Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 May 23:14:101059.
doi: 10.1016/j.jshs.2025.101059. Online ahead of print.

Six-year follow-up of glycemic control and cardiovascular risk factors after a one-year intensive lifestyle intervention in type 2 diabetes: An extension of the randomized U-TURN trial

Mette Yun Johansen  1 , Cody Garett Durrer  1 , Nanna Skytt Pilmark  1 , Grit Elster Legaard  1 , Kristian Karstoft  2 , Katrine Bagge Hansen  3 , Christopher Scott MacDonald  1 , Thomas Peter Almdal  4 , Jakob Bue Bjorner  5 , Nicolai J Wewer Albrechtsen  6 , Allan Arthur Vaag  7 , Robin Christensen  8 , Bente Klarlund Pedersen  1 , Mathias Ried-Larsen  9
Affiliations

Six-year follow-up of glycemic control and cardiovascular risk factors after a one-year intensive lifestyle intervention in type 2 diabetes: An extension of the randomized U-TURN trial

Mette Yun Johansen et al. J Sport Health Sci. .

Abstract

Purpose: This study aimed to describe the effects of a 1-year lifestyle intervention on hemoglobin A1c (HbA1c) and cardiovascular risk factors 5 years after cessation of the lifestyle intervention in persons with type 2 diabetes (T2D).

Methods: From April 2015 to August 2016, 98 persons with T2D (duration < 10 years) were randomly allocated (2:1, stratified by sex) to a 1-year lifestyle intervention group (INT) (n = 64) or a standard care group (StC) (n = 34). All participants received standard care with blinded, target-driven medical therapy. INT included up to 5-6 weekly supervised aerobic and strength training sessions and dietary plans targeting a body mass index ≤ 25 kg/m². No intervention was given during the follow-up period. Forty-nine (77%) and 19 (56%) participants in INT and StC attended the 6-year follow-up. Based on the original intention-to-treat population, the primary outcome was the change in HbA1c from baseline to 6-year follow-up. Secondary outcomes included weight, Low density lipoprotein (LDL) cholesterol, blood pressure (BP), and cardiorespiratory fitness.

Results: Ninety-eight participants (mean age = 54.6 years; 46% women; mean baseline Hemoglobin A1c (HbA1c) = 49.8 mmol/mol) were analyzed. HbA1c changed 6% and 13% in the INT and StC from baseline to 6-year follow-up (between group difference = -6% (95% confidence interval(95%CI): -14% to 3%); p = 0.18). While no differences were observed for most secondary outcomes, the diastolic BP decreased 6.0 (95%CI: 2.1 to 9.8) mmHg more in the StC compared to INT.

Conclusion: The sustained effect of the lifestyle intervention on glycemic control and cardiovascular risk factors was marginal, and it was surprisingly associated with inferior diastolic BP regulation.

Keywords: Diet; Exercise; HbA1c; Pharmacology; Type 2 diabetes.

PubMed Disclaimer

Conflict of interest statement

MR-L has received speakers fees from Astra Zenica A/S and Novo Nordisk A/S and is employed by Novo Nordisk A/S. TPA holds stocks in Novo Nordisk A/S. MYJ is employed by Novo Nordisk A/S. All the support had no involvement in the study design and writing of the manuscript or the decision to submit it for publication. No other authors declare that they have competing interests.

Figures

Fig 1
Fig. 1
Flow of participants through the study. BMI = body mass index;HbA1c = hemoglobin A1c; StC = standard care group.
Fig 2
Fig. 2
HbA1c levels for standard care vs. intensive lifestyle groups, intention to treat analysis. Estimated marginal means with 95% confidence intervals (Boxes) of HbA1c and sex. As the baseline is constrained, the boxes merge for the 2 groups at that time point. Circles represent individual participant values. HbA1c = Hemoglobin A1c; INT = intensive lifestyle intervention group; StC = standard care group.
See this image and copyright information in PMC

References

    1. Davies M.J., Aroda V.R., Collins B.S., et al. Management of hyperglycemia in type 2 diabetes, 2022. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) Diabetes Care. 2022;45:2753–2786. - PMC - PubMed
    1. American Diabetes Association Professional Practice C Obesity and weight management for the prevention and treatment of type 2 diabetes: Standards of care in diabetes-2024. Diabetes Care. 2024;47(Suppl. 1):S145–SS57. - PMC - PubMed
    1. Umpierre D., Ribeiro P.A., Kramer C.K., et al. Physical activity advice only or structured exercise training and association with hba1c levels in type 2 diabetes: A systematic review and meta-analysis. JAMA. 2011;305:1790–1799. - PubMed
    1. Esposito K., Maiorino M.I., Petrizzo M., Bellastella G., Giugliano D. The effects of a mediterranean diet on the need for diabetes drugs and remission of newly diagnosed type 2 diabetes: Follow-up of a randomized trial. Diabetes Care. 2014;37:1824–1830. - PubMed
    1. Esposito K., Maiorino M.I., Ciotola M., et al. Effects of a mediterranean-style diet on the need for antihyperglycemic drug therapy in patients with newly diagnosed type 2 diabetes: A randomized trial. Ann Intern Med. 2009;151:306–314. - PubMed

LinkOut - more resources