Intensive lifestyle intervention benefits people with high-risk prediabetes

People with prediabetes can improve their blood glucose levels over time with an intensive lifestyle modification that includes plenty of exercises, delaying or even preventing type 2 diabetes. Individuals with prediabetes who were at the highest risk benefited the most from extensive lifestyle changes.

The review of the German Center for Diabetes Research (DZD)’s Prediabetes Lifestyle Intervention Study (PLIS), which was undertaken at 8 DZD locations across Germany, demonstrates this. The findings have now been published in the Diabetes journal.

Many persons with prediabetes can normalize their blood glucose levels and prevent acquiring type 2 diabetes by increasing their physical activity and eating a healthier diet. However, a traditional lifestyle intervention does not benefit everyone (LI). According to recent research, there are distinct subtypes of prediabetes with varied risk profiles.

In a multicenter randomized controlled trial, researchers from the German Center for Diabetes Research (DZD) investigated whether people with prediabetes and a high-risk benefit from intensification of the intervention and how people with low risk are affected by a conventional LI compared to no lifestyle changes.

In each case, the LI lasted 12 months, followed by a two-year follow-up period. A total of 1,105 people with prediabetes were studied at several study sites across Germany, and their insulin secretion, insulin sensitivity, and liver fat level were used to assign them to a high-risk or low-risk phenotype. The study was completed by 82 percent of the participants.

After three years, glucose tolerance was more likely to normalize in participants with conventional LI than in those in the control group.

Hans-Ulrich Häring

A lot helps a lot more exercise improves blood glucose and cardiometabolic values

People at high risk for diabetes, such as those who make too little insulin or have a fatty liver with insulin resistance, were randomly randomized to receive either standard LI or a more rigorous intervention with twice the amount of activity required.

More exercise, i.e. more intensive LI, helped persons at high risk improve their blood glucose and cardiometabolic levels, as well as lower liver fat content to within normal ranges, according to the findings. LI as it is now practiced is ineffective.

Low-risk participants either completed a standard LI or were assigned to a control group that just received a one-time brief consultation.

“After three years, glucose tolerance was more likely to normalize in participants with conventional LI than in those in the control group,” said Professor Hans-Ulrich Häring of the German Center for Diabetes Research and the last author of the study.

Insulin sensitivity and secretion, liver fat level, and cardiometabolic risk were all nearly identical.

Lifestyle intervention based on risk phenotype improves diabetes prevention

“Our study results show that an individualized LI based on the risk phenotype is beneficial for diabetes prevention,” said study leader Professor Andreas Fritsche from the Institute of Diabetes Research and Metabolic Diseases of Helmholtz Munich at the University of Tübingen (IDM) and the Department of Diabetology, Endocrinology, and Nephrology (Director: Professor Andreas Birkenfeld, MD) at Tübingen University Hospital, summarizing the results.

“For successful prevention, we need to identify high-risk patients in the future and focus on providing them with an intensified lifestyle intervention.”

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