1 % and < -1.0 in 8 % . At 1 year , weight loss was greater in ILI than DSE ( -8.6 % versus -0.7 % ) , and glycemic control and fitness were also improved . Bone loss over 1 year was greater in ILI at the total hip ( -1.4 % versus -0.4 % ; p < 0.001 ) and femoral neck ( -1.5 % versus -0.8 % ; p = 0.009 ) , but change in BMD for the lumbar spine and whole body did not differ between groups . In ILI , bone loss at the total hip was independently associated with weight loss in men and women and with poorer glycemic control in men , but was not associated with changes in fitness . One year of an intensive lifestyle intervention in adults with type 2 diabetes , result ing in weight loss , was associated with a modest increase in hip bone loss despite improved fitness and glycemic control BACKGROUND The circumstances under which the glycemic index ( GI ) and glycemic load ( GL ) are derived do not reflect real-world eating behavior . Thus , the ecologic validity of these constructs is incompletely known . OBJECTIVE This study examined the relation of  dietary intake to glycemic response when foods are consumed under free-living conditions . DESIGN Participants were 26 overweight or obese adults with type 2 diabetes who participated in a r and omized trial of lifestyle modification . The current study includes baseline data , before initiation of the intervention . Participants wore a continuous glucose monitor and simultaneously kept a food diary for 3 d. The dietary  variables  included  GI , GL , and intakes of energy , fat , protein , carbohydrate , sugars , and fiber .  The glycemic response variables included AUC , mean and SD of continuous glucose monitoring ( CGM ) values , percentage of CGM values in euglycemic and hyperglycemic ranges , and mean amplitude of glycemic excursions . Relations between daily dietary intake and glycemic outcomes were examined . RESULTS Data were available from 41 d of monitoring . Partial correlations , controlled for energy intake , indicated that GI or GL was significantly associated with each glycemic response outcome . In multivariate analyses , dietary GI accounted for 10 % to 18 % of the variance in each glycemic variable , independent of energy and carbohydrate intakes ( P < 0.01 ) . CONCLUSIONS The data support the ecologic validity of the GI and GL constructs in free-living obese adults with type 2 diabetes . GI was the strongest and most consistent independent predictor of glycemic stability and variability BACKGROUND Despite the increasing prevalence of type 2 diabetes in youth , there are few data to guide treatment . We compared the efficacy of three treatment regimens to achieve durable glycemic control in children and adolescents with recent-onset type 2 diabetes . METHODS Eligible patients 10 to 17 years of age were treated with metformin ( at a dose of 1000 mg twice daily ) to attain a glycated hemoglobin level of less than 8 % and were r and omly assigned to continued treatment with metformin alone or to metformin combined with rosiglitazone ( 4 mg twice a day ) or a lifestyle-intervention program focusing on weight loss through eating and activity behaviors . The primary outcome was loss of glycemic control , defined as a glycated hemoglobin level of at least 8 % for 6 months or sustained metabolic decompensation requiring insulin . RESULTS Of the 699 r and omly assigned participants ( mean duration of diagnosed type 2 diabetes , 7.8 months ) , 319 ( 45.6 % ) reached the primary outcome over an average follow-up of 3.86 years . Rates of failure were 51.7 % ( 120 of 232 participants ) , 38.6 % ( 90 of 233 ) , and 46.6 % ( 109 of 234 ) for metformin alone , metformin plus rosiglitazone , and metformin plus lifestyle intervention , respectively . Metformin plus rosiglitazone was superior to metformin alone ( P=0.006 ) ; metformin plus lifestyle intervention was intermediate but not significantly different from metformin alone or metformin plus rosiglitazone . Prespecified analyses according to sex and race or ethnic group showed differences in sustained effectiveness , with metformin alone least effective in non-Hispanic black participants and metformin plus rosiglitazone most effective in girls . Serious adverse events were reported in 19.2 % of participants . CONCLUSIONS Monotherapy with metformin was associated with durable glycemic control in approximately half of children and adolescents with type 2 diabetes . The addition of rosiglitazone , but not an intensive lifestyle intervention , was superior to metformin alone . ( Funded by the National Institute of Diabetes and Digestive and Kidney Diseases and others ; TODAY Clinical Trials.gov number , NCT00081328 . ) This systematic overview summarizes the relevant evidence from multiple systematic review s of the benefits of nonpharmacological interventions for preventing  type 2 diabetes mellitus ( T2MD ) in women diagnosed with gestational diabetes mellitus ( GDM ) . A comprehensive search using the Cochrane Library , CINAHL , EMBASE and MEDLINE via Ovid SP , and PubMed data bases was completed on 18 November 2015 . Any systematic review s that evaluated r and omized controlled trials ( RCTs ) with defined nonpharmacological interventions for preventing T2DM in women diagnosed with GDM were eligible for inclusion . The authors independently performed critical appraisal s and quality assessment s of the included review s using the AMSTAR tool , and extracted data were converted to coherent values for tabular summarization . Six eligible review s of diet and /or exercise , breastfeeding , and reminder interventions were identified ; however , the method ologies of the review s varied greatly , and the majority of the evidence suggested unclear bias . We found inconsistent reporting on the rates at which diet and exercise interventions reduced the risk of T2DM progression , but these interventions were found to be effective at reducing glycemic load . Combined diet , exercise , and breastfeeding interventions proved to be effective at returning women to their postpartum weight . Neither diet alone nor exercise alone proved to be effective at lowering the risk of T2DM . Overall , there was no robust evidence to support the hypothesis that nonpharmacological interventions are effective at lowering the risk of T2DM in women diagnosed with GDM , and there was no consistent evidence showing that these interventions improved the predictor outcomes of T2DM , such as glycemic load or anthropometric changes Introduction In 2008 , the UK National Osteoporosis Guideline Group ( NOGG ) produced a guideline on the prevention and treatment of osteoporosis , with an up date in 2013 . This paper presents a major up date of the guideline , the scope of which is to review the assessment and management of osteoporosis and the prevention of fragility fractures in postmenopausal women and men age 50 years or over . Methods Where available , systematic review s , meta-analyses and r and omised controlled trials were used to provide the evidence base . Conclusions and recommendations were systematic ally grade d according to the strength of the available evidence . Results Review of the evidence and recommendations are provided for the diagnosis of osteoporosis , fracture-risk assessment , lifestyle measures and pharmacological interventions , duration and monitoring of bisphosphonate therapy , glucocorticoid-induced osteoporosis , osteoporosis in men , postfracture care and intervention thresholds . Conclusion The guideline , which has received accreditation from the National Institute of Health and Care Excellence ( NICE ) , provides a comprehensive overview of the assessment and management of osteoporosis for all healthcare professionals who are involved in its management 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 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 OBJECTIVE To describe the costs of the Diabetes Prevention Program ( DPP ) interventions to prevent or delay type 2 diabetes . RESEARCH DESIGN AND METHODS We describe the direct medical costs , direct nonmedical costs , and indirect costs of the placebo , metformin , and intensive lifestyle interventions over the 3-year study period of the DPP . Re source use and cost are summarized from the perspective of a large health system and society . Research costs are excluded . RESULTS The direct medical cost of laboratory tests to identify one subject with impaired glucose tolerance ( IGT ) was $ 139 . Over 3 years , the direct medical costs of the interventions were $ 79 per participant in the placebo group , $ 2,542 in the metformin group , and $ 2,780 in the lifestyle group . The direct medical costs of care outside the DPP were $ 272 less per participant in the metformin group and $ 432 less in the lifestyle group compared with the placebo group . Direct nonmedical costs were $ 9 less per participant in the metformin group and $ 1,445 greater in the lifestyle group compared with the placebo group . Indirect costs were $ 230 greater per participant in the metformin group and $ 174 less in the lifestyle group compared with the placebo group . From the perspective of a health system , the cost of the metformin intervention relative to the placebo intervention was $ 2,191 per participant and the cost of the lifestyle intervention was $ 2,269 per participant over 3 years . From the perspective of society , the cost of the metformin intervention relative to the placebo intervention was $ 2,412 per participant and the cost of the lifestyle intervention was $ 3,540 per participant over 3 years . CONCLUSIONS The metformin and lifestyle interventions are associated with modest incremental costs compared with the placebo intervention . The evaluation of costs relative to health benefits will determine the value of these interventions to health systems and society OBJECTIVE Objectives of this ancillary analysis of a prospect i ve , prevention study among Asian Indians with impaired glucose tolerance ( IGT ) were a ) to quantify the reduction in incident diabetes at 24 months in participants who achieved normal glucose tolerance ( NGT ) at 6 months ( NGT-6 m ) compared with the other participants , b ) the factors influencing the reversal to NGT at the end of the study at 24 months ( NGT-24 m ) , and c ) to assess changes in cardiometabolic risk factors in different categories of dysglycemia at 24 months . RESEARCH DESIGN AND METHODS Data from a 2-year primary prevention trial were used . Effect of reversion to NGT-6 m on incidence of type 2 diabetes mellitus ( T2DM ) was analyzed using the Cox proportional hazards model . Predictive variables for reversal to NGT were identified using multiple logistic regression analysis . Changes in cardiometabolic risk factors were estimated according to the final glycemic status using fixed-effect , mixed-linear regression modeling . RESULTS The risk of T2DM in 2 years was lower by 75 % in NGT-6 m group ( hazard ratio 0.25 [ 95 % CI 0.12–0.52 ] ) . Predictive variables for reversal to NGT-24 m were good baseline β-cell function ( odds ratio [ OR ] 2.79 [ 95 % CI 2.30–3.40 ] ) and its further improvement ( OR 5.70 [ 95 % CI 4.58–7.08 ] ) , and NGT-6 m ( OR 2.10 [ 95 % CI 1.14–3.83 ] ) . BMI decreased in those who reverted to NGT . Deterioration to T2DM was associated with an increase in the levels of cardiometabolic risk factors . CONCLUSIONS Early reversion to NGT by lifestyle intervention in prediabetic men was associated with a significant reduction in subsequent incidence of diabetes . Good baseline β-cell function and its further improvement and NGT-6 m were associated with reversion to NGT-24 months . Reversion to NGT was associated with modest improvements , whereas conversion to T2DM was associated with significant worsening of the cardiometabolic risk profile 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 OBJECTIVE To determine serum adiponectin , C-reactive protein ( CRP ) , TNF-α and IL-6 levels in impaired glucose tolerance ( IGT ) and type 2 diabetes mellitus ( T2DM ) patients with periodontitis before and after periodontal intervention  , and to investigate the relationship between T2DM and periodontitis . METHODS A total of 50 IGT and 106 T2DM patients with periodontitis were enrolled . The T2DM patients were divided into two groups : T2DM without macrovascular disease ( DM1 ) group and T2DM with macrovascular disease ( DM2 ) group . Each group was r and omly divided into two subgroups according to whether they performed periodontal intervention . The normal control group ( NC group ) consisted of 30 healthy adults .  The serum adiponectin , CRP , TNF-α and IL-6 levels were measured at baseline and 3 months after periodontal intervention . RESULTS The serum adiponectin levels at baseline had decreased tendency with significant difference between each two groups , while CRP , TNF-α , and IL-6 levels had increased tendency with significant difference between each two groups among NC , IGT , DM1 and DM2 groups ( all P<0.01 ) . At 3 months after periodontal intervention , the serum adiponectin levels were increased than those without periodontal intervention ( all P<0.01 ) , while CRP , IL-6 and TNF-α significantly decreased ( all P<0.05 ) in both IGT and DM1 groups . In DM2 group , only CRP levels at 3 months after periodontal intervention were significantly decreased ( P<0.05 ) . Moreover , the HbAlc levels in T2DM patients were improved at 3 months after periodontal invention ( P<0.01 ) . CONCLUSION Periodontal intervention is helpful for glucose control , which may be associated with increased serum adiponectin levels and decreased inflammatory cytokine levels BACKGROUND Behavioral research to improve lifestyle in broadly defined population s of patients with type 2 diabetes is limited . OBJECTIVE We evaluated a behavioral intervention featuring technology-based self-monitoring on biophysiologic outcomes of glycemic control and markers of cardiovascular risk . DESIGN In this single-site , r and omized clinical trial , participants were stratified by good and poor glycemic control ( glycated hemoglobin < 8 % or ≥8 % ) and absence or presence of kidney disease , ( estimated glomerular filtration rate ≥60 or < 60 mL/min ) and r and omized within strata . Measurements were obtained at 0 , 3 , and 6 months . PARTICIPANTS / SETTING Self-referred , community-dwelling adults with type 2 diabetes mellitus . INTERVENTION The intervention group received Social Cognitive Theory-based counseling paired with technology-based self-monitoring , and results were compared with an attention control group . MAIN OUTCOME MEASURES Glycated hemoglobin , fasting serum glucose , lipid levels , blood pressure , weight , body mass index , and waist circumference were evaluated . STATISTICAL ANALYSES PERFORMED Mean differences within and between r and omization groups were compared over time . Intervention effects over time were estimated using r and om intercept models . RESULTS Two hundred ninety-six subjects were r and omized , 256 ( 86.5 % ) completed 3-month and 246 ( 83.1 % ) completed 6-month assessment s. Glycated hemoglobin was reduced in the intervention group by 0.5 % at 3 months and 0.6 % at 6 months ( P<0.001 for each ) , and the control group by 0.3 % ( P<0.001 ) at 3 months and 0.2 % ( P<0.05 ) at 6 months ; but between-group differences were not significant . In those with baseline glycated hemoglobin ≥8 % and estimated glomerular filtration rate ≥60 mL/min , glycated hemoglobin was reduced in the intervention group by 1.5 % at 3 months and 1.8 % at 6 months ( P<0.001 for each ) , and the control group by 0.9 % ( P<0.001 ) at 3 months and 0.8 % ( P<0.05 ) at 6 months ; but between-group differences were not significant . In r and om intercept models , the estimated reduction in glycated hemoglobin of 0.29 % was not significant . CONCLUSIONS Two behavioral approaches to improving general lifestyle management in individuals with type 2 diabetes mellitus were effective in improving glycemic control , but no significant between-group differences were observed 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 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 Chlorogenic acid has been described as a novel polyphenol with metabolic effects on glucose homeostasis . The aim of this study was to evaluate the effect of chlorogenic acid administration on glycemic control , insulin secretion , and insulin sensitivity in patients with impaired glucose tolerance ( IGT ) . A r and omized , double-blind , placebo-controlled clinical trial was performed in 30 patients with IGT ; 15 patients r and omly assigned to oral chlorogenic acid received 400 mg three times per day for 12 weeks , and the other 15 patients received placebo in the same way . Before and after the intervention , anthropometric and metabolic measurements , including fasting plasma glucose ( FPG ) , glycated hemoglobin A1c , and a lipid profile , were performed . Area under the curve of glucose and insulin as well as the insulinogenic , Stumvoll , and Matsuda indices were calculated . Wilcoxon , Mann-Whitney U , and chi-square tests were performed , and P ≤ .05 was considered statistically significant . There were significant decreases in FPG ( 5.7 ± 0.4 vs. 5.5 ± 0.4 mmol/L , P = .002 ) , insulinogenic index ( 0.71 ± 0.25 vs. 0.63 ± 0.25 , P = .028 ) , body weight , body mass index , waist circumference , triglycerides , total cholesterol , low-density lipoprotein cholesterol , and very low-density lipoprotein levels in the chlorogenic acid group , with an increment in the Matsuda index ( 1.98 ± 0.88 vs. 2.30 ± 1.23 , P = .002 ) . There were no significant differences in the placebo group . In conclusion , chlorogenic acid administration in patients with IGT decreased FPG and insulin secretion , while increasing insulin sensitivity and improving both anthropometric evaluations and the lipid profile Introduction Large proportions of the population are not meeting recommended levels of physical activity and have increasingly sedentary lifestyles . Low levels of physical activity are predictive of poor health outcomes and time spent sedentary is related to a host of risk factors independently of physical activity levels . Building an evidence base of the best approaches to intervene in the lifestyles of inactive individuals is crucial in preventing long-term disease , disability and higher mortality rates . Methods and analysis Systematic search es will be conducted on all relevant data bases ( eg , PubMed , Scopus , CINAHL , PsycINFO ) . Studies will be included if they assess interventions aim ed at changing physical activity or sedentary behaviour levels in adults ( over 18 ) who are inactive and do not suffer from chronic conditions . Studies must also be r and omised controlled trials ( RCTs ) , have a primary outcome of physical activity or sedentary behaviour , and measure outcomes at least 6 months after intervention completion . Studies will be coded using the Behaviour Change Technique ( BCT ) taxonomy v1 and Template for Intervention Description and Replication ( TIDieR ) guidelines . 2 review ers will independently screen full-text articles and extract data on study characteristics , participants , BCTs , intervention features and outcome measures . Study quality will also be assessed independently by 2 review ers using the Cochrane risk of bias tool . A meta- analysis will be considered if there is sufficient homogeneity across outcomes . GRADE criteria will be used to assess quality of evidence . Dissemination This will be the first review to systematic ally appraise interventions aim ed at changing the physical activity or sedentary behaviour of inactive individuals using RCT design s with a 6-month follow-up post-intervention . This review will better inform intervention design ers targeting inactive population s and inform the design of a future complex intervention . Review registration number This protocol was registered with the International Prospect i ve Register of Systematic Review s ( PROSPERO ) on 17 October 2014 ( registration number : CRD42014014321 ) 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 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 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 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 : To conduct a r and omised trial of a physical activity ( PA ) intervention , The First Step Program ( FSP ) for adults with type II diabetes . DESIGN : A 16-week intervention study and 24-week follow-up assessment . PARTICIPANTS : A total of 47 overweight/obese , sedentary individuals ( age=52.7±5.2 y ; BMI = 33.3±5.6 kg/m2 ) recruited through a diabetes education centre . MEASUREMENTS : Primary outcome :  daily PA assessed by pedometer ( steps/day ) . Secondary outcomes : anthropometric measures ( weight , BMI , waist girth , hip girth ) ; indicators of cardiovascular health ( resting heart rate and blood pressure ) ; glycemic control ( fasting glucose , insulin , HbA1c , glucose concentration 120 min postglucose load ) ; plasma lipid status ( total cholesterol , HDL cholesterol , LDL cholesterol , and triglycerides ) . RESULTS : Relative to the CONTROL group , FSP participants increased  their PA > 3000 steps/day ( approximately 30 min/day ) during the intervention ( P<0.0001 ) . Waist and hip girth decreased ( approximately 2–3 cm ) , but did not differ significantly between groups . Significant changes did not emerge for any of the other variables . CONCLUSIONS : The FSP is a practical intervention that elicits an immediate and profound change in walking behaviour . Such change is an important ‘ first step ’ towards increasing the volume and /or intensity of PA necessary to improve long-term health outcomes in this largely sedentary and overweight or obese population . Relapse by 24 weeks indicates that other strategies such as booster sessions are needed to maintain lifestyle change . Further research must determine realistic and responsive health outcomes for this population that are achievable through practical , real-world programming 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 Common genetic variants have been recently associated with fasting glucose and insulin levels in white population s. Whether these associations replicate in pre-diabetes is not known . We extended these findings to the Diabetes Prevention Program , a clinical trial in which participants at high risk for diabetes were r and omized to placebo , lifestyle modification or metformin for diabetes prevention . We genotyped previously reported polymorphisms ( or their proxies ) in/near G6PC2 , MTNR1B , GCK , DGKB , GCKR , ADCY5 , MADD , CRY2 , ADRA2A , FADS1 , PROX1 , SLC2A2 , GLIS3 , C2CD4B , IGF1 , and IRS1 in 3,548 Diabetes Prevention Program participants . We analyzed variants for association with baseline glycemic traits , incident diabetes and their interaction with response to metformin or lifestyle intervention . We replicated associations with fasting glucose at MTNR1B ( P<0.001 ) , G6PC2 ( P = 0.002 ) and GCKR ( P = 0.001 ) . We noted impaired β-cell function in carriers of glucose-raising alleles at MTNR1B ( P<0.001 ) , and an increase in the insulinogenic index for the glucose-raising allele at G6PC2 ( P<0.001 ) . The association of MTNR1B with fasting glucose and impaired β-cell function persisted at 1 year despite adjustment for the baseline trait , indicating a sustained deleterious effect at this locus . We also replicated the association of MADD with fasting proinsulin levels ( P<0.001 ) . We detected no significant impact of these variants on diabetes incidence or interaction with preventive interventions . The association of several polymorphisms with quantitative glycemic traits is replicated in a cohort of high-risk persons . These variants do not have a detectable impact on diabetes incidence or response to metformin or lifestyle modification in the Diabetes Prevention Program AIM --To evaluate the effect of the duration of formalin fixation and of tumour heterogeneity on quantitative estimates of oestrogen receptor content ( oestrogen receptor index ) and proliferative activity ( MIB-1 index ) in breast cancer . METHODS --Two monoclonal antibodies , MIB-1 and oestrogen receptor , were applied to  formalin fixed , paraffin wax embedded tissue from 25 prospect ively collected oestrogen receptor positive breast carcinomas , using a microwave antigen retrieval method . Tumour tissue was allocated systematic ally to different periods of fixation to ensure minimal intraspecimen variation . The percentages of MIB-1 positive and oestrogen receptor positive nuclei were estimated in fields of vision sample d systematic ally from the entire specimen and from the whole tumour area of one " representative " cross-section . RESULTS --No correlation was found between the oestrogen receptor and MIB-1 indices and the duration of formalin fixation . The estimated MIB-1 and oestrogen receptor indices in tissue sample d systematic ally from the entire tumour were closely correlated with estimates obtained in a " representative " section . The intra- and interobserver correlation of the MIB-1 index was good , although a slight systematic al error at the second assessment of the intraobserver study was noted . CONCLUSION --Quantitative estimates of oestrogen receptor content and proliferative activity are not significantly influenced by the period of fixation in formalin , varying from less than four hours to more than 48 hours . The MIB-1 and the oestrogen receptor indices obtained in a " representative " section do not deviate significantly from average indices determined in tissue sample s from the entire tumour . Finally , the estimation of MIB-1 index is reproducible , justifying its routine use OBJECTIVE To describe two lifestyle prevention strategies tested in first-degree relatives of patients with type 2 diabetes and to present the short-term effects of these strategies on nutrient intake , physical activity pattern , and body weight . DESIGN In this 16-week controlled intervention trial , subjects were assigned to one of three treatment conditions : diet group ( D ) ( n=25 ) , diet and exercise group ( DE ) ( n=30 ) , or control group ( C ) ( n=22 ) . Subjects/ setting Non-diabetic relatives of individuals with diabetes were recruited ( n=77 ; men and women ; age 25 to 55 years ) . INTERVENTION Intervention groups received group counseling on two occasions and follow-up through unannounced telephone interviews every 10 days . Counseling regarding diet and physical activity was based on the Nordic Nutrition Recommendations . In addition , increased intake of fatty fish and low glycemic index foods were recommended . Main outcome measures Changes in diet ( assessed by food frequency question naires ) , leisure time physical activity ( assessed through interviews ) , fatty acid composition of erythrocyte membrane , and body weight . Statistical analysis One-way analysis of variance and Mann-Whitney U test were used to compare changes among groups . RESULTS Compared with the control group , both intervention groups decreased intake of saturated fatty acids ( percent of energy ) , increased intake of dietary fiber , and reduced average glycemic index of the diet . The ratio of n-6:n-3 fatty acids of the erythrocyte membranes decreased , confirming increased intake of fatty fish . Body weight decreased 1.7 kg ( 2.1 % , P=.030 ) in group DE , and physical activity increased in the least-active subjects ( + 70 min/week , P<.01 within group ) . Applications/ Conclusions Healthy individuals with heredity for type 2 diabetes can achieve desired changes in lifestyle factors associated with increased risk for the disease 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 OBJECTIVE To determine the relationship between social support and certain indicators of physical and mental wellbeing in older adults with type 2 diabetes . MATERIAL AND METHODS We undertook a population -based cross sectional study of 705 adults with type 2 diabetes from the Instituto Mexicano del Seguro Social ( IMSS ) . Participants were r and omly selected from a list of diabetic patients located in the south of Mexico City . Physical and mental wellbeing were assessed through three indicators : 1 ) Health related quality of life ( HRQL ) ; 2 ) depressive symptomatology , and 3 ) glycemic control . Level of social support level was determined using the The Social Support Health Survey instrument . Multiple linear regression models were used to analyze the independent association of social support with the physical and mental wellbeing indicators , controlling for progression time , diabetes complications , co-morbidity and socio-demographic variables . RESULTS High levels of social support were reported by 64 % of participants . Social support and HRQL increased in direct proportion : the more social support a participant reported the less depressive distress and better fasting glucose levels they showed . The results maintained their significance in the four social support subscales , with the exception of affectionate and emotional or informational support subscales , which were not significantly correlated with fasting glucose . Multiple linear regression analyses showed that better levels of social support are associated with improved HRQL ( beta = 0.12 ) , less incidence of depressive symptoms ( beta = -0.20 ) and lower fasting glucose ( beta = -0.10 ) . CONCLUSIONS Our findings suggest that greater levels of social support may improve certain indicators of physical and mental wellbeing in older adults with type 2 diabetes , regardless of the presence of diabetes complications and other chronic pathologies . Thus , promoting social support for the IMSS ' diabetic patients could be a useful intervention 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 Aims /hypothesisThe aim of this study was to determine the secular trends in prevalence of diabetes and IGT in urban India . Material s and methods The Chennai Urban Rural Epidemiology Study ( CURES ) screened 26,001 individuals aged ≥20 years using the American Diabetes Association fasting capillary glucose criteria . The study population , which was representative of Chennai , was recruited by systematic r and om sampling . Every tenth subject from Phase 1 of CURES was invited to participate in Phase 3 for screening by World Health Organization ( WHO ) plasma glucose criteria . The response rate was 90.4 % ( 2,350 responders from 2,600 potential subjects ) . The prevalences of diabetes and IGT in CURES were compared with three earlier studies : two conducted on a representative population of Chennai in 1989 and 1995 , and the other the National Urban Diabetes Survey ( NUDS ) completed in 2000 . Results The overall crude prevalence of diabetes using WHO criteria in CURES was 15.5 % ( age-st and ardised 14.3 % ) , while that of IGT was 10.6 % ( age-st and ardised 10.2 % ) . Prevalence of diabetes increased by 39.8 % ( 8.3–11.6 % ) from 1989 to 1995 ; by 16.3 % ( 11.6–13.5 % ) between 1995 and 2000 ; and by 6.0 % ( 13.5–14.3 % ) between 2000 and 2004 . Thus within a span of 14 years , the prevalence of diabetes increased by 72.3 % ( χ2 trend 22.23 , p<0.0001 ) . The prevalence of IGT increased by 9.6 % from 1989 to 1995 and by 84.6 % between 1995 and 2000 ( χ2 trend 52.9 , p<0.0001 ) . However , it decreased by 39.3 % between 2000 and 2004 ( p<0.0001 ) . There was a shift in the age at diagnosis of diabetes to a younger age in CURES compared with NUDS . Conclusions /interpretationCompared with earlier studies , the prevalence of diabetes in Chennai , representing urban India , has increased while that of IGT has decreased Objective : To assess the effect of a comprehensive yogic breathing program on glycemic control and quality of life ( QOL ) in patients with diabetes . Material s and Methods : This is a prospect i ve r and omized controlled intervention trial . Patients having HbA1c between 6 and 9 % for at least 3 months with lifestyle modification and oral antidiabetic medication were included . They were followed-up and r and omized at 6 months into two groups : one group receiving st and ard treatment of diabetes and the other group receiving st and ard treatment of diabetes and taught and told to regularly practice the comprehensive yogic breathing program ( Sudarshan Kriya Yoga and Pranayam ) . Change in fasting and post-pr and ial blood sugars , glycated hemoglobin and QOL as assessed by the World Health Organization QOL WHOQOL BREF question naire were assessed . Results : There was a trend toward improvement in glycemic control in the group practicing the comprehensive yogic breathing program compared with the group following st and ard treatment alone , although this was not significant . There was significant improvement in physical , psychological and social domains and total QOL post-intervention in the group practicing the comprehensive yogic breathing program as compared with the group following st and ard treatment alone . Conclusion : There was significant improvement in the QOL and a non-significant trend toward improvement in glycemic control in the group practicing the comprehensive yogic breathing program compared with the group that was following st and ard treatment alone 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 BACKGROUND Adults with type 2 diabetes mellitus often have limitations in mobility that increase with age . An intensive lifestyle intervention that produces weight loss and improves fitness could slow the loss of mobility in such patients . METHODS We r and omly assigned 5145 overweight or obese adults between the ages of 45 and 74 years with type 2 diabetes to either an intensive lifestyle intervention or a diabetes support- and -education program ; 5016 participants contributed data . We used hidden Markov models to characterize disability states and mixed-effects ordinal logistic regression to estimate the probability of functional decline . The primary outcome was self-reported limitation in mobility , with annual assessment s for 4 years . RESULTS At year 4 , among 2514 adults in the lifestyle-intervention group , 517 ( 20.6 % ) had severe disability and 969 ( 38.5 % ) had good mobility ; the numbers among 2502 participants in the support group were 656 ( 26.2 % ) and 798 ( 31.9 % ) , respectively . The lifestyle-intervention group had a relative reduction of 48 % in the risk of loss of mobility , as compared with the support group ( odds ratio , 0.52 ; 95 % confidence interval , 0.44 to 0.63 ; P<0.001 ) . Both weight loss and improved fitness ( as assessed on treadmill testing ) were significant mediators of this effect ( P<0.001 for both variables ) . Adverse events that were related to the lifestyle intervention included a slightly higher frequency of musculoskeletal symptoms at year 1 . CONCLUSIONS Weight loss and improved fitness slowed the decline in mobility in overweight adults with type 2 diabetes . ( Funded by the Department of Health and Human Services and others ; Clinical Trials.gov number , NCT00017953 . ) OBJECTIVE To examine the effects of a Parish Nurse Intervention Program ( PNIP ) on maternal health behaviors , glycemic control , and neonatal outcomes among Mexican American women with gestational diabetes . DESIGN A r and omized controlled trial comparing care as usual ( CAU ) with a supplementary 1-hour education session for diabetes education reinforcement by a Parish Nurse . SETTING An outpatient treatment clinic for gestational diabetes within a 250-bed tertiary care , non-profit hospital with a Parish Nurse partnership . PARTICIPANTS One hundred Mexican American women were included in the study with r and omization into Parish Nurse Intervention Program ( n=49 ) and care as usual ( n=51 ) groups . MAIN OUTCOME MEASURES The Health Promoting Lifestyle Profile II ( HPLP II ) and two measures of glycemic control pre- and post-intervention , as well as newborn size , and days of maternal and neonatal hospitalization . RESULTS Outcomes indicate significantly improved Health Promoting Lifestyle Profile II scores in the Parish Nurse Intervention Program group post-intervention compared with the Care As Usual group . No significant differences between groups regarding glycemic control , macrosomia , or days of maternal or neonatal hospitalization were found . CONCLUSIONS A Parish Nurse Intervention Program for pregnant women of Mexican descent with gestational diabetes is effective in leading to improved self-reported health promoting behaviors 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 / OBJECTIVES Glycosylated hemoglobin ( HbA1C ) measurements in patients with diabetes mellitus contribute to glycemic control , and , therefore to lower diabetic complication rates . Determine if an intervention that includes cl aims -based feedback about patterns of HbA1C measurement results in more frequent monitoring of HbA1C in diabetic Medicare beneficiaries . SUBJECTS Primary care physicians in a single Southern state treating Medicare beneficiaries with diabetes mellitus . METHODS A group-r and omized evaluation of an intervention that included cl aims -based feedback about patterns of HbA1C measurement , educational material s , and practice aids . RESULTS Rates for each quality indicator increased from 1996 to 1998 for both the intervention and comparison groups , although increases were larger for intervention counties . HbA1C testing rates increased in intervention counties 16.8 % compared to 13.0 % in the comparison counties , an absolute difference of 4.0 % ( 95 % CI , 0.7 to 7.3 ) . Differences for other indicators were small , although positive and favoring the intervention , and lacked statistical significance . CONCLUSIONS Physician interventions that included practice -level feedback about monitoring of glycemic control successfully led to improved care of diabetic Medicare beneficiaries AIM To assess efficacy and safety of saxagliptin added to metformin versus placebo plus metformin in Asian patients with type 2 diabetes mellitus ( T2DM ) and inadequate glycemic control on metformin alone . METHODS Adults ( HbA(1c ) 7.0 - 10.0 % , on stable metformin ≥ 1500 mg/day ) were r and omized 1:1 to saxagliptin 5 mg daily plus metformin ( n = 283 ) or placebo plus metformin ( n = 287 ) . The primary end point was HbA(1c ) change from baseline to Week 24 . RESULTS Saxagliptin plus metformin provided significant adjusted mean decreases versus placebo plus metformin ( p ≤ 0.0052 ) in HbA(1c ) ( -0.78 % versus -0.37 % ) , fasting plasma glucose ( -1.14 mmol/L versus -0.58 mmol/L ) , and postpr and ial glucose area under the curve from 0 to 180 min ( -315 mmol min/L versus -160 mmol min/L ) . Significantly more saxagliptin-treated patients achieved a therapeutic glycemic response ( HbA(1c)<7.0 % ) ( 46.5 % versus 30.5 % ; p = 0.0001 ) . The proportion of patients experiencing adverse events ( excluding hypoglycemia ) was similar for saxagliptin plus metformin ( 42.8 % ) versus placebo plus metformin ( 40.8 % ) . Hypoglycemic events were reported in 1.4 % of patients in each group . CONCLUSION Saxagliptin added to metformin  significantly improved glycemic control and was well tolerated in Asian patients with T2DM who had inadequate glycemic control with metformin and diet and lifestyle modification 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 OBJECTIVE The long-term impact of intentional weight loss on cardiovascular events remains unknown . We describe 12-month changes in body weight and cardiovascular risk factors in PREvención con DIeta MEDiterránea (PREDIMED)-Plus , a trial design ed to evaluate the long-term effectiveness of an intensive weight loss lifestyle intervention on primary cardiovascular prevention . RESEARCH DESIGN AND METHODS Overweight/obese adults with metabolic syndrome aged 55–75 years ( n = 626 ) were r and omized to an intensive weight loss lifestyle intervention based on an energy-restricted Mediterranean diet , physical activity promotion , and behavioral support ( IG ) or a control group ( CG ) . The primary and secondary outcomes were changes in weight and cardiovascular risk markers , respectively . RESULTS Diet and physical activity changes were in the expected direction , with significant improvements in IG versus CG . After 12 months , IG participants lost an average of 3.2 kg vs. 0.7 kg in the CG ( P < 0.001 ) , a mean difference of −2.5 kg ( 95 % CI −3.1 to −1.9 ) . Weight loss ≥5 % occurred in 33.7 % of IG participants compared with 11.9 % in the CG ( P < 0.001 ) . Compared with the CG , cardiovascular risk factors , including waist circumference , fasting glucose , triglycerides , and HDL cholesterol , significantly improved in IG participants ( P < 0.002 ) . Reductions in insulin resistance , HbA1c , and circulating levels of leptin , interleukin-18 , and MCP-1 were greater in IG than CG participants ( P < 0.05 ) . IG participants with prediabetes/diabetes significantly improved glycemic control and insulin sensitivity , along with triglycerides and HDL cholesterol levels compared with their CG counterparts . CONCLUSIONS PREDIMED-Plus intensive lifestyle intervention for 12 months was effective in decreasing adiposity and improving cardiovascular risk factors in overweight/obese older adults with metabolic syndrome , as well as in individuals with or at risk for diabetes Objective Few interventions have combined life-style and psychosocial approaches in the context of Type 2 diabetes management . The purpose of this study was to determine the effect of a multicomponent behavioral intervention on weight , glycemic control , renal function , and depressive symptoms in a sample of overweight/obese adults with Type 2 diabetes and marked depressive symptoms . Methods A sample of 111 adults with Type 2 diabetes were r and omly assigned to a 1-year intervention ( n = 57 ) or usual care ( n = 54 ) in a parallel groups design . Primary outcomes included weight , glycosylated hemoglobin , and Beck Depression Inventory II score . Estimated glomerular filtration rate served as a secondary outcome . All measures were assessed at baseline and 6 and 12 months after r and omization by assessors blind to r and omization . Latent growth modeling was used to examine intervention effects on each outcome . Results The intervention result ed in decreased weight ( mean [ M ] = 0.322 kg , st and ard error [ SE ] = 0.124 kg , p = .010 ) and glycosylated hemoglobin ( M = 0.066 % , SE = 0.028 % , p = .017 ) , and Beck Depression Inventory II scores ( M = 1.009 , SE = 0.226 , p < .001 ) , and improved estimated glomerular filtration rate ( M = 0.742 ml·min−1·1.73 m−2 , SE = 0.318 ml·min−1·1.73 m−2 , p = .020 ) each month during the first 6 months relative to usual care . Conclusions Multicomponent behavioral interventions  targeting weight loss and depressive symptoms as well as diet and physical activity are efficacious in the management of Type 2 diabetes . Trial Registration : This study is registered at Clinical trials.gov ID : NCT01739205 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 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 Type 2 diabetes ( T2D ) is a growing national health problem affecting 35 % of adults ≥20 years of age in the United States . Recently , diabetes has been categorized as an inflammatory disease , sharing many of the adverse outcomes as those reported from cardiovascular disease . Medical nutrition therapy is recommended for the treatment of diabetes ; however , these recommendations have not been up date d to target the inflammatory component , which can be affected by diet and lifestyle . To assess the current state of evidence for which dietary programs contain the most anti-inflammatory and glycemic control properties for patients with T2D , we conducted an integrative review of the literature . A comprehensive search of the PubMed , CINAHL , Scopus , and Web of Science data bases from January 2000 to May 2012 yielded 786 articles . The final 16 studies met the selection criteria including r and omized control trials , quasiexperimental , or cross-sectional studies that compared varying diets and measured inflammatory markers . The Mediterranean and DASH diets along with several low-fat diets were associated with lower inflammatory markers . The Mediterranean diet demonstrated the most clinical ly significant reduction in glycosylated hemoglobin ( HbA1c ) . Information on best dietary guidelines for inflammation and glycemic control in individuals with T2D is lacking . Continued research is warranted The common single-nucleotide polymorphism in the FTO ( fat mass and obesity associated ) gene is consistently associated with an increased risk of obesity . However , the knowledge of a potential modifying effect of the FTO gene on changes in body weight achieved by lifestyle intervention is limited . We examined whether the FTO gene variant ( rs9939609 , T/A ) is associated with body weight and BMI and long-term weight changes in the Finnish Diabetes Prevention Study ( DPS ) . Altogether , 522 ( aged 40 - 65 years ; BMI > or=25 kg/m(2 ) ) subjects with impaired glucose tolerance ( IGT ) were r and omized to control and lifestyle intervention groups . SNP rs9939609 was genotyped from 502 subjects . At baseline , those with the AA genotype had  higher BMI  than subjects with other genotypes ( P = 0.006 ) . The association was observed in women ( P = 0.016 ) but not in men . During the 4-year follow-up , the subjects with the AA genotype had consistently the highest BMI ( P = 0.009 ) in the entire study population . The magnitude of weight reduction was greater in the intervention group , but the risk allele did not modify weight change in either of the groups . Our results confirm the association between the common FTO variant and BMI in a cross-sectional setting and during the long-term lifestyle intervention . We did not observe association between FTO variant and the magnitude of weight reduction achieved by long-term lifestyle intervention . Based on the results from the DPS , it is unlikely that the common variant of the FTO gene affects the success of lifestyle modification on weight loss BACKGROUND African American ( AA ) women with Type 2 diabetes mellitus ( T2DM ) in the rural south experience less weight loss and poorer glycemic control in traditional diabetes management programs compared to Caucasians . This paper describes the design , rationale , and baseline characteristics from an innovative community health worker ( CHW ) delivered intervention program in this population . METHODS / DESIGN This prospect i ve trial r and omized rural AA women with uncontrolled T2DM ( HbA1c ≥ 7.0 ) to receive a behaviorally-centered , culturally-tailored lifestyle intervention during 16 contacts  from a trained AA CHW or 16 approved diabetes educational mailings . Changes from baseline in glycosylated hemoglobin levels ( HbA1c ) , blood pressure ( BP ) , weight , body mass index ( BMI ) , self-reported dietary and physical activity patterns , and psychosocial measures including diabetes distress , empowerment , depression , self-care , medication adherence , and life satisfaction will be assessed at 6- and 12-months . BASELINE RESULTS Two hundred AA women ( mean age = 53.09 ± 10.89 years ) with T2DM from impoverished rural communities were enrolled . Baseline data demonstrated profoundly uncontrolled diabetes of long term duration ( mean HbA1c = 9.11 ± 1.82 ; mean BMI = 37.68 ± 8.20 ; mean BP = 134.51 ± 20.39/84.19 ± 11.68 ; 10.5 ± 0.7 years ) . Self-care behavior assessment revealed poor dietary and medication adherence and sedentary lifestyle . Most psychosocial measures ranged within normal limits . CONCLUSION The present sample of AA women from impoverished rural communities exhibited significantly uncontrolled T2DM of long duration with associated obesity and poor lifestyle behaviors . An innovative CHW led lifestyle intervention may lead to more effective strategies for T2DM management in this population AIMS To compare the effects of lifestyle modification programs that prescribe low-glycemic load ( GL ) vs. low-fat diets in a r and omized trial . METHODS Seventy-nine obese adults with type 2 diabetes received low-fat or low-GL dietary instruction , delivered in 40-week lifestyle modification programs with identical goals for calorie intake and physical activity . Changes in weight , HbA(1c ) , and other metabolic parameters were compared at weeks 20 and 40 . RESULTS Weight loss did not differ between groups at week 20 ( low-fat : -5.7±3.7 % ; low-GL : -6.7±4.4 % , p=.26 ) or week 40 ( low-fat : -4.5±7.5 % ; low-GL : -6.4±8.2 % , p=.28 ) . Adjusting for changes in antidiabetic medications , subjects on the low-GL diet had larger reductions in HbA(1c ) than those on the low-fat diet at week 20 ( low-fat : -0.3±0.6 % ; low-GL : -0.7±0.6 % , p=.01 ) , and week 40 ( low-fat : -0.1±1.2 % ; low-GL : -0.8±1.3 % ; p=.01 ) . Groups did not differ significantly on any other metabolic outcomes ( p≥.06 ) . CONCLUSIONS Results suggest that targeting GL , rather than dietary fat , in a low-calorie diet can significantly enhance the effect of weight loss on HbA(1c ) in patients with type 2 diabetes Background Diabetes mellitus is a lifelong chronic condition that requires self-management . Lifestyle modification and adherence to antidiabetes medications are the major determinants of therapeutic success in the management of diabetes . Purpose To assess the effects of a pharmaceutical care ( PC ) model on medication adherence and glycemic levels of people with type 2 diabetes mellitus . Patients and methods A total of 241 people with type 2 diabetes were recruited from a major teaching hospital in Malaysia and allocated at r and om to the control ( n=121 ) or intervention ( n=120 ) groups . Participants in the intervention group received PC from an experienced pharmacist , whereas those in the control group were provided the st and ard pharmacy service .  Medication adherence was assessed using the Malaysian Medication Adherence Scale , and glycemic levels ( glycated hemoglobin values and fasting blood glucose [ FBG ] ) of participants were obtained at baseline and after 4 , 8 , and 12 months . Results At baseline , there were no significant differences in demographic data , medication adherence , and glycemic levels between participants in the control and intervention groups . However , statistically significant differences in FBG and glycated hemoglobin values were observed between the control and intervention groups at months 4 , 8 , and 12 after the provision of PC ( median FBG , 9.0 versus 7.2 mmol/L [ P<0.001 ] ; median glycated hemoglobin level , 9.1 % versus 8.0 % [ P<0.001 ] at 12 months ) . Medication adherence was also significantly associated with the provision of PC , with a higher proportion in the intervention group than in the control group achieving it ( 75.0 % versus 58.7 % ; P=0.007 ) . Conclusion The provision of PC has positive effects on medication adherence as well as the glycemic control of people with type 2 diabetes . Therefore , the PC model used in this study should be duplicated in other health care setting s for the benefit of more patients with type 2 diabetes Abstract Background : The global epidemic of diabetes calls for innovative interventions . This study evaluated the effectiveness of the Project Dulce model , with and without wireless technology , on glycemic control and other clinical and self-reported outcomes in patients with poorly controlled type 2 diabetes in Mexico . Subjects and Methods : Adults with type 2 diabetes and a glycated hemoglobin A1c ( HbA1c ) level of ≥8 % were recruited from Family Medical Unit # 27 of the Instituto Mexicano del Seguro Social ( IMSS ) in Tijuana , México , and r and omly assigned to one of three groups : Project Dulce – only ( PD ) ; Project Dulce technology-enhanced with mobile tools ( PD-TE ) ; or IMSS st and ard of care/control group ( CG )  . Clinical and self-reported outcomes were assessed at baseline , Month 4 , and Month 10 . Time-by-group interactions and within-group changes were analyzed . Results : HbA1c reductions from baseline to Month 10 were significantly greater in PD-TE ( −3.0 % [ −33 mmol/mol ] ) and PD ( −2.6 % [ −28.7 mmol/mol ] ) compared with CG ( −1.3 % [ −14.2 mmol/mol ] ) ( P = 0.009 and 0.001 , respectively ) . PD-TE and PD also exhibited significant improvement in diabetes knowledge when compared with CG ( P < 0.05 for both ) . No statistically significant differences were detected between PD and PD-TE on these indicators ( P = 0.54 and 0.86 , respectively ) . Several within-group improvements were observed on other clinical and self-report indicators but did not vary significantly across groups . Conclusions : Project Dulce with and without wireless technology  substantially improved glycemic control and diabetes knowledge in high-risk patients with type 2 diabetes in a Mexican family medical unit , suggesting that integrating peer-led education , nurse coordination , and 3 G wireless technology is an effective approach for improving diabetes outcomes in high-risk population
D and PA+D  interventions had larger effects on glucose reduction  than PA alone .
Lifestyle  interventions significantly improved FPG , HbA1c , FI , HOMA-IR , and bodyweight among adults without IGT or diabetes , and might reduce progression of hyperglycemia to type 2 diabetes mellitus
This study systematic ally assessed the effectiveness of lifestyle interventions on glycemic indicators among adults ( ⩾18years ) without IGT or diabetes .