Effect of weight loss with lifestyle intervention on risk of diabetes

Abstract

Objective: Diabetes Prevention Program (DPP) participants randomized to the intensive lifestyle intervention (ILS) had significantly reduced risk of diabetes compared with placebo participants. We explored the contribution of changes in weight, diet, and physical activity on the risk of developing diabetes among ILS participants.

Research design and methods: For this study, we analyzed one arm of a randomized trial using Cox proportional hazards regression over 3.2 years of follow-up.

Results: A total of 1,079 participants were aged 25-84 years (mean 50.6 years, BMI 33.9 kg/m(2)). Weight loss was the dominant predictor of reduced diabetes incidence (hazard ratio per 5-kg weight loss 0.42 [95% CI 0.35-0.51]; P < 0.0001). For every kilogram of weight loss, there was a 16% reduction in risk, adjusted for changes in diet and activity. Lower percent of calories from fat and increased physical activity predicted weight loss. Increased physical activity was important to help sustain weight loss. Among 495 participants not meeting the weight loss goal at year 1, those who achieved the physical activity goal had 44% lower diabetes incidence.

Conclusions: Interventions to reduce diabetes risk should primarily target weight reduction.

Figure 1

Diabetes incidence (per 100 person-years) by change in weight after baseline among DPP ILS participants based on the multivariate model in Table 2. •, overall risk in the group at the mean weight loss over an average of 3.2 years of follow-up.

Figure 2

HRs for diabetes onset over 3.2 years of follow-up in DPP ILS subgroups defined by meeting intervention goals at 1 year compared with those meeting none of the goals (group 1). The solid line is adjusted for baseline covariates used in Table 2 (other than IGR and insulin); the dashed line is also adjusted for weight change over time. ♦, adjusted HRs; •, adjusted HRs plus weight change.