Determinants of weight outcomes in type 2 diabetes prevention intervention in primary health care setting (the DE-PLAN project)

BMC Public Health

Jaakko Tuomilehto¹  Jaana Lindström²  Peter E. H. Schwarz³  Beata Piwońska-Solska⁴  Ewa Wójtowicz⁴  Alicja Hubalewska-Dydejczyk⁴  Zbigniew Szybiński⁴  Aleksandra Gilis-Januszewska⁴  Adam Windak⁵  Katarzyna Kissimova-Skarbek⁶ 

[1] Centre for Vascular Prevention, Danube-University Krems;Chronic Disease Prevention Unit, National Institute for Health and Welfare(THL);Department for Prevention & Care of Diabetes, Medical Clinic Unit III, University Clinic Carl Gustav Carus at Technical University Dresden;Department of Endocrinology, Jagiellonian University, Medical College;Department of Family Medicine, Chair of Medicine and Gerontology, Jagiellonian University Medical College;Department of Health Economics and Social Security, Institute of Public Health, Jagiellonian University, Medical College;

关键词: Type 2 diabetes;    Prevention;    Lifestyle intervention;    Diet;    Physical activity;    Weight loss;   

DOI  :  10.1186/s12889-017-4977-1

来源: DOAJ

【 摘 要 】

Abstract Background Real life implementation studies performed in different settings have proved that lifestyle interventions in the prevention of type 2 diabetes (DM2) can be effective, although the weight reduction results are typically modest compared to randomized control trials. Our objective was to identify the factors that predict successful weight loss in a less intensive, lower budget, real life setting lifestyle diabetes prevention intervention. Methods Study participants (n = 175) with increased DM2 risk (Finnish Diabetes Risk Score (FINDRISC) > 14) but no diabetes at baseline received ten group lifestyle counselling sessions, physical activity and motivation sessions during a ten-month intervention. Stepwise regression analysis was used to determine demographic, clinical, and lifestyle predictors of successful weight reduction defined as a reduction of ≥5% of the initial body weight. Results At 12 months following the initiation of the intervention, 23.4% of study participants lost ≥5% weight (mean loss of 7.9 kg, SD = 5.8). Increased physical activity (44% vs 25%, p = 0.03), decreased total fat consumption (88% vs 65%, p = 0.006) and adherence to four-five lifestyle goals (71% vs 46%, p = 0.007) were more often reported among those who managed to lose ≥5% weight versus those who did not. In a multivariate analysis, meeting the ≥5% weight loss goal was most effective in individuals with a higher baseline BMI (OR 1.1, 95%CI 1.0–1.2), baseline and medium versus higher education (OR 5.4, 95% CI 1.2–24.7) and a history of increased glucose (OR 2.6, 95%CI 1.1–1.3). A reduction of total fat in the diet was an independent lifestyle predictor, increasing the probability of successful weight loss by 3.8 times (OR 3.8, 95% CI 1.2–11.4). Conclusion Baseline higher BMI, lower education and a history of increased glucose predicted the successful weight loss among individuals with a high risk for the DM2 following lifestyle intervention in a real life primary health care setting. People who manage to lose weight more often adhere to lifestyle changes, while the reduction of total fat in diet independently predicts successful weight loss. Further studies exploring the predictors of success in implementation studies in DM2 prevention should help health care providers redesign interventions to improve their effectiveness and outcomes. Trial registration ISRCTN, ID ISRCTN96692060 , registered 03.08.2016 retrospectively.

【 授权许可】

Unknown