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Fritsche, A. ; Wagner, R. ; Heni, M. ; Kantartzis, K. ; Machann, J. ; Schick, F.* ; Lehmann, R. ; Peter, A. ; Dannecker, C. ; Fritsche, L. ; Valenta, V. ; Nawroth, P.P. ; Kopf, S.* ; Pfeiffer, A.F.* ; Kabisch, S.* ; Dambeck, U.* ; Stumvoll, M.* ; Blüher, M.* ; Birkenfeld, A.L.* ; Schwarz, P.* ; Hauner, H.* ; Clavel, J.* ; Seißler, J.* ; Lechner, A.* ; Müssig, K.* ; Weber, K.* ; Laxy, M. ; Bornstein, S.* ; Schürmann, A.* ; Roden, M.* ; Hrabě de Angelis, M. ; Stefan, N. ; Häring, H.-U.

Different effects of lifestyle intervention in high- and low-risk prediabetes.

Diabetes 70, 2785-2795:2785-2795 (2021)
Postprint DOI
Open Access Green
Free by publisher: Publ. Version/Full Text online available 09/2022
Lifestyle intervention (LI) can prevent type 2 diabetes, but response to LI varies depending on risk subphenotypes. We tested if prediabetic individuals with low risk benefit from conventional LI and individuals with high risk benefit from an intensification of LI in a multi-center randomized controlled intervention over 12 months with 2 years follow up. 1105 prediabetic individuals based on ADA glucose criteria were stratified into a high- and low-risk phenotype, based on previously described thresholds of insulin secretion, insulin sensitivity and liver fat content. Low-risk individuals were randomly assigned to conventional LI according to the DPP protocol or control (1:1), high-risk individuals to conventional or intensified LI with doubling of required exercise (1:1). A total of 908 (82%) participants completed the study. In high-risk individuals, the difference between conventional and intensified LI in post-challenge glucose change was -0.29 mmol/l [CI:-0.54;-0.04], p=0.025. Liver fat (-1.34 percentage points [CI:-2.17;-0.50], p=0.002) and cardiovascular risk (-1.82[CI:-3.13-0.50],p=0.007) underwent larger reductions with intensified than with conventional LI. During a follow up of 3 years, intensified compared to conventional LI had a higher probability to normalize glucose tolerance (p=0.008). In conclusion, it is possible in high-risk individuals with prediabetes to improve glycemic and cardiometabolic outcomes by intensification of LI. Individualized, risk-phenotype-based LI may be beneficial for the prevention of diabetes.
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Publication type Article: Journal article
Document type Scientific Article
Keywords Diabetes Prevention Program; Impaired Glucose-tolerance; Insulin-secretion; Fat Quantification; Weight-loss; Follow-up; Type-2; Pathogenesis; Individuals; Sensitivity
ISSN (print) / ISBN 0012-1797
e-ISSN 1939-327X
Journal Diabetes
Quellenangaben Volume: 70, Issue: 12, Pages: 2785-2795 Article Number: 2785-2795 Supplement: ,
Publisher American Diabetes Association
Publishing Place Alexandria, VA.
Reviewing status Peer reviewed
Grants German Federal Ministry for Education and Research