1. Different Effects of Lifestyle Intervention in High- and Low-Risk Prediabetes: Results of the Randomized Controlled Prediabetes Lifestyle Intervention Study (PLIS)
- Author
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Martin Hrabé de Angelis, Rainer Lehmann, Norbert Stefan, Jürgen Machann, Hans Hauner, Stefan Kabisch, Peter Schwarz, Michael Roden, Fritz Schick, Stefan R. Bornstein, Kostantinos Kantartzis, Andreas L. Birkenfeld, Louise Fritsche, Andreas Peter, Andreas Fritsche, Corinna Dannecker, Stefan Kopf, Julia Clavel, Annette Schürmann, Martin Heni, Robert Wagner, Andreas Pfeiffer, Matthias Blüher, Vera Valenta, Katharina S. Weber, Andreas Lechner, Peter P. Nawroth, Hans-Ulrich Häring, Jochen Seißler, Renate Schick, Michael Stumvoll, Ulrike Dambeck, Michael Laxy, and Karsten Müssig
- Subjects
Adult ,Blood Glucose ,Male ,medicine.medical_specialty ,Adolescent ,Endocrinology, Diabetes and Metabolism ,Type 2 diabetes ,Risk Assessment ,Prediabetic State ,Young Adult ,Behavior Therapy ,Germany ,Internal medicine ,Diabetes mellitus ,Liver fat ,Lifestyle intervention ,Internal Medicine ,medicine ,Humans ,Prediabetes ,Insulin secretion ,Life Style ,Aged ,Glycemic ,business.industry ,Patient Acuity ,Insulin sensitivity ,Glucose Tolerance Test ,Middle Aged ,medicine.disease ,Treatment Outcome ,Diabetes Mellitus, Type 2 ,Female ,business ,Risk Reduction Behavior - Abstract
Lifestyle intervention (LI) can prevent type 2 diabetes, but response to LI varies depending on risk subphenotypes. We tested whether individuals with prediabetes with low risk (LR) benefit from conventional LI and individuals with high risk (HR) benefit from an intensification of LI in a multicenter randomized controlled intervention over 12 months with 2 years’ follow-up. A total of 1,105 individuals with prediabetes based on American Diabetes Association glucose criteria were stratified into an HR or LR phenotype based on previously described thresholds of insulin secretion, insulin sensitivity, and liver fat content. LR individuals were randomly assigned to conventional LI according to the Diabetes Prevention Program (DPP) protocol or control (1:1) and HR individuals to conventional or intensified LI with doubling of required exercise (1:1). A total of 908 (82%) participants completed the study. In HR individuals, the difference between conventional and intensified LI in postchallenge glucose change was −0.29 mmol/L [95% CI −0.54; −0.04], P = 0.025. Liver fat (−1.34 percentage points [95% CI −2.17; −0.50], P = 0.002) and cardiovascular risk (−1.82 percentage points [95% CI −3.13; −0.50], P = 0.007) underwent larger reductions with intensified than with conventional LI. During a follow-up of 3 years, intensified compared with conventional LI had a higher probability of normalizing glucose tolerance (P = 0.008). In conclusion, it is possible in HR individuals with prediabetes to improve glycemic and cardiometabolic outcomes by intensification of LI. Individualized, risk phenotype–based LI may be beneficial for the prevention of diabetes.
- Published
- 2021