Effects of obesity, metabolic syndrome, and non‐alcoholic or alcoholic elevated liver enzymes on incidence of diabetes following lifestyle intervention: A subanalysis of the J‐DOIT1

Objectives Using annual health check‐up data, the aim of this study was to identify target populations for lifestyle interventions to effectively prevent diabetes in a real‐world setting. Methods The Japan Diabetes Outcome Intervention Trial‐1, a prospective, cluster‐randomized controlled trial, was launched to test if year‐long telephone‐delivered lifestyle support by health professionals can prevent the development of type 2 diabetes (T2D) in people with impaired fasting glucose (IFG) identified at health check‐ups. A total of 2607 participants aged 20‐65 years with IFG were randomized to an intervention arm (n = 1240) or a control arm (n = 1367). We performed subgroup analysis to examine the effects of the intervention on the incidence of T2D in participants with body mass index (BMI) ≥25, metabolic syndrome (MetS), and non‐alcoholic or alcoholic elevated liver enzymes at the baseline. Cox regression analysis adjusted for sex was used to calculate the hazard ratios (HRs). Results In addition to IFG, the presence of BMI ≥25, MetS, and elevated liver enzymes increased the incidence of diabetes by two‐ or three‐fold. During a median follow‐up period of 4.9 years, only the non‐alcoholic elevated liver enzyme group showed a low incidence rate owing to lifestyle interventions (adjusted HR: 0.42, 95% confidence interval: 0.18‐0.98). Conclusion The results suggest that people who have IFG and non‐alcoholic elevated liver enzymes are a good target population for lifestyle interventions to effectively reduce the incidence of diabetes in a real‐world setting.