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

Lookup NU author(s): Dr Linda Penn, Professor Martin White, Professor Mark Walker, Professor John Mathers



Background: Prevalence of type 2 diabetes (T2D) is increasing worldwide. T2D prevention by lifestyle intervention is effective. Pragmatic scalable interventions are needed, with evidence to efficiently target and monitor such interventions. We report pooled analyses of data from three European trial cohorts: to analyse T2D incidence, sustained weight loss and utility of risk predictors. Methods: We analysed data on 749 adults with impaired glucose tolerance (278 men and 471 women, mean age 56 years, mean BMI 31 kgm−2) recruited between 1993 and 2003, and randomised to intensive lifestyle intervention (I) or lifestyle advice control (C). The intervention aimed to increase physical activity, modify diet, and promote weight loss≥5%. Using Cox-regression survival analysis, we assessed T2D incidence and the impact on T2D incidence of sustained weight loss, and of baseline cut-point values of FINDRISC score, fasting plasma glucose (FPG), and HbA1c. Results: Mean follow-up duration was 3.1 years. T2D was diagnosed in 139 participants (I = 45/379, C = 94/370). Cumulative T2D incidence was 57% lower in the intervention compared with the control group (HR 0.42 (95% CI 0.29 to 0.60) P<0.001). Participants with ≥5% weight loss at one year had 65% lower T2D incidence (HR 0.35 (95% CI 0.22 to 0.56) P<0.001); maintaining ≥5% weight loss for two and three years further reduced T2D incidence. Recommended cut-points to identify those at high risk for T2D would have identified different proportions of European Diabetes Prevention Study (EDIPS) participants with similar hazard-ratios for intervention effect. Conclusions: Pooled analysis of EDIPS trial data reinforces evidence for T2D prevention by lifestyle intervention. Analysis showed the preventive effect of ≥5% weight loss, especially if maintained long term, which has utility for intervention monitoring. Analysis of proposed cut-points demonstrates difficulties in balancing risk and benefit, to efficiently target interventions and suggests evidence is needed to define clinical policy.

Publication metadata

Author(s): Penn L, White M, Lindstrom L, den Boer A, Blaak E, Eriksson JG, Feskens E, Ilanne-Parikka P, Keinänen-Kiukaanniemi SM, Walker M, Mathers JC, Uusitupa M, Tuomilehto J

Publication type: Article

Publication status: Published

Journal: PLoS One

Year: 2013

Volume: 8

Issue: 2

Print publication date: 01/02/2013

Date deposited: 09/07/2013

ISSN (electronic): 1932-6203

Publisher: Public Library of Science


DOI: 10.1371/journal.pone.0057143


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Funder referenceFunder name
Finnish Diabetes Research Foundation
Finnish Foundation for Cardiovascular Research
Juho Vainio Foundation
Kuopio University Hospital
Yrjo Jahnsson Foundation
Ministry of Education
Novo Nordisk Foundation
Oulu University Hospital
Tampere University Hospital
057146/Z/99/ZWellcome Trust
129330Academy of Finland
2000.00.020Dutch Diabetes Research Foundation
128315Academy of Finland
38387/54175Academy of Finland
40758/5767Academy of Finland
2007.15.002Dutch Diabetes Research Foundation
8473/2298Academy of Finland
DFN 98.901Dutch Diabetes Research Foundation
BMH4-CT98-3759 (DG 12-SSMI)European Union Concerted Action (CA)
NWO 2200.0139Netherlands Organization for Scientific Research
ZonMW 940-35-034Netherlands Organization for Health Research and Development