Importance of Weight Loss Maintenance and Risk Prediction in the prevention of Type 2 Diabetes: Analysis of European Diabetes Prevention Study RCT

BACKGROUND: Prevalence of type 2 diabetes (T2D) is increasing worldwide. prevention by lifestyle intervention is effective. Pragmatic scalable interventions are needed, with evidence to efficiently target and interventions. We report pooled analyses of data from three European cohorts: to analyse T2D incidence, sustained weight loss and utility of predictors. METHODS: We analysed data on 749 adults with impaired tolerance (278 men and 471 women, mean age 56 years, mean BMI 31 kgm) between 1993 and 2003, and randomised to intensive lifestyle lifestyle advice control (C). The intervention aimed to increase activity, modify diet, and promote weight loss>/=5%. Using Cox- survival analysis, we assessed T2D incidence and the impact on T2D sustained weight loss, and of baseline cut-point values of FINDRISC fasting plasma glucose (FPG), and HbA. RESULTS: Mean follow-up duration years. T2D was diagnosed in 139 participants (I = 45/379, C = 94/370). T2D incidence was 57% lower in the intervention compared with the (HR 0.42 (95% CI 0.29 to 0.60) P<0.001). Participants with >/=5% weight one year had 65% lower T2D incidence (HR 0.35 (95% CI 0.22 to 0.56) maintaining >/=5% weight loss for two and three years further reduced incidence. Recommended cut-points to identify those at high risk for T2D have identified different proportions of European Diabetes Prevention (EDIPS) participants with similar hazard-ratios for intervention effect. CONCLUSIONS: Pooled analysis of EDIPS trial data reinforces evidence for prevention by lifestyle intervention. Analysis showed the preventive >/=5% weight loss, especially if maintained long term, which has utility intervention monitoring. Analysis of proposed cut-points demonstrates difficulties in balancing risk and benefit, to efficiently target and suggests evidence is needed to define clinical policy. TRIAL THE FINNISH DIABETES PREVENTION STUDY, HELSINKI, FINLAND: NCT00518167 The SLIM diabetes prevention study, Maastricht, The Clinical Trials.gov; NCT00381186 The EDIPS-Newcastle diabetes prevention Newcastle upon Tyne, UK: International Standard Randomised Controlled Number; ISRCTN15670600